Melvyn Westreich

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (34)42.1 Total impact

  • Avshalom Shalom, Melvyn Westreich, Sharon Sandbank
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    ABSTRACT: loss of an excised lesion can have devastating clinical and legal consequences. Previously, the incidence of pathological specimen loss was 1/1466 (0.07%) due to failure to place pathology specimens in correctly labeled containers. We theorized that a strict protocol for handling specimens would help reduce losses. To devise a protocol to reduce the loss of pathology specimens. In this study, 7105 specimens excised by one plastic surgeon were sent to the pathology laboratory using a strict protocol, which included: using a carefully labeled specimen container, inserting the specimen into the container immediately after excision (not at the end of the procedure), positioning the specimen container close to the surgical field during the surgery, and both the nurse and surgeon signing their names on the container at the end of the procedure to confirm the contents and labeling. One Mohs specimen was accidentally thrown away by a pathology laboratory technician after the frozen section report was written (an incidence of 1/7105, 0.00014%). All specimens arrived at the pathology department and no lesions were lost in the operating room. A strict written protocol for specimen handling significantly reduces loss of pathology specimens.
    The Israel Medical Association journal: IMAJ 07/2013; 15(7):356-8. · 0.98 Impact Factor
  • Avshalom Shalom, Assaf Persitz, Melvyn Westreich
    Dermatologic Surgery 09/2012; · 1.87 Impact Factor
  • Ophir Schein, Melvyn Westreich, Avshalom Shalom
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    ABSTRACT: BACKGROUND: Studies have focused on enhancing flap viability using superoxide dismutase (SOD), but only a few used SOD from human origin, and most gave the compound systemically. We evaluated the ability of SOD to improve random skin flap survival using human recombinant copper-zinc superoxide dismutase (Hr-CuZnSOD) in variable doses, injected intradermally into the flap. METHODS: Seventy male Sprague Dawley rats were randomly assigned into 4 groups. Cephalic random pattern flaps were elevated on their backs and intradermal injections of different dosages of Hr-CuZnSOD were given 15 minutes before surgery. Flap survival was evaluated by fluorescein fluorescence. Analysis of variance (ANOVA) and t test statistical analyses were performed. RESULTS: Flap survival in all treated groups was significantly better than in the controls. CONCLUSIONS: The beneficial effect of HR-CuZnSOD on flap survival is attained when it is given intradermally into the flap tissue. Theoretically, Hr-CuZnSOD delivered with local anesthetics used in flap elevation may be a valuable clinical tool. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 08/2012; · 2.83 Impact Factor
  • Omer Wolf, Melvyn Westreich, Avshalom Shalom
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    ABSTRACT: There are two main approaches to breast reduction surgery today: the traditional long scar ("Wise-pattern") technique and the more recent short ("vertical") scar technique, which is becoming more popular. During the last two decades there has been a gradual shift between the two techniques, including at our institute. To evaluate the evidence behind this obvious trend. We retrospectively collected data fromarchived hospital charts of all patients who underwent breast reduction surgery during the period 1995-2007. Epidemicological, clinical and postoperative data were analyzed and compared between patients in whom the short scar vs. the long scar techniques was used. During the study period 91 patients underwent breast reduction surgery in our department: 34 with the Wise-pattern breast reduction technique and 57 with the short-scar procedure. There was no significant difference in operative and postoperative data, including length of hospital stay. In some of the categories there was even a slight advantage (but not statistically significant) to the former. The only significant difference was the size of reduction, with a tendencyto prefer the long scar technique for larger reductions; however, with experience gained the limit for short scar reductions was gradually extended to a maximum of 1470 g. We noticed a sharp increase in the safe and uneventful practice of the short scar technique in breast reduction of < or = 1400 g--especially in young women without extreme ptosis. This observation, together with other advantages, namely, reduced scar length, prolonged shape preservation and better breast projection, support the use of this technique.
