Moris Topaz - Academia.edu (original) (raw)

Papers by Moris Topaz

Burns & Trauma

Background Following combat-related, extensive soft tissue injury from gunshot wounds or blasts, ... more Background Following combat-related, extensive soft tissue injury from gunshot wounds or blasts, prolonged duration from injury to full wound closure is associated with infection, increased morbidity and mortality, failure to mobilize, poor functional outcome and increased cost. The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds. Methods This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries (5 gunshot wounds, 5 blasts) treated using the TopClosure® Tension Relief System (TRS) with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy (ROINPT) via the Vcare α® device. Results Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction. Two patients had upper limb injury and the rest lower limb i...

Frontiers in Surgery, 2021

The closure of a massive abdominal wall defect is illustrated using a novel dynamic closure techn... more The closure of a massive abdominal wall defect is illustrated using a novel dynamic closure technique - the TopClosure® tension relief system. This system attaches to the abdominal wall immediately after laparotomy and allows for early approximation of the skin, avoiding an open abdomen and the complications associated with this. The technique in this case was employed after extensive resection of the abdominal wall for infected skin metastases of colonic adenocarcinoma and circumvented post-operative ventilation and open abdomen. Early recovery after such extensive surgery is important in terms of patient morbidity and mortality. In this case, primary surgery may not have been an acceptable risk to undertake without the option of Top Closure of the abdomen. We illustrate the technique of abdominal wall closure through a series of images of the procedure.

Journal of Tissue Viability, 2018

Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound trea... more Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems.

Cirugía Española, 2019

Resumen En los tumores mamarios grandes en relacion con el tamano de la mama se requieren metodos... more Resumen En los tumores mamarios grandes en relacion con el tamano de la mama se requieren metodos reconstructivos complejos. Se describe un metodo alternativo de cierre que permite el cierre primario del defecto mediante la relajacion de la piel y el uso de un sistema de relajacion de la tension. Estos sistemas de relajacion permiten el cierre primario inmediato de grandes defectos cutaneos en pacientes con tumores que son grandes en comparacion con el tamano de la mama. El cierre de la herida quirurgica sin tension en los bordes permite una curacion temprana y una rapida movilizacion con buena funcionalidad. Una curacion optima facilita la radioterapia postoperatoria a tiempo sin problemas en la reconstruccion.

Journal of tissue viability, 2016

Closure of large soft tissue defects following surgery or trauma as well as closure of large chro... more Closure of large soft tissue defects following surgery or trauma as well as closure of large chronic wounds constitutes substantial but common reconstructive challenges. In such cases, an attempt to use conventional suturing will result in high-tension closure, therefore alternative external skin stretching systems were developed. These types of devices were meant to reduce local mechanical loads in the skin and the underlying tissues, taking advantage of the viscoelastic properties of the skin, especially mechanical creep, for primary wound closure. Studies have shown the clinical advantages of skin stretching systems, however, quantitative bioengineering models, demonstrating closure of large wounds, are lacking. Here we present finite element (FE) modeling of the TopClosure(®) tension relief system (TRS) and its biomechanical efficacy in three (real) wound cases, compared with the alternative of a conventional surgical suturing closure technique. Our simulations showed that peak ...

Orthopedics in Disasters, 2016

Mass casualties related to either natural or man-made disasters are a reality of our lives, affec... more Mass casualties related to either natural or man-made disasters are a reality of our lives, affecting large populations happening in both developed and developing countries. The earthquake that hit Haiti on January 12, 2010, caused around 237,000 deaths and nearly 300,000 wounded and left about 1 million homeless—revealing just how unprepared most countries are to deal with mass casualties and disaster-related injuries. A large percentage of the injuries typically seen in these situations are to the limbs [1, 2]. An overwhelming number of casualties; delayed presentation; crush injuries and crush syndrome; lack of adequate medical facilities and sometimes expertise, regional and cultural; and other factors influence the decision to amputate, to save lives, or to preserve function.

