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Biomedical subjects

J Bostwick

Publications and source records attributed to J Bostwick.

At least 73 records · Page 4Linked to original sources
PubMed1986

Conservative treatment for breast cancer. Complications requiring reconstructive surgery.

Women who select conservative treatment for carcinoma of the breast (tumor excision followed by supervoltage radiation therapy) place a premium on breast preservation and aesthetics. When local control fails and they require a mastectomy, or when the aesthetic appearance is unacceptable, they may request breast reconstruction. The goal of this study is to evaluate a series of 10 patients who required reconstructive breast surgery after complications of conservative treatment. Patient classification: I. Breast or chest wall necrosis (3). II. Breast fibrosis and gross asymmetry (3). III. Local recurrence of breast cancer (5). IV. Positive margins after the initial lumpectomy (1). The mean age was 34 years. Radiation dosage average was 5252 rads with two patients receiving iridium-192 implant boosts. The reconstructive management was complex and usually required a major musculocutaneous flap because of the radiation effects.

Adult↗
PubMed1985

Breast reduction utilizing the maximally vascularized central breast pedicle.

Experience using a maximally vascularized central breast pedicle to nourish the nipple-areola is presented. The pedicle is designed to incorporate vascular contributions from the lateral thoracic artery, intercostal perforators, internal mammary perforators, and thoracoacromial artery by means of the pectoralis major muscle. The basic technique is as follows: First, the areola is incised and 2-cm-thick skin and subcutaneous flaps are dissected medially, laterally, and superiorly, freeing the entire central breast mound. Second, the breast is reduced in a "Christmas tree" manner, being careful not to narrow the base of the pedicle. Third, excess skin and subcutaneous tissue is excised inferomedially and laterally and the nipple is inset into proper locations. The advantages of this technique are (1) large and small reductions can be done, (2) pedicle length does not appear to be a problem, and (3) the central mound gives the forward projection needed for good contour and good aesthetic results. Sixty-five patients with follow-up to 4 years are presented.

Adult↗
PubMed1985

Double-pedicle transverse rectus abdominis myocutaneous flap for unilateral breast and chest-wall reconstruction.

Fifteen patients underwent unilateral breast and chest-wall reconstruction by a double-pedicle transverse rectus abdominis myocutaneous flap technique. Criteria for using both pedicles include (1) exceptionally large soft-tissue requirements, (2) prior abdominal operations compromising the vasculature to portions of the anterior abdominal wall, and (3) certain higher-risk patients with suspected microvascular pathology. Double pedicles allowed the transfer of the skin island as one unit or as two independent hemiellipses of tissue. Follow-up time ranges from 4 to 17 months. Complications included partial tissue loss in two patients, one abdominal flap seroma, and one patient with a hernia.

Abdominal Muscles↗
PubMed1984

Denervated muscle flaps: mass and thickness changes following denervation.

It has been previously well documented in different animal models and different muscle groups that there is an early rapid loss, followed by stabilization, of muscle mass. This study supports the findings and, in addition, correlates the change in thickness with the change in weight after ligation of the thoracodorsal pedicle.

Animals↗
PubMed1984

Radiation to the breast. Complications amenable to surgical treatment.

UNLABELLED: Major complications of radiation directed to the breast, axilla, and mediastinum were treated in 54 patients from 1974 to 1983. A classification of these complications facilitates both an understanding of the pattern of injury and the development of a treatment plan. CLASSIFICATION: I. Breast necrosis; II. Radionecrosis and Chest Wall Ulceration; III. Accelerated Coronary Atherosclerosis with Median Sternotomy Wound Failure After Coronary Revascularization; IV. Brachial Plexus Pain and Paresis; V. Lymphedema and Axillary Cicatrix; VI. Radiation-induced Neoplasia. The treatment has evolved during the 10-year study period to excision of the necrotic wound, including any tumor, and closure with a transposed muscle or musculocutaneous flap of latissimus dorsi (II, III, V) or rectus abdominis (I, II, VI). This strategy reflects a change from primary use of the omentum during the first years of the study. The vascularity, oxygen and antibiotic delivery of these muscle and musculocutaneous flaps promote wound healing, usually with one operation. The transfer of these muscles has not caused significant functional deficits.

