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Biomedical subjects

J D Franklin

Publications and source records attributed to J D Franklin.

At least 19 recordsLinked to original sources
PubMed1999

Internal fixation of the sternum in median sternotomy dehiscence.

Sternal dehiscence may be defined as separation of the bony sternum and manubrium following median sternotomy. It may occur at any time postoperatively and has various etiologies. Restoration of sternal integrity in sternal dehiscence is a challenging problem, particularly when associated with deep-seated infection. This report reviews a single-stage technique that virtually eliminates the infected sternotomy wound and provides anatomic reduction and stabilization of the sternum. Complete debridement of infected and/or nonviable soft tissue, bone, and cartilage is followed by pulse irrigation. Parallel stainless steel mandibular reconstruction plates are then placed on each side of the remaining sternum and wired together. One or more transmanubrial compression plates may be added. Bilateral pectoralis major musculocutaneous flap advancement and primary skin closure is performed over two to three closed suction drains. From January of 1994 to July of 1996, this technique was used by the same surgeon in 26 male and 4 female patients aged 43 to 78 years (mean = 61). Indications for the operation were sternal dehiscence with infection (osteomyelitis and/or mediastinitis) in 14 patients and sternal dehiscence without infection in 16 patients. All patients survived to discharge with mean time on the ventilator, intensive care unit length of stay, and postoperative length of stay of 0.7, 2, and 8 days, respectively. Choice and duration of antibiotics were based on culture results and operative findings. Subsequent hardware removal was necessary in one patient for hardware loosening and three patients for late periplate infection. A closed wound was eventually achieved in all 30 patients, and sternal stability was restored in 29 patients. In the management of sternal dehiscence, the described technique of internal fixation can provide anatomic sternal reduction and stabilization, elimination of infection, and wound closure in a single-stage operation. Successful outcomes were achieved despite the presence of severe infection.

Adult↗
PubMed1991

Management of arginine monohydrochloride extravasation in the forearm.

We initially observed our patient, who had subcutaneous arginine monohydrochloride extravasation in the volar forearm, until his wound demarcation was complete. After wound demarcation, we proceeded with debridement and partial-thickness skin grafting. Upper extremity function was totally normal 3 months after this therapy. This is the first case report in the literature that describes a child with an arginine monohydrochloride-induced extravasation necrosis.

Amino Acid Metabolism, Inborn Errors↗
PubMed1990

Fasciocutaneous island flap based on the medial plantar artery: clinical applications for leg, ankle, and forefoot.

Soft-tissue deficits over the plantar forefoot, plantar heel, tendo calcaneus, and lower leg are often impossible to cover with a simple skin graft. The previously developed medial plantar fasciocutaneous island flap has been adapted to cover soft-tissue defects over these areas. This fasciocutaneous flap based on the medial plantar neurovascular bundle is capable of providing sensate and structurally similar local tissue. Application of this fasciocutaneous island flap is demonstrated in 12 clinical cases. Successful soft-tissue cover was achieved on the plantar calcaneus (four patients), tendo calcaneus (four patients), lower leg (two patients), and plantar forefoot (two patients). Follow-up ranged from 6 months to 5 years. All flaps were viable at follow-up. Protective sensation was present in 11 of 12 flaps evaluated at 6 months. In addition, all 11 patients were able to ambulate in normal footwear. The medial plantar island flap seems to be more durable than a skin graft, and the donor site on the non-weight-bearing instep is well tolerated. This study demonstrates that the medial plantar fasciocutaneous island flap should be considered as another valuable tool in reconstructive efforts directed at the plantar forefoot, plantar heel, posterior ankle, and lower leg.

Adolescent↗
PubMed1989

Rigid facial skeletal fixation: advances in treatment.

Rigid facial skeletal fixation with miniplates, combined with craniofacial reconstruction techniques, has dramatically changed the treatment of facial fractures. Our use of these newer techniques in 142 facial fractures treated during the past 14 months has resulted in improved aesthetics and function, with a low complication rate. Advances over other techniques include (1) craniofacial incisions with wide subperiosteal exposure, (2) rigid skeletal fixation that virtually eliminates the need for continued intermaxillary fixation, suspension wires, or tracheostomy, (3) primary bone grafting with cranial bone, and (4) early definitive treatment. These innovative techniques establish a higher standard of care for facial fractures, as illustrated by the three cases we review.