European Journal of Plastic Surgery, 2006

European Journal of Plastic Surgery, 2008

There has been an upsurge in the technology of injectable volumetric filler materials for soft ti... more There has been an upsurge in the technology of injectable volumetric filler materials for soft tissue augmentation of the face in the past decade. This is a dynamic field that has provided plastic surgeons and dermatologists who treat the aging face with newer tools and techniques. Injectable volumetric fillers can be applied in a variety of combinations and can be added to the various surgical options in conjunction with surgery or as maintenance following surgery. In practice, there are essentially four classes of materials that may be considered gold standard for minimally invasive rejuvenation and beautification of the face: botulinum toxin A, autologous fat, derivatives of hyaluronic acid, and, to a limited extent, hydroxyapatite. These coincide with the philosophy of applying materials and devices associated with the least amount of risk. Long lasting, or permanent-nondegradable, nonextractable, and nonabsorbable fillers remain an unresolved controversial issue, as the longer lasting the device, the greater also is the likelihood for long-term or even irreversible complications. The current trend for nonsurgical minimally invasive procedures for beautifying the face will most probably continue to surge, in light of their affordability in the growing economies around the globe, the increasing demand for a youthful look, and the need for less downtime for these procedures. There will be a rising demand for more hi-tech (bio-or genetically engineered) safe fillers with higher purity and less immunogenicity that allow a short recuperation time in order to attain a product that will serve as an ideal injectable volumetric filler for soft tissue augmentation.

Biomaterials, 2010

Thrombin has been clinically used for topical hemostasis and wound management for more than six d... more Thrombin has been clinically used for topical hemostasis and wound management for more than six decades. The half-life of thrombin in human plasma is shorter than 15 s due to close control by inhibitors. In order to stabilize the thrombin, it was bound to maghemite (g-Fe 2 O 3) nanoparticles, as demonstrated in previous work. The aim of the present study was to examine the efficiency of the bound thrombin for wound healing applications compared to the free thrombin. For this purpose incisional wounds on rat skin were treated with a mixture of fibrinogen, CaCl 2 solution and free or bound thrombin. The wounds' edges were then approximated by skin staples. The control incisional wounds were closed with staples only. In the course of 28 days of healing the highest values of skin tensile strength were observed following treatment with the bound thrombin. Significantly lower values of tensile strength were observed following treatment with the free thrombin, and the lowest values were obtained following treatment with staples only. The histological findings correlate with the mechanical strength measurements, which demonstrate the most advanced stages of healing following treatment with the bound thrombin.

Ultrasound in Medicine & Biology, 2002

High-intensity ultrasound (US) energy (HIUE) has been extensively used in the last 3 decades in a... more High-intensity ultrasound (US) energy (HIUE) has been extensively used in the last 3 decades in a wide range of surgical procedures, including phacoemulsification. The generation of radicals and sonoluminescence (SL) by application of continuous-wave (CW) HIUE to an aqueous medium under conditions simulating cataract phacoemulsification surgery is demonstrated by electron paramagnetic resonance (EPR) spectroscopy and a sensitive photon-detecting system. The findings provide direct evidence for the generation of acoustic cavitation in the simulated intraocular environment, pointing out that generation of acoustic cavitation in clinical phacoemulsification and other surgical applications of US is possible. The findings imply that the effects of acoustic cavitation in aqueous medium may contribute to the endothelial damage observed clinically following phacoemulsification cataract surgery. Saturation of the irrigating solution with various gases modifies the acoustic cavitation. Saturation of the irrigating solution with CO2 practically eliminates acoustic cavitation, with the concomitant elimination of radicals and SonL. CO2 may be utilized clinically to suppress acoustic cavitation in phacoemulsification and other medical applications. A cavitation index (CI) is introduced for the purpose of standardizing phacoemulsification instrumentation and other medical US devices that employ HIUE.

