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Negative-pressure wound therapy (NPWT) has become a widely used and well-described treatment for acute and chronic wounds. The authors discuss advantages of XL-NPWT for large burns, infection prevention, promoting re-epithelialization, and fluid management. The techniques are described such as the “total body wrap” or “sandwich” technique, in which affected areas are sandwiched between large polyurethane dressings and silver-impregnated nonadherent foam that is applied to both recipient and donor sites, as well as over any intervening intact skin or burn wound. Although relatively new, XL-NPWT has proven to be safe and effective in treating burns ≥15% TBSA.

The technique of three-dimensional (3D) nipple-areola complex (NAC) tattooing is a significant advance in obtaining improved esthetic results for women undergoing breast reconstruction. The application of 3D techniques or “realism” in tattoo artistry has significant potential to improve the esthetic outcomes of reconstructive surgery. Traditional coloring techniques for NAC tattooing ignore the artistic principles of light and shadow to create depth on a two-dimensional surface. The method presented in this article is essentially the inverse of traditional technique and results in a more realistic and 3D reconstruction that can appear better than surgical methods. When combined with surgical nipple reconstruction in appropriate patients, excellent results can be achieved. Overall, plastic surgeons have just begun to explore the possible applications of medical tattoos in plastic surgery that may allow us to enhance the esthetic results of not only breast reconstruction but other areas alike.