    The Israel Medical Association journal: IMAJ 05/2012; 14(5):304-6. · 0.98 Impact Factor
  • Avshalom Shalom, Ophir Schein, Melvyn Westreich
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    ABSTRACT: The maintenance of vascular patency is one of the key points to be considered after a pedicled transverse rectus abdominis myocutaneous (TRAM) flap has been raised and when closing the anterior rectus fascia to avoid a hernia. In this study we describe a new approach to closing the most superior part of the fascia to help insure vascular patency. Forty patients who had their breasts reconstructed with TRAM flaps made up the study group. The new back cut technique was used in 25 patients. Of the remaining 15 patients, four required early revision on the day of operation for severe venous congestion or ischaemia. None of the patients who had the back cut technique required early revision. We found the back cut technique to be safe and easy, and we think that it can reduce the incidence of flap ischaemia and still achieve tight fascial closure.
    Journal of plastic surgery and hand surgery. 04/2012; 46(2):91-4.
  • Avshalom Shalom, Eyal Kramer, Melvyn Westreich
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    ABSTRACT: Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing burn wound survival. Originally, we demonstrated that human recombinant copper-zinc superoxide dismutase (Hr-CuZnSOD) could increase the survival of failing ischemic flaps in a rat model. Because of the possible similar pathophysiology of tissue ischemia in flaps and the zone of stasis in burns, we conducted a later study using 2 groups of rats with standardized intermediate burns, to ascertain whether Hr-CuZnSOD could increase zone of stasis survival in rats. The results showed that postburn Hr-CuZnSOD failed to improve zone of stasis survival in burns. We decided to undertake a new controlled study to ascertain whether there is a protective effect of Hr-CuZnSOD in cases of intermediate burns. We used 2 groups of rats, one of which received prophylactic treatments with Hr-CuZnSOD before the induction of standardized intermediate burns. Results showed that preburn Hr-CuZnSOD also failed to improve zone of stasis survival in burns. Further studies are needed to adequately understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether Hr-CuZnSOD has a role in the clinical management of burns or should be abandoned.
    Annals of plastic surgery 06/2011; 66(6):607-9. · 1.29 Impact Factor
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    ABSTRACT: Basal cell carcinoma (BCC) is the most common malignant tumor in the world. Total tumor ablation is the gold standard of treatment. Our aim in this study was to evaluate the effectiveness of a new clinical method, we dubbed the "stretch test," in reducing the incidence of incomplete excision of BCC. All BCCs excised between October 2001 and June 2007, by 1 plastic surgeon, served as the treatment population. Until September 2004, BCCs were excised in the traditional manner and this group served as a control. From October 2004, the stretch test was used in all patients with BCC and this group served as a study group. Overall, the incomplete excision rate was 3.7% (22/596). The rate of incompletely excised BCC until 2004 was 6.4% (16/249) and it decreased significantly (P < 0.05) from 2004 to 1.7% (6/347) in the group in which the stretch test maneuver was used. We found a significant decrease in the rate of incomplete excision of BCC when the stretch test was employed. This reduces the need for reexcision, improves patient recovery, and satisfaction, and helps reduce healthcare costs.
    Annals of plastic surgery 05/2011; 68(1):72-3. · 1.29 Impact Factor
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    ABSTRACT: Burns are a major health care problem. Early treatment increases survival of intermediate burn zones, thus decreasing morbidity, mortality, surgery, and hospitalization. Previously, aspirin was shown to improve burn perfusion and increase failing flap survival. Owing to similarities between failing flaps and intermediate burn zones, we conducted this study to evaluate the effect of aspirin on intermediate burn zone survival. An intermediate burn was created in 30 rats randomly divided into three experimental groups: pre- and postburn aspirin groups and a control group. Final burn survival was evaluated on day 7. No statistical difference was observed between the test and control groups. Both aspirin regimens failed to improve intermediate burn survival. Presumably, administration of aspirin could not prevent the noxious tissue events of burn injury that cause cell death. Possibly, different dosages or modes of administering aspirin could have a beneficial effect on burn wound survival.
