Using the autospreader flap in primary rhinoplasty.

Background: When performing dorsal reduction in primary rhinoplasty, one must pay close attention to the height of the upper lateral cartilages. They are in part responsible for the dorsal aesthetic lines and often require a lower profile.

Methods: The technique the authors describe uses the transverse portion of the upper lateral cartilages rotated medially to function as a local spreader flap while reducing the profile of the dorsum and preserving the aesthetic lines.

Use of suture anchors in the reconstruction of soft tissue defects with pedicled muscle flaps.

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.

Breast necrosis following use of the internal mammary artery for coronary artery bypass.

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.

Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis.

Objective: Poststernotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery that continues to have a significant morbidity and mortality despite aggressive therapy. Vacuum-assisted closure uses controlled suction to provide evacuation of wound fluid, decrease bacterial colonization, stimulate granulation tissue, and reduce the need for dressing changes.

Methods: One hundred two patients from Duke University Hospital, The Durham Veterans Administration Hospital, and referring institutions underwent vacuum-assisted closure treatment.

Simple approach to the radiated scalp wound using INTEGRA skin substitute.

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.