Adult↗
PubMed1984

More experience with the "reverse" latissimus dorsi musculocutaneous flap: precise location of blood supply.

Our work demonstrates that the "reverse" latissimus dorsi musculocutaneous flap has a predictable and consistent blood supply. A major portion of the muscle can be nourished by the dorsal perforating branches of the ninth, tenth, and eleventh intercostal vessels. The skin island based on the "reverse" latissimus dorsi muscle can be as large as 8 X 20 cm. This is confirmed by anatomic dissections and clinical cases. Knowledge of the blood supply facilitates elevation of the flap and extends its utility.

Adult↗
PubMed1984

Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery.

The key to understanding the blood supply of the anterior hemiabdomen is knowledge of the central superficial inferior epigastric artery system and the peripheral contribution of the epigastric, deep and superficial circumflex, and iliac arteries and external oblique perforators. These systems all feed into the subdermal plexus of the anterior abdominal wall. Angiographic confirmation of multiple communications between the superficial inferior epigastric artery and other major sources of abdominal wall blood supply has been obtained. Experience using the superficial inferior epigastric artery flap as a pedicled and microsurgical transfer has been described.

Abdomen↗
PubMed1983

Latissimus dorsi blood supply after thoracodorsal vessel division: the serratus collateral.

The reliability of the latissimus dorsi musculocutaneous flap for breast reconstruction following radical mastectomy and an axillary dissection that may have divided the thoracodorsal vessels is enhanced by preservation of the serratus collateral into the flap. Observations during axillary dissections have confirmed the constant presence of the serratus branch. Primate studies document latissimus dorsi flap viability when elevated on this branch. Studies during microvascular transfer document reversal of flow in the serratus branch to supply the latissimus dorsi muscle after division of the thoracodorsal artery. Latissimus dorsi flap elevation as an island may be reliably based on the serratus branch.

Animals↗
PubMed1983

The mastectomy defect. A philosophy of reconstruction.

The armamentarium of the reconstructive breast surgeon has greatly expanded in recent years. The current techniques of reconstruction range from the use of a silicone breast implant with local tissue to the recruitment of large quantities of distant soft tissue. Each technique and its relative indications, advantages, and disadvantages are reviewed. The concept of individualized selection of breast reconstruction technique is emphasized, keeping in mind the well-informed patients' wishes and needs.

Breast↗
PubMed1982

Aesthetic aspects of breast reconstruction.

Implant exposure, malposition, and capsular contracture, problems often seen with subcutaneous placement of implants in breast reconstruction, have been largely eliminated by submuscular placement of the implant. The pectoralis major, serratus anterior, rectus abdominus, and the latissimus dorsi are available as muscle and musculocutaneous flaps for coverage of implants in breast reconstruction. As symmetry is the goal in breast reconstruction, the shape and form of the opposite breast is taken into account in selecting a suitable flap for breast reconstruction. The roles and indications for each of these flaps in reconstruction of the breast are presented.

Breast↗
PubMed1982

Chest wall reconstruction--management of the difficult chest wound.

Full-thickness chest wall defects after ablative surgery for metastatic cancer, trauma, infection, or irradiation injury have posed major and often impossible dilemmas for reconstruction. At times, resection has had to be abandoned because reconstruction was deemed infeasible. However, recent knowledge of the multicentric blood supply and anatomy of the latissimus dorsi and pectoralis major muscle make it possible to use these muscles and myocutaneous units (even following division of their major blood supply) for reconstruction of the chest wall. The reconstruction of difficult anterolateral chest wall defects is discussed and the options available to the surgeon before and after interruption of the major blood supply to these flaps are presented.

Adult↗
PubMed1982

Latissimus dorsi flap: current applications.

The latissimus dorsi muscle has provided a useful flap for studying and defining the principles of the myocutaneous method. Clinically, it has yielded a valuable myocutaneous unit, based on its various pedicles. It has also provided the microvascular surgeon with a versatile unit that supplies a large volume of tissue with a long vascular pedicle. Investigation of the vascularity of the latissimus dorsi unit has led to better understanding of the vascularity of the muscle, and has extended the range of application of the myocutaneous method.

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