Plastic and Reconstructive Surgery, 2005

Background: A multicenter study was conducted to test the ability of electrical impedance scannin... more Background: A multicenter study was conducted to test the ability of electrical impedance scanning to differentiate between benign and malignant skin lesions. The performance of a dual electrical impedance scanning/image analysis device was also assessed. Methods: Electrical impedance scanning measurements of 449 preoperative lesions found on 382 patients and including 53 melanomas from the trunk and extremities were performed. Results were correlated with histopathologic findings. In addition, ABCD parameters for the lesions were automatically calculated by the system. Results: Electrical impedance scanning detected melanomas of the trunk and extremities with 91 percent sensitivity and 64 percent specificity. Moreover, sensitivity of electrical impedance scanning was increased to 100 percent for in situ and thin melanomas of smaller size (n ϭ 27). Visual examination identified as malignant only 67 percent of these early tumors (p ϭ 0.002). Clinical examination detected 96 percent of the larger or thicker melanomas (n ϭ 26), whereas electrical impedance scanning detected only 81 percent of them. Combined electrical impedance scanning and image analysis detected 100 percent of the melanomas, independent of their thickness,

Plastic and Reconstructive Surgery, 2004

Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.

Journal of Cataract and Refractive Surgery, 2008

To characterize the mechanism of injury caused by phacoemulsification and examine the protective ... more To characterize the mechanism of injury caused by phacoemulsification and examine the protective effect of ascorbic acid in cultured bovine corneal endothelial cells (CECs).

Aesthetic Surgery Journal, 2002

S c i e n t i f i c F o r u m the second postoperative month, and once a day subsequently. We sug... more S c i e n t i f i c F o r u m the second postoperative month, and once a day subsequently. We suggest to our patients that this once-a-day regimen become a lifelong habit. Among patients who have received naturally shaped implants, we prefer massages to begin no earlier than 1 week after the operation to prevent any rotation. The most difficult problem we encountered with the massage regimen was ensuring that patients understood how to perform this maneuver properly. We found that especially during the first postoperative week or two, patients did not move their prostheses but only the above-lying mammary parenchyma during the massage in an effort to avoid pain. We tried to explain that the implant had to be pushed inferiorly and medially, whereas nipples had to move only slightly. However, we succeeded in this only when we gave our patients a series of pictures showing precisely what we meant (Figure). We believe such illustrations are useful teaching aids, because often a concept that seems obvious to an experienced surgeon may be difficult for a patient to understand. ■

Aesthetic Surgery Journal, 1998

Annals of Surgery, 2013

This study was designed to investigate the therapeutic potential of regulated negative pressure w... more This study was designed to investigate the therapeutic potential of regulated negative pressure wound therapy (RNPT) in treating infected blast injuries in swine. Approximately 30% to 80% of blast injuries develop infection, which increases the morbidity and mortality of these casualties. RNPT has been used in US military operations in Iraq; however, no randomized controlled study has been conducted on the use of RNPT to treat infected war injuries. Infected soft tissue blast injuries were treated with gauze dressings or RNPT with different pressures ranging from -5 to -35 kPa. To evaluate the wound healing process, the wound area, wound depth, the number of proliferative cells, and the vascular endothelial cells in the granulation tissue were measured at different time points. Furthermore, to evaluate the infection and inflammation of the blast injury, the bacterial load, bacterial species, and several inflammatory markers were detected. Compared with gauze dressing treatments, RNPT reduced bacterial load more efficiently, initiated granulation tissue formation earlier, and increased the inflammation faster. Negative pressures ranging from -10 to -25 kPa applied on the RNPT group showed beneficial effects in treating the infected soft tissue blast injury. RNPT did not significantly change both the aerobic and anaerobic bacterial composition compared with those of the gauze dressing group. RNPT clearly shows beneficial effects in treating the infected soft tissue blast injury in comparison with the gauze dressing therapy in swine.