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Osteomyelitis of the sternoclavicular joint is a rare yet challenging problem. It is commonly treated by resection and a muscle flap. We report a case that was treated with single-stage resection of both the sternoclavicular joint and part of the sternum followed by implantation of calcium sulfate beads impregnated with antibiotics and primary closure without a muscle flap. A single-stage debridement with resection for osteomyelitis of the sternoclavicular joint and primary closure with calcium sulfate beads impregnated with antibiotics may be an option when dealing with this difficult clinical problem.

Background . Standard cannulation of the femoral artery in preparation for repair of a dissection involving the ascending aorta carries a high risk of malperfusion. Arterial perfusion through the right axillary artery is more likely to perfuse the true lumen and should be advantageous in acute dissections involving the ascending aorta. Methods . Thirteen patients underwent repair of acute ascending aortic dissections and were perfused through the right axillary artery. All had deep hypothermic circulatory arrest. Results . There was one mild intraoperative cerebrovascular accident with complete recovery and one operative death secondary to low cardiac output. There were no intraoperative problems with perfusion through the axillary artery, and there were no postoperative problems or complications involving the axillary artery, axillary vein, or brachial plexus. Conclusions . Arterial perfusion through the right axillary artery is a safe and effective means of more reliably perfusing the true lumen. In this regard, it may be superior to femoral artery perfusion and could lead to improved outcomes with repair of acute deBakey type I and II aortic dissections.

Esophageal reconstruction has been achieved with a variety of innovative surgical techniques, including colonic interposition, gastric pull-up, pedicled, and free jejunal grafts. The authors describe an unusual case of complete thoracic esophageal reconstruction, necessitating an entirely free microvascular colon interposition as a salvage procedure to reconstitute the alimentary tract from the neck to the abdomen. To their knowledge, this specific method of reconstruction of the esophagus has not been previously reported.