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Branchial cleft sinuses are congenital anomalies that usually present in childhood or early adulthood. It is uncommon that such a sinus will remain asymptomatic to the sixth decade of life. This case describes the presence of a second branchial cleft sinus in the setting of carotid artery disease, where both were treated surgically simultaneously without complication. [ABSTRACT FROM PUBLISHER]

The transverse rectus abdominis musculocutaneous (TRAM) flap is a commonly used method for autologous tissue postmastectomy breast reconstruction. It is a major operative procedure, and some have argued that it needlessly exposes patients to increased risk of complications and blood transfusions. In this series the authors review their experience with 105 consecutive complex postmastectomy breast reconstructions, limited to double-pedicle flaps, identifying complications rates and blood transfusion requirements. Blood transfusions were required in 2.8% of patients undergoing bipedicle or bilateral TRAM flap breast reconstruction. Blood transfusions were only required in patients who experienced a complication. Obesity was associated with an increased rate of complications and blood transfusion. Routine typing and cross-matching of blood and self-donation of blood may not be required for TRAM flap breast reconstruction in low-risk patients.