Biomedical subjects
Publications and source records attributed to D J Hurwitz.
Huge sacral defects can be closed reliably with sliding gluteus maximus myocutaneous flaps. In ambulatory patients, this flap is designed to maintain innervation, vascularity, and functional integrity of the muscle.
The rich vascular network of the gluteal and posterior thigh region provides for a larger range of flaps for reconstructive surgery than previously described. Facility with these flaps requires an appreciation of relevant anatomy, embryology, and anthropology. Structural changes in the gluteus maximus muscle are critical to the evolutionary advance toward an upright stance during walking. The superficial and deep segmentation of the gluteus maximus are best appreciated by phylogenic and ontogenetic study. Femoral arterial and gluteal arterial anastomotic hemodynamics are affected by the relative involution of the gluteal system in late embryogenesis. The gluteal thigh flap should include contributions from the femoral system when the cutaneous branch of the inferior gluteal artery cannot be identified. Huge sacral wounds can be closed with gluteus maximus myocutaneous flaps with maintenance of muscular function by detaching the entire origin, sliding the muscle medially, and reconstructing these attachments. By dissection between the divergent inserting fibers of the gluteus maximus, a long, superficial portion of the muscle can be raised that forms the basis of the extended gluteus maximus flap. The pedicle of the flap is at the level of the piriformis muscle and the skin paddle can be placed over the midportion of the posterior thigh. Finally, the first deep femoral perforating artery forms the basis of a posterolateral fasciae latae flap that is well suited for coverage of defects over the trochanter.
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Meticulous anatomic dissection of the vasculature of the superficial anterolateral neck indicates that the platysma and overlying skin are supplied by direct cutaneous arteries measuring 0.5 mm in diameter. The small arteries are branches of the postauricular and occipital arteries in the upper lateral neck, the facial and submental arteries in the upper medial neck, the superior thyroid artery in the middle of the neck, the subclavian artery in the lower medial neck, and the transverse or superficial cervical arteries in the lateral aspect of the neck. These vessels traverse the undersurface of the platysma muscle to provide blood flow to the overlying skin. As opposed to this direct cutaneous system, the myocutaneous blood supply perforating through the sternocleidomastoid is scant. The platysma skin flap will survive if the blood supply from at least one region is preserved. In addition, it may be beneficial to include the external jugular and/or the communicating veins in the flap. By following these guidelines, the platysma flap has been successfully used for facial reconstruction in 7 of 8 consecutive patients.
A new flap of the buttock and posterior thigh has been developed for closure of wounds of the perineal and postsacral regions. Flap anatomy and operation technique are described. Five patients with difficult wounds were selected to demonstrate the versatility and range of this flap. In 40 patients under 65 years of age with a variety of buttock and perineal wounds, there have been no appreciable wound-healing problems with use of this flap.
Our diagnostic and therapeutic approach to arteriovenous malformation is based on the available knowledge of the hemodynamics of these lesions. Four cases are presented. One demonstrates the deleterious effects of proximal vessel ligation. Two cases are treated with flow-controlled embolization, wide excision, and axial flap coverage of the defect with no recurrence on physical examination at more than 2 years. The final case illustrates a relatively small arteriovenous malformation that replaced one-half of the lower lip and chin. An extensive resection is done and the defect is reconstructed with an innervated and well-vascularized neck flap.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Room temperature-curing methyl methacrylate has been sandwiched between two layers of Marlex mesh and molded in the operating room to achieve chest wall stability following an extensive anterolateral resection. Reliable coverage with latissimus dorsi myocutaneous flap has made this simple, aesthetically pleasing, and firm reconstruction practical, even in a patient who received high-dose irradiation.
A case is presented which demonstrates the use of a pectoralis major myocutaneous flap for repair in a heavily radiated neck and chest, with neck contracture and a tracheocutaneous fistula.
Careful surgery, a precise dressing technique with prolonged immobilization, and the utilization of designs borrowed from the glove industry are integral aspects in our attempts to resufrace the dorsal surface of the hand. One case is presented to demonstrate our method.
Trauma to the anterior cervical region, whether blunt or penetrating, is life threatening and often causes a major loss of tissue to both the larynx and the trachea. We report our experience in reconstructing the larynx and trachea with the pectoralis major myocutaneous island flap in an unusual case of extensive traumatic cervical injury.