Accidents, Traffic↗
PubMed1986

Pectoralis major musculocutaneous flaps: long-term follow-up of hypopharyngeal reconstruction.

We have reviewed our experience with 25 patients who have undergone major head and neck resections and required hypopharyngeal pectoralis major flap reconstruction. Six patients were alive 1 year following reconstruction and five patients consented to evaluation of flap function with endoscopy, with biopsy, barium swallow, and esophageal manometrics. The patients were older (61 +/- 6 years) and the flaps were large (42 +/- 9 cm2). Barium studies were the most useful method of evaluating these patients. Postoperative stricture and laryngeal aspiration were found in two patients. Biopsy of the flap demonstrated loss of keratin in the overlying epidermis, while the gross appearance was more like the surrounding mucosa. A review of dietary intake in these cases revealed that two patients weighed less than their preoperative weights, while another refused oral feedings despite a good functional result. Three of five patients preferred gastrostomy feedings to oral alimentation.

Aged↗
PubMed1986

Split jejunal free-tissue transfer in oropharyngoesophageal reconstruction.

From January 1, 1981 to July 1, 1981, ten patients underwent immediate reconstruction utilizing split jejunal free-tissue transfers following resection of large oropharyngeal neoplasms. All 10 flaps were successfully transferred. Three patients were irradiated preoperatively and six patients were irradiated 2 to 3 weeks postoperatively. Nine patients were available for follow-up until their death from 10 to 39 months postoperatively (average 26 months). All but two patients died of their original tumor. Six of the nine patients had a good early functional result; taking semisoft or soft diets allowed them to maintain or gain weight. Three patients had poor early results with limited oral feedings due to repeated aspiration in two and severe gastroesophageal reflux in another. Postoperative graft biopsies were obtained in five patients, showing normal mucosa or mild chronic inflammation histologically even following irradiation. Postoperative barium studies showed varying degrees of graft peristalsis. Complication rates were acceptable, and donor-site morbidity was minimal. Neither preoperative nor postoperative radiation affected the viability of the grafts. Therefore, this technique should continue to find application as a reliable method of providing like tissue for reconstructing a variety of large oropharyngeal defects.

Aged↗
PubMed1984

Preservation of anal function after total excision of the anal mucosa for Bowen's disease.

Six women with Bowen's disease of the anogenital area were treated by total excision of the anal mucosa, perianal skin and, in some cases, partial vulvectomy. Two patients had foci of microinvasive squamous carcinoma. Adequate tumor margins were determined by frozen sections. The resulting mucosal and cutaneous defects were grafted with medium split-thickness skin grafts applied to the anal canal and sutured circumferentially to the rectal mucosa. Grafts were held in place by a finger cot inserted in the anal canal and stuffed with cotton balls. Patients were constipated five or six days with codeine. The skin grafts healed per primam. One additional patient was similarly treated for a chronic herpetic ulceration of the anus and healed. Contrary to dire predictions, all patients were able to distinguish between gaseous and solid rectal contents and sphincter function was preserved. In one patient, Bowen's disease has recurred in the grafted perianal skin.

Adult↗
PubMed1983

Venous endothelial changes after experimental cooling of free flaps.

The free epigastric rabbit flap was used to observe morphological alterations in the microvasculature following prolonged hypothermic ischemic intervals. Free flaps were raised, cooled 1-6 days, and reanastomosed. The epigastric artery, vein, and dermal vessels were examined by electron microscopy. Efforts to keep flap tissues in the cold less than or equal to 5 days were successful (85% of flaps survived following reanastomosis N = 15). Flap failures were accompanied by extensive disruption to the endothelial cells of the epigastric vein. The findings support the efficacy of a cooling period less than or equal to 5 days for free flaps. The morphological alterations in the venous endothelium of the flap also suggest a plausible explanation for flap failures which occur in spite of patent anastomotic sites.

Animals↗
PubMed1983

Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses.

Microlymphaticovenous anastomoses provide a potential for reducing lymphedema of the upper extremity complicating radical mastectomy or irradiation. Lymphoscintigraphy is a valuable investigative modality in the perioperative evaluation of patients undergoing this surgical procedure. The radionuclide studies provide information regarding structural change and physiologic derangement with a low radiation dose to the patient. It is a simple, painless procedure requiring minimal skill and no surgical intervention. In addition, a reproducible method for preparing a radiocolloid suitable for lymphatic imaging using an approved drug as a precursor has been developed.

Arm↗
PubMed1981

Immediate reconstruction of the pharynx and cervical esophagus with the pectoralis major myocutaneous flap following laryngopharyngectomy.

The "island" pectoralis major myocutaneous flap has been used in nine patients for immediate hypopharyngeal and cervicoesophageal reconstruction following laryngopharyngectomy. Two patients underwent total hypopharyngeal and cervicoesophageal reconstruction. Postoperative evaluation revealed adequate lumens with no evidence of stricture. There was retained innervation of the flaps through the lateral pectoral nerve, but no additional innervation from the cricopharyngeal musculature could be demonstrated. Normal esophageal motility was maintained, but cervicoesophageal pressures were diminished. Donor site morbidity was minimal, and the complication rate was low. We present the pectoralis major myocutaneous flap as an alternate method for hypopharyngeal and cervicoesophageal reconstruction.

Esophagus↗
PubMed1981

Effect of lymphangiography on lymphedema.

Lymphangiography, using oily radiopaque Lipiodol Ultra Fluid has been shown to increase lymphedema in one-third of the patients with obstructive lymphedema and to cause lymphatic obliteration (demonstrated histologically). No effective element has been observed, although subclinical infection could not be ruled out. Allergy is another possible contributor, but the evidence from this series suggests that Lipiodol may act as a direct irritant when it is not rapidly cleared, as in the case of obstructive lymphedema, and proceed to obliteration of the residual lymphatics. On the basis of these findings, elective routine preoperative lymphangiography for lymphedema is considered strongly inadvisable.

Female↗
PubMed1980

Single-stage reconstruction of mandibular and soft tissue defects using a free osteocutaneous groin flap.

Microvascular reconstruction of the mandible and soft tissues using the composite groin flap is ideal in selected patients. No other available bone so closely approximates the mandible in both thickness and curvature as does the iliac crest. The soft tissues are available for reconstruction and may allow the surgeon to avoid a second flap, except in cases where both lining and cover are needed. The deep circumflex artery is of generous size, usually 2 to 2.5 mm in diameter, allowing greater reliability in the microvascular anastomoses. The flap has a fairly long vascular predicle, 6 to 8 cm. The ability of this flap to withstand irradiation and infection because of its blood supply permits early institution of postoperative radiotherapy and prevents bone loss due to small intraoral wound dehisicence or total flap loss. Although the donor site requires extensive dissection, it can be closed primarily, eliminating the need for skin grafts or other flaps. As further experience is gained with this flap, both the functional and cosmetic results should be improved. In patients undergoing resection of the remaining portion of the mandible, the symphysis or the anterior portion of the mandible, a procedure of this type should be done primarily to prevent deformity and to minimize disability for the patient.

Aged↗
PubMed1980

Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy.

Cross-facial nerve grafts followed in 4 to 12 months by microneurovascular free gracilis transplantation can produce adequate reconstruction in the lower two-thirds of a paralysed face. The mixed sensory and motor deep peroneal nerve and the small muscle bulk of the extensor digitorum brevis limit its usefulness in facial palsy. The gracilis has proved to be a much superior muscle. A feasible method for total reamination of unilateral facial palsy is presented.

Adolescent↗
PubMed1980

The effects of cooling on experimental free flap survival.

Cooling to 6-7 degrees significantly increases ischaemic tissue survival to 48 and, probably, 72 hours. Inflammatory changes develop in direct proportion to the duration of the cold ischaemia time. The skin and vessels within the flap appear to be minimally affected by cold ischaemia while fat and muscle demonstrate significant necrosis, inflammation and ultimate fibrosis. Very little, if any, muscle survives the ischaemic insult studied in this model.

Animals↗
PubMed1980

Replantation and revascularisation surgery in children.

Salvage of any amputated, or devascularised, digit or extremity in a child should be seriously considered and carefully planned. Bone shortening should be minimised. Replanted and revascularised digits and extremities do grow and often demonstrate minimal retardation when well revascularised and minimally traumatised. Even in more extensive injuries progressive growth is observed. Replanting of single digits is worth while in children. Vein grafting should be seriously considered when replanting any avulsed digit. The return of excellent sensation and good function in amputated parts in children makes these procedures rewarding and beneficial.

Adolescent↗