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M J Jurkiewicz

Publications and source records attributed to M J Jurkiewicz.

At least 55 records · Page 3Linked to original sources
PubMed1984

Reconstructive surgery of the cervical esophagus.

Free heterotopic transplantation of segments of the distal alimentary tract revascularized in the neck provide a very satisfactory, straightforward method of reconstruction of the cervical esophagus. At present pharyngoesophageal reconstructions are of four major types: (1) free skin grafts; (2) local or regional skin flaps; (3) subcutaneous or intrathoracic interposition or migration on a vascular pedicle of more distal positions of the alimentary tract--stomach or colon; and (4) a free graft of jejunum or colon. This report is an account of each of these methods with an emphasis on free revascularized grafts of the jejunum. Fifty-five such reconstructions have been performed at Emory Affiliated Hospitals. There were six graft failures for a transfer reliability of 90%. There were three perioperative deaths for a perioperative mortality of 5%. Comparison with similar reported series using either direct esophagogastric anastomosis, colon interposition, or staged deltopectoral skin flap reconstruction would suggest that the free jejunal graft procedure has lower morbidity and mortality. I believe it to be the method of choice in reconstruction of the cervical esophagus.

Animals↗
PubMed1983

The platysma musculocutaneous flap: experience with 24 cases.

The platysma musculocutaneous flap has been used in 24 patients for reconstruction in the head and neck area. In 22 patients, the superior vascular pedicle, the submental branch of the facial artery, was used, and in two other patients, the inferior pedicle, the superficial branch of the transverse cervical artery, was used. Twelve patients had reconstruction of the intraoral lining with a skin paddle on the platysma. The buccal mucosa and mandibular alveolar ridge are particularly well suited to this flap. Six patients had restoration of external skin, four had provision of both skin and lining with the same flap, and two had coverage of vulnerable structures with muscle alone. Forty-two percent of patients experienced a minor complication. Only four patients, however, required further surgery, and all 24 patients ultimately had satisfactory results. Of seven patients experiencing loss of a portion of the skin paddle, six had intraoral reconstruction. Meticulous dissection and attention to anatomic detail is necessary in raising the flap. Because of its thinness and pliability, we feel that the platysma musculocutaneous flap is an important addition to the techniques of head and neck reconstruction.

Adult↗
PubMed1982

The omentum: its use as a free vascularized graft for reconstruction of the head and neck.

The experience at Emory University Affiliated Hospitals with transplantation of the greater omentum as a free revascularized graft in 18 patients is presented. In each instance, there was realization of the therapeutic objective, either 1) the amelioration of congenital or acquired somatic deformity (14 patients) or 2) the control of infection (4 patients). Because the omentum is a syncytium of blood vessels and a variable amount of fat within redundant leaves of peritoneal membrane laden with macrophages, it is a tissue that serves admirably its extended role as an extracelomic free transplant. The greater omentum has been used for this purpose in five patients with hemifacial atrophy (Romberg's disease); three patients with hemifacial microsomia (first and second branchial arch syndrome); two patients with extensive losses of the maxilla, palate, and face due to a shotgun blast; two patients with atrophy and facial growth arrest due to x-irradiation; and two patients with deformity of the jaw and neck following tumor resection. In three additional patients, the omentum was used to obliterate the dead space after debridement of an infected open frontal sinus following failure of conventional therapy. In one instance, a revascularized free graft of omentum was used to salvage a patient with an exposed irradiated carotid artery graft and skin flap failure following radical neck dissection. In these 18 patients, there were no intra-abdominal complications consequent to harvest of the omentum. In one patient afflicted with hemifacial atrophy, there was spotty necrosis of the overlying attenuated facial skin flap and limited fat necrosis. In the follow-up period of four months to seven years, there has been no instance of late resorption. The method is reliable and has considerable promise in reconstructive surgery.

Face↗
PubMed1981

Free jejunal grafts for reconstruction of pharynx and cervical esophagus.

Reconstruction of the pharynx and cervical esophagus is a surgical challenge associated with high complications, multiple-staged procedures, and prolonged hospitalizations. In a series of cases, single-stage transfer-free jejunal graft reconstructions had a 85% success rate with low complications in a series of patients who received preoperative, postoperative, and curative radiation treatment. There are advantages to this reconstruction procedure; however, there can also be complications.

Aged↗
PubMed1981

Management of acute full-thickness losses of the abdominal wall.

Over a 20-year interval, 167 patients sustained acute full-thickness abdominal wall loss due to necrotizing infection (124 patients), destructive trauma (32 patients), or en bloc tumor excision (11 patients). Polymicrobial infection or contamination was present in all but five of the patients. Of 13 patients managed by debridement and primary closure under tension, abdominal wall dehiscence occurred in each. Only two patients survived, the 11 deaths being caused by wound sepsis, evisceration, and/or bowel fistula. Debridement and gauze packing of a small defect was used in 15 patients; the single death resulted from recurrence of infectious gangrene. Pedicled flap closure, with or without a fascial prosthesis beneath, led to survival in nine of the 12 patients so-treated; yet flap necrosis from infection was a significant complication in seven patients who survived. The majority of patients (124) were managed by debridements, insertions of a fascial prostheses (prolene in 101 patients, marlex in 23 patients), and alternate day dressing changes, until the wound could be closed by skin grafts placed directly on granulations over the mesh or the bowel itself after the mesh had been removed. Sepsis and/or intestinal fistulas accounted for 25 of the 27 deaths. Major principles to evolve from this experience were: 1) insertion of a synthetic prosthesis to bridge any sizeable defect in abdominal wall rather than closure under tension or via a primarily mobilized flap; 2) use of end bowel stomas rather than exteriorized loops or primary anastomoses in the face of active infection, significant contamination, and/or massive contusion; and 3) delay in final reconstruction until all intestinal vents and fistulas have been closed by prior operation.

Abdominal Muscles↗
PubMed1981

Open wounds of the scalp: an account of methods of repair.

Scalp wounds attended by loss of substance are commonly managed either by direct skin grafting or a large transposition flap of adjacent scalp and skin grafting of the donor site defect. Either of these methods has all of the inherent disadvantages of the results of skin grafting: insensate, glabrous surface devoid of hair, recurrent ulceration after minor trauma, and, finally, abnormal appearance. In the past 5 years 23 patients at Emory Affiliated Hospitals have undergone a procedure whereby all existing scalp has been mobilized by fashioning arterialized flaps and the scalp reconstructed with normal hairbearing skin. Multiple relaxing incisions in the galea are requisite to the success of the method. An underlying defect in the bony calvaria can be reconstructed at a second stage by multiple split rib grafts.

Adult↗
PubMed1981

Problem wounds.

Explore the source record for details and available documents.

Abdominal Muscles↗
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

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↗