    Journal of Cutaneous Maedicine and Surgery 01/2011; 15(2):111-4. · 0.78 Impact Factor
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    ABSTRACT: Tissue biopsy loss can have devastating clinical and legal consequences. To evaluate the incidence and cause of tissue biopsy loss. The study followed biopsy specimens taken by one plastic surgeon in an outpatient clinic between October 2001 and April 2005. Four thousand two hundred minor surgical procedures were performed, and 4,400 biopsy specimens were sent to pathology. In case of specimen loss, a formal investigation was performed. Five specimens were reported as lost during the period. Two were retrieved, two were lost probably because of failure to insert the pathology specimen into the container, and one was lost in the pathology laboratory during processing. Overall incidence of specimen loss was 1 in 1,466 (0.068%). In this study, we identified the critical point of specimen loss to be noninsertion of the specimen into the container by medical staff. To prevent future errors at this critical point, strict guidelines such as immediate insertion of the specimen into the container and signing on the container confirming that the specimen is in the correct labeled container at the end of the procedure are recommended.
    Dermatologic Surgery 07/2010; 36(7):1084-6. · 1.87 Impact Factor
  • Eyal Kramer, Eran Hadad, Melvyn Westreich, Avshalom Shalom
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    ABSTRACT: Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.
    The American surgeon 01/2010; 76(1):11-4. · 0.92 Impact Factor
  • Avshalom Shalom, Liora Hollander, Melvyn Westreich
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    ABSTRACT: Recombinant human growth hormone, a very potent anabolic hormone, plays a significant role in growth regulation, bone metabolism, and wound healing. This study evaluates its effect on random flap survival. Rats were randomly divided into 2 groups. A dorsal random flap, cephalically based, was used. One group received 5 mg/kg subcutaneous injection of recombinant human growth hormone 1 hour before surgery and a repeat dosage every 24 hours for 1 week. The others served as controls. At the end of 1 week, average weight and flap survival was evaluated. There was no difference in flap survival between the groups. Treated rats had gained significantly more weight. Recombinant human growth hormone had no beneficial effect on flap survival. The lack of a deleterious effect of the hormone on random flap survival and its significant effect on rat weight and well being supports its safe use during flap surgery.
    Annals of plastic surgery 10/2009; 63(5):556-7. · 1.29 Impact Factor
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    ABSTRACT: Due to the absence of accurate tools and appropriate photographic material there is a paucity of objective studies on facial aging in the modern literature. To measure changes in two elements of the face: brow ptosis and cheek mass migration, using an objective tool that we developed which we then used to evaluate facial aging in two subjects studying serial professional photographs over a 25 year period. We studied the photographic atlas of the "Brown Sisters," a record of the yearly group photograph of four sisters taken by the photographer Nicolas Nixon. For technical reasons only two of the sisters fulfilled the criteria we set for the study. We used the interpupillary distance of each photograph studied to standardize the brow height and cheek mass distance from the interpupillary line. We observed progressive medial brow descent occurring at about the age of 30, with apparent stabilization thereafter. In contrast, there was a continuous process of lateral brow descent through the years. A process of gradual cheek mass descent was noted in the second half of the third decade. Our results indicate that the dynamic brow changes start in the second half of the third decade, with more significant lateral brow descent than medial brow descent. The cheek mass reflective point moves in an inferior-lateral direction. The tool we developed can be used to follow aging changes and postoperative results, thereby helping the surgeon achieve true rejuvenation surgery.
    The Israel Medical Association journal: IMAJ 08/2009; 11(8):470-3. · 0.98 Impact Factor
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    ABSTRACT: Hypospadias has been associated with synchronous congenital anomalies, especially in the urogenital system, and routine screening of patients with hypospadias has been advocated. In recent years, ultrasound (US) has replaced intravenous pyelography (IVP) as the primary screening test for urological deformities, yet there has never been a study of the relative diagnostic efficacy of the two tests in these patients. In this study, we assessed the incidence of urogenital and extraurogenital congenital anomalies in our hypospadias patients that were noted during physical examination and/or laboratory and imaging screening, and evaluated the efficacy of our changing routine screening protocols. We conducted a retrospective analysis of the charts of all hypospadias patients seen at Assaf Harofeh Medical Center. One hundred and sixty-three hypospadias patients fulfilled the documentation criteria we set for this study. We found a high incidence of urogenital and extraurogenital anomalies associated with hypospadias and noted a previously unreported increased incidence of various forms of facial dysmorphism. Additionally, we noted that the accepted concept that US or IVP alone were satisfactory screening tools for asymptomatic low-grade hypospadias patients is probably incorrect. Based on our findings, we recommend that initial screening of all asymptomatic hypospadias patients include US, cystogram, urinalysis, and urine culture.
    Pediatric Nephrology 07/2008; 23(10):1809-16. · 2.94 Impact Factor
  • Avshalom Shalom, Tal Friedman, Melvyn Westreich
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    ABSTRACT: Aspirin and heparin are commonly given to patients undergoing microvascular procedures to increase flap survival and patency, yet there is scant information concerning the effect these flaps have on nonmicrovascular flaps. The objective was to obtain baseline values concerning the effect of aspirin and heparin on the viability of standardized flap tissues. One hundred rats were divided into five groups receiving high-dose aspirin, low-dose aspirin, high-dose aspirin in combination with heparin, and heparin alone and the final group were controls. The viability of the tissue was measured at 1 week by fluorescein fluorescence. There was significant improvement in flap survival in the high-dose aspirin and high-dose aspirin combination groups. It appears that high-dose aspirin increases survival of ischemic flap tissue irrespective of the presence of microvascular anastomosis and may be of clinical benefit in all flap surgery. The authors have indicated no significant interest with commercial supporters.
    Dermatologic Surgery 07/2008; 34(6):785-90; discussion 790. · 1.87 Impact Factor
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    ABSTRACT: Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice. The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures. Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded. Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%). True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults.
    Dermatologic Surgery 06/2008; 34(8):1077-9. · 1.87 Impact Factor
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    ABSTRACT: Hyaluronic acid is a common component of the extracellular matrix, has many medical applications, and is widely used as a soft tissue filler in patients who simultaneously or eventually undergo cosmetic procedures to the areas treated. The objective was to study the effect of hyaluronic acid on wound healing and viability of random-pattern flaps in rats. Twenty-six male rats were randomly divided into two groups. A cephalically based random dorsal flap was used-14 rats received hyaluronic acid to the bed of the flap immediately after surgery; 12 served as controls. After 1 week, flap survival was evaluated by fluorescein fluorescence. A t-test statistical analysis of survival relationships was performed. Flap viability in hyaluronic acid-treated rats was slightly better than in controls (average flap length survival 46.7 and 40.6 mm, respectively; p<.2). Although hyaluronic acid had a slight beneficial effect on flap viability, no significant improvement in flap survival was shown. The lack of any deleterious effect of hyaluronic acid on relatively ischemic tissues is further evidence of its harmless effect during surgical intervention. Further studies should be performed to clarify the potential benefit of hyaluronic acid on random flaps. The authors have indicated no significant interest with commercial supporters.
    Dermatologic Surgery 06/2008; 34(9):1212-5. · 1.87 Impact Factor
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    ABSTRACT: Many patients undergoing surgical procedures take medications that influence the coagulation system. It is common practice to discontinue the use of aspirin and warfarin products 7 to 10 days before any major surgical procedure. However, there is some controversy as to whether these medications should be discontinued for minor dermatological procedures. Our aim was to study the incidence of complications in patients receiving aspirin or warfarin and undergoing minor dermatological procedures. Two thousand three hundred twenty-six patients, operated on by a single surgeon, were studied for complications. Warfarin was used by 28 patients, 228 took aspirin, and the remainder took neither. There was no difference in the complication rate among the three groups as long as the surgeon diligently obtained hemostasis. It appears that patients taking aspirin or warfarin do not need to discontinue these medications before minor dermatological procedures.
