The regulation of protein synthesis is vital for a host of cell biological processes, but investigating roles for protein synthesis have been hindered by the inability to selectively interfere with it. To inhibit protein synthesis with spatial and temporal control, we have developed a photo-releasable anisomycin compound, N-([6-bromo-7-hydroxycoumarin-4-yl]methyloxycarbonyl)anisomycin (Bhc-Aniso), that can be removed through exposure to UV light. The area of protein synthesis inhibition can be restricted to a small light-exposed region or, potentially, the volume of two-photon excitation if a pulsed IR laser is the light source. We have tested the compound's effectiveness with an in vitro protein-translation system, CHO cells, HEK293 cells, and neurons. The photo-released anisomycin can inhibit protein synthesis in a spatially restricted manner, which will enable the specific inhibition of protein synthesis in subsets of cells with temporal and spatial precision.

Objective: To determine the utility of instillation negative pressure wound therapy (NPWT) in achieving eradication of infection and definitive wound closure in patients with infected left ventricular assist device (LVAD). Approach: A retrospective review was performed in a series of patients with infected and exposed LVADs who were treated with instillation NPWT in conjunction with surgical debridement. Results: Three consecutive patients were included who developed periprosthetic infection subsequent to LVAD implantation. In all cases, the utilization of a vacuum-assisted closure with instillation (VACi) along with surgical debridement and IV antibiotics eradicated infection resulting in successful retention of hardware. Cases 1 and 2 received definitive wound closure within 3 and 12 days of starting treatment, respectively. Case 3 initially deferred surgery in favor of local wound care. Eventually the patient elected for surgical treatment and underwent closure 164 days after initial presentation. All three patients healed completely without residual evidence of infection. Flap reconstruction with a pedicled rectus flap was used to achieve definitive closure in all patients. One patient subsequently required pump replacement secondary to thrombosis and mechanical pump failure. Innovation: LVAD infections are met with high morbidity and mortality rates, and timely salvage is critical. In this initial series, VACi has proven a viable therapy option to help control and eradicate infection without LVAD removal. Conclusion: This series illustrates the value of newer techniques such as VACi in combination with surgical debridement and antibiotic therapy in effectively salvaging LVADs that were infected.

Summary:Congenital symmastia is distressing and difficult to treat, and traditional surgical modalities have met with limited success. We present a novel approach for a patient that failed all traditional surgical options. The anatomic deformity is analyzed using a modified version of Blondeel’s 3-step analysis (conus, footprint, and skin envelope, to which we added a fourth element “intermammary web”). Combining operative principles from breast cancer reconstruction, we describe 5 operative steps that help correct the deformity, followed by a new postoperative splinting regimen that addresses the common pitfalls that could lead to recurrence.

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Summary: The patient is a 31-year-old woman with a history of prior resection of a presumed keloid scar around her Pfannenstiel incision found to be endometrial tissue on final pathology. She presented 5 years later with recurrence of pain and a mass associated with menses despite maximal medical therapy for endometriosis. Computed tomography of her abdomen and pelvis demonstrated an infiltrative soft tissue mass measuring 8.8 cm × 4.0 cm. Surgical oncology conducted an en bloc resection of the mass and obstetrics and gynecology performed a concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy. Plastic and reconstructive surgery completed the repair of the final 23 cm × 10 cm full-thickness abdominal wall defect with bridging biologic mesh, complex layered closure, and incisional negative-pressure wound therapy. Final pathology confirmed a diagnosis of endometriosis. Patient’s hospital course was uncomplicated, and follow-up at 6 months does not demonstrate clinical or radiographic evidence of bulge or hernia recurrence. Abdominal wall endometrioma is a well-documented occurrence in prior cesarean scars; plastic surgeons can contribute to a multidisciplinary approach in reconstruction when resection compromises abdominal wall integrity, necessitating expertise in complex repairs.