Edemas of the face and lymphoscintigraphic examination.

Facial edemas not secondary to surgery and/or radiotherapy for head and neck cancer are relatively uncommon. Our aim is to report a retrospective analysis of the lymphoscintigraphic and SPECT-CT investigations obtained in patients with such facial edema. Retrospective review of exams (planar imagings in all and with SPECT-CT in 5) obtained after the subcutaneous injection of 99mTc HSA Nanosized colloids between the eyebrows in five men and seven women. Four main lymphatic pathways were identified on sequential planar imagings: para-nasal left and right and supra- ocular left and right. For eleven patients, the absence of visualization of lymphatic drainage and/or their delayed appearance correlated well with the localisation of the edematous areas. In two patients with post-traumatic and post- surgical edemas, SPECT-CT showed one deep left sided cervical lymph node (LN) in front of the first cervical vertebra. This lymphoscintigraphic approach represents a simple and valuable way to assess the lymphatic drainage pathways of the face and to establish the diagnosis of facial lymphedema.

[Algorithm for surgical treatment of limb lymphedema]. / Traitement chirurgical du lymphœdème des membres : algorithme de prise en charge.

Whether primary or secondary, limb lymphedema is a relatively common disease whose impact on the quality of life of patients is important. Although the microsurgical reconstruction techniques seem to be the techniques of choice in the treatment of limb lymphedema, no consensus about treatment of limb lymphedema has yet been defined. Considering the advantages and disadvantages of surgical techniques and their impact on the quality of life of patients, we propose a surgical treatment algorithm of limb lymphedema.

Massive Hemi-facial Edema After Permanent Filler Removal in an HIV-Positive Patient. Precautions and Patient Information.

UNLABELLED: HIV-related lipodystrophy and facial lipo-atrophy are well-described problems stigmatizing many HIV patients. As these patients often require large volumes of filler material, a more permanent solution is necessary. Before the popularization of lipofilling, synthetic permanent fillers have mostly been used. We describe a case report of a patient who had undergone removal of a permanent filler, polyacrylamide gel, because of dislocation of the filler, but who presented a massive hemi-facial edema immediately after the removal. Swelling subsided after 5 days. The use of permanent fillers has diminished due to frequent early and late complications, but a high awareness for permanent filler removal complications remains necessary. Possible pathways to explain these late complications are described. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Artery only microanastomosis in nose replantation: a report of two cases.

The nose is a central, prominent unit of the face. The surgical approach to complete nasal amputations is challenging and an experienced microsurgical team should always attempt microvascular replantation. This one-stage procedure could result in a superior clinical outcome compared to delayed reconstructive procedures. Two successful microvascular replantations of the distal half of the nose were performed. Both amputations were the result of two completely different aetiologies (sharp guillotine-like vