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Biomedical subjects

M J Jurkiewicz

Publications and source records attributed to M J Jurkiewicz.

At least 19 recordsLinked to original sources

Stimulation of healing of chronic wounds by epidermal growth factor.

We evaluated the effect of topical epidermal growth factor treatment on healing of chronic wounds in a prospective, open-label, crossover trial. Five males and four females who ranged in age from 40 to 72 years (average 57 +/- 9 years) were enrolled. Four patients had adult-onset diabetes mellitus, two had rheumatoid arthritis, two had old burn scars, and one had a failed abdominal incision. The average duration of the ulcers prior to treatment with epidermal growth factor was 12 +/- 5 months (range 1 to 48 months). Following failure of the wounds to heal with conventional therapies, including debridement, skin graphs, and vascular reconstruction, wounds were treated twice daily with Silvadene alone for periods ranging from 3 weeks to 6 months. No evidence of healing was observed in any of the patients' wounds during Silvadene treatment, and patients were crossed over to twice a day treatment with Silvadene containing 10 micrograms epidermal growth factor per gram. Wounds of eight patients healed completely with epidermal growth factor-Silvadene treatment in an average of 34 +/- 26 days (mean +/- SD, range 12 to 92 days) and did not reoccur for periods ranging from 1 to 4 years. One patient failed therapy. These results suggest that topical treatment of chronic wounds with epidermal growth factor may stimulate healing.

Administration, Cutaneous

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

The transverse lumbosacral back flap.

The transverse lumbosacral back flap is presented as a good one to use for coverage of sacral defects. Its reliability appears to be due to an axial pattern of its proximal portion, and to an uninterrupted subdermal vascular plexus across the midline of the back (supplying the terminal portion). A retrospective analysis of its use in 20 patients, over the last 3 years, suggests that when it is designed properly it can be most useful in the management of sacral pressure sores.

Adolescent

The transmaxillary K-wire.

The transmaxillary K-wire is a simple, fast, safe, and effective technique for the fixation of unstable tractured malar bones. Combined with other techniques such as interdental fixation it simplifies and provides the fixation of the Le Fort II fracture or osteotomy and certain osteotomies used for facial advancement. The technique of insertion is described and illustrated.

Bone Nails

Reconstruction of male external genitalia with elephantiasis.

The surgical rehabilitation of a patient with severely deformed and functionally disabled genitalia due to long-standing lymphedema and infection is described and illustrated. The term "elephantiasis" has been applied to such gross lesions. Appropriate surgery to the penis, scrotum, and perineum has yielded a gratifying result. The principles and techniques of the surgical approach in such an undertaking are presented and discussed.

Axilla

Pressure sores.

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Anti-Bacterial Agents

The omentum: an account of its use in the reconstruction of the chest wall.

Ten patients with lesions of the chest wall amenable to surgical therapy were reconstructed by a transposition flap of the greater omentum. Eight of these patients had been previously treated for cancer of the female breast by mastectomy and irradiation or by irradiation alone (in one instance). Of these 8, 6 had progressive ulceration of the chest wall consistent with radiation necrosis and three had residual carcinoma within the ulcer. One patient had melanoma of the chest wall still persistent after surgical resection and irradiation. Another had epidermoid carcinoma, whereas two sought breast reconstruction after successful mastectomy for cancer. In five patients the omentum was transposed directly on the pleura and lung or chest wall. In three patients prolene mesh was interposed to stabilize the chest wall. In two patients the defect attendant upon a Halsted mastectomy was ameliorated by a one-stage reconstruction using transposed omentum to cover a silastic gel prosthesis and to support an overlying skin graft. In three patients there were mild transient symptoms of gastric outlet obstruction postoperatively. In one patient delayed healing occurred because of partial separation of the omentum from the underlying irradiated pleura and in another there was partial loss of skin graft and omentum due to hematoma. A closed wound was achieved in all cases without infection.

Adenocarcinoma

Penetrating injuries of the face and neck.

Experience with 547 consecutive cases of cervical and facial penetrating trauma has indicated the value of an individualized approach rather than a firm policy of exploration for all wounds penetrating the platysma. In addition, the accumulated data suggest that the concept of separate classes of carotid injuries based on presence or absence of neurologic deficits bears further evaluation with respect to the advisability of reconstituting carotid artery flow.

Adolescent