    The American surgeon 05/2008; 74(4):354-7. · 0.92 Impact Factor
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    ABSTRACT: Skin tumors are the most common malignancies in the western population, with surgical excision as the definitive treatment. The author's objectives were to estimate the precision of clinical diagnosis of skin tumors by a plastic surgeon in a community clinic. The study includes clinical and histological data of patients operated on solely by one plastic surgeon, between November 2001 to July 2003. The sensitivity and positive predictive value were measured and compared to the literature. The study included 1640 patients. Out of 1806 excised skin lesions, 17.4% were malignancies. Basal cell carcinoma was the most common tumor, followed by squamous cell carcinomas and melanomas. Sensitivity for skin malignancy was 94%, and 76.5% for specific skin malignancy. Positive predictable value for any malignancy was 69.4%, and 72% for the basal cell carcinoma, the most common skin malignancy. Clinical examination is the main diagnostic tool for the plastic surgeon and dermatologist in the evaluation of skin lesions. Surgical excision is considered when clinical diagnosis is not productive or when malignancy is suspected. For most malignancies, diagnostic excision is therapeutic as well. Positive predictable value is a prospective index estimating the clinical diagnostic skills of the clinician. In our opinion, new technologies such as dermatoscopy should be used more often in the evaluation of skin lesions.
    Harefuah 05/2008; 147(4):305-8, 375.
  • Source
    A Shalom, E Kramer, M Westreich
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    ABSTRACT: Objectives. Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing survival from burn wounds. We previously demonstrated that human recombinant copper-zinc superoxide dismutase could increase the survival of failing ischaemic flaps in a rat model. Because of the similar pathophysiology of tissue ischaemia in flaps and intermediate zone burns, we conducted a later study employing two groups of rats with standardized intermediate burns, to ascertain whether or not human recombinant copper-zinc superoxide dismutase could increase intermediate burn zone survival in rats. The results showed that post-burn human recombinant copper-zinc superoxide dismutase failed to improve intermediate burn zone survival. We decided to undertake a new study to ascertain whether there was a protective effect of human recombinant copper-zinc superoxide dismutase in intermediate burns. Methods. This controlled study employed two groups of rats, one of which received prophylactic treatment with human recombinant copper-zinc superoxide dismutase before the induction of standardized intermediate burns. Results. The results showed that pre-burn human recombinant copper-zinc superoxide dismutase also failed to improve intermediate burn zone survival. Conclusions. Further studies are needed to fully understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether human recombinant copper-zinc superoxide dismutase has a place in the clinical management of burns.
    The Annals of Fires and Burn Disaster 03/2008; 21(1):16-9.
  • Avshalom Shalom, Tal Friedman, Melvyn Westreich
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    ABSTRACT: Our laboratory has been studying the effect of aspirin, given alone or in combination with other medications, on random pattern skin flaps. We have consistently found that preoperative aspirin in high doses (200 mg/kg) increases flap survival, apparently as a result of its ability to modify the inflammatory reaction and/or direct vasodilatation, and not as a consequence of antiaggregation of platelets. In an effort to further elucidate how this effect is modulated, we designed this experiment in which we gave aspirin after the operative procedure to simulate an acute clinical surgical problem such as a failing or ischemic flap. Our results failed to show any difference between the rats that received postoperative aspirin and the untreated control group. It would appear that aspirin given postoperatively is not able to counteract the noxious elements that affect flap survival. This work indicates an important relationship between the timing of administration and the beneficial effects of aspirin. By investigating fully the mechanism whereby aspirin is able to improve flap survival, we hope to isolate this mechanism so an alternative pharmacological agent, safer than aspirin, can be found for clinical use.
    The American surgeon 12/2007; 73(11):1126-8. · 0.92 Impact Factor

Publication Stats

71 Citations
42.10 Total Impact Points

Institutions

  • 2000–2012
    • Tel Aviv University
      • Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 1999–2012
    • Assaf Harofeh Medical Center
      Ayun Kara, Central District, Israel