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Biomedical subjects

J Bostwick

Publications and source records attributed to J Bostwick.

At least 91 records · Page 5Linked to original sources
PubMed1980

Persistent tracheostomy stoma.

Prolonged presence of a tracheostomy tube or prolonged tracheostomy stoma can result in a failure of spontaneous closure. The stoma may remain open until surgically closed. Muscle flaps as well as skin flaps can be used to close the persistent tracheostomy stoma. These flaps seal the stoma, provide soft tissue between the trachea and the skin, and allow a satisfactory cosmetic result. The sternohyoid muscle is readily accessible for this purpose. This procedure was used in five patients with a satisfactory result in each.

Fistula↗
PubMed1980

Infected median sternotomy wound. Successful treatment by muscle flaps.

The purpose of this paper is to present the experience at Emory University Hospital with the infected median sternotomy wound and to offer a treatment plan for those patients recalcitrant to the usual therapy of debridement and closed catheter irrigation with antimicrobial agents. When standard treatment fails, we proceed not only with the necessary thorough debridement to convert the wound to a relatively clean one but also concomitant closure by pectoralis major muscle flaps to completely obliterate dead space. Transposition flaps of rectus abdominus muscle or omentum are used when necessary to complete the closure. In the initial phase of this study, there were 3,239 patients who underwent open heart procedures through a median sternotomy approach in the years 1975 through 1978. In the 50 patients who had wound infections (1.54%), there were nine deaths. Three were thought to be unrelated to the sternal wound infection, four patients ruptured the ventricle or aorta, two patients died of generalized sepsis. Of these 50 patients, 22 responded to simple drainage; 28 had involvement of the mediastinum (0.86%). Of the 28 patients, 25 had debridement and closed mediastinal irrigation by catheter. Fourteen of these 25 did not respond. In these failing patients, 12 were treated by further debridement and closure by muscle flaps. Nine of these 12 were rescued. In the past nine months, an additional 1,052 patients had an open heart procedure. Of these, 11 had a median sternotomy infection. There have been no deaths in this latter group of patients, most of whom were treated by the muscle flap procedure. In addition to the improvement in mortality, morbidity has been reduced substantially. This procedure provides for a rational approach that we have found to permit salvage of a high percentage of patients who failed conventional closed irrigation techniques.

Anti-Bacterial Agents↗
PubMed1980

The subcutaneous mastectomy cripple: surgical rehabilitation with the latissimus dorsi flap.

Despite the advances in reconstruction after subcutaneous mastectomy, we have seen a group of patients who have developed disabling complications of their surgery. These patients have become "subcutaneous mastectomy cripples." In general, these patients have two primary reconstructive problems: (1) inadequate coverage of their silicone implant, and (2) loss of breast skin from infection and ischemic necrosis of skin flaps. The latissimus dorsi flap easily corrects these two defects. We have presented our experience with the "subcutaneous mastectomy cripple" and described the use of latissimus dorsi muscle and musculocutaneous flaps in their management.

Adult↗
PubMed1980

Dosimetry of a silicone breast prosthesis.

Dose measurements were conducted in a phantom which simulates breast tissue and in another phantom which simulates a breast containing a silicone prosthesis. No detectable difference was found when the irradiations were carried out with tangential beams of 60Co radiation. The degree of backscatter and absorption of radiation by the prosthesis and phantom were also similar. A slight decrease in dose of approximately 8% was found at the interface between the prosthesis and muscle-equivalent material.

Breast Neoplasms↗
PubMed1980

The latissimus dorsi musculocutaneous flap: a one-stage breast reconstruction.

As an alternative to multistaged tube pedicle flap breast reconstruction, we present a reliable, one-stage method of breast reconstruction using the latissimus dorsi muscle and musculocutaneous flap. Based on our experience with 200 falps over the last three years, we believe that the latissimus dorsi flap is a safe and effective operation for supplying skin and muscle tissue for breast reconstruction.

Breast↗
PubMed1980

The burned female breast.

Historically, treatment of the burned female breast has been unsatisfactory. By using the latissimus dorsi myocutaneous flap, many patients can be reconstructed in a single operation. A more aggressive approach in adolescent patients whose breasts are developing may result in more normal breasts. In such patients, nipple reconstruction is delayed until a later time.

Adult↗
PubMed1980

Recent advances in breast reconstruction: transposition of the latissimus dorsi muscle singly or with the overlying skin.

This article presents the details of an operation for the transposition of the latissimus dorsi muscle as an integral part of the reconstruction of the breast. Muscle alone may be transposed to restore lost pectoralis major muscle contour following the standard Halsted radical mastectomy, or a compound island flap of skin and muscle may be used to replace both the resected muscle and skin.

Adult↗
PubMed1979

Sixty latissimus dorsi flaps.

In clinical experiences with 60 cases, we have found the latissimus dorsi to be a reliable and versatile flap. We describe its use for a functional muscle transfer (in restoration of elbow flexion and repair of abdominal wall defects), for arm and shoulder coverage, for breast reconstruction, and as a free flap.

Abdominal Muscles↗
PubMed1978

Experience with the Horton-Devine dermal graft in the treatment of Peyronie's disease.

We treated 15 patients with Peyronie's disease surgically with the dermal graft technique described by Horton and Devine. Details of the preoperative management and surgical technique are provided. Return of normal sexual function without residual chordee or pain was achieved in more than 75 per cent of the patients, suggesting that this is the procedure of choice in the management of severe Peyronie's disease.

Adult↗
PubMed1978

Breast reconstruction after a radical mastectomy.

Breast reconstruction after a radical mastectomy remains a complex problem. We describe the use of a latissimus dorsi myocutaneous flap, a transverse abdominal flap, or a pedicled flap of the greater omentum to obtain satisfactory cover for the implant and enable us to correct the deformity in one operation.

Breast↗