Vacuum-assisted drainage is an effective therapy for mediastinitis following debridement or before placement of a vascularized tissue flap.

The authors review the anatomical indications in which they found this technique to be simple, reproducible, and effective in shaping the dorsal midvault while preserving the function of the internal valve. Autospreader flap rotation should be considered when dorsal reduction is required.

The chronic irradiated scalp wound remains one of the most difficult reconstructions for the plastic surgeon. With its inherent radiodermatitis and poor healing potential, chronic ulcers down to bone will result if coverage cannot be achieved. Reconstructive procedures as simple as a skin graft have a high complication rate in the irradiated wound and often fail. Local tissue transfer also has a high failure and complication rate because of the decreased vascularity of the wound bed and radiation damage to the surrounding scalp tissue, limiting its manipulation. The authors report two cases using a simple method with INTEGRA bilaminate skin substitute (Integra Life Sciences, Plainsboro, NJ) for repair of difficult wounds of the radiated scalp. Case one involves a patient with nonhealing radiation ulcers that had failed local wound care, hyperbaric oxygen, and split-thickness skin grafting. Case two involves a patient with extensive squamous cell cancer of the scalp that recurred despite total scalp radiation, requiring resection of more than 50% of the total surface area of the scalp. Both these patients were successfully treated using INTEGRA artificial skin substitute (Integra Life Sciences). This simple method using INTEGRA (Integra Life Sciences) resulted in complete healing of the radiated scalp wound and an acceptable, functional, and cosmetic outcome with minimal morbidity to the patients.

Coronary artery bypass grafting is a common surgical procedure for myocardial revascularization. This operation usually involves the use of the left internal mammary artery to bypass the left anterior descending coronary artery. The internal mammary artery and its perforators are also an important blood supply to the female breast, though not considered a critical blood supply. Due to an abundant blood supply from multiple sources, complications of the female breast are rare. We present a case report of a patient who developed necrosis of the entire medial left breast and superior abdominal wall following coronary artery bypass grafting which used the left internal mammary artery.

Suture anchors have been commercially developed to facilitate stable attachment of soft tissues to bone. Although their use is well characterized in orthopedic literature, suture anchors may also be of benefit in the reconstruction of large soft tissue defects by plastic surgeons. Suture anchors (Mitek Surgical Products, Inc., Westwood, MA) were used to fasten pedicled muscle flaps to exposed bone in 7 patients at Duke University undergoing reconstruction of large soft tissue defects. The suture anchor appeared to provide stability for the advancement flap, and there were no suspected postoperative muscle dehiscences or suture breakages. The suture anchor provides an easy, secure method to attach soft tissue to exposed bone, and preliminary experience appears to support their use in certain soft tissue reconstruction procedures by plastic surgeons. Suture anchors should be reserved for cases in which a large muscle flap is needed to cover exposed bone and poses a risk of shearing away from the bone, or adequate periosteum and soft tissue is not available for standard suture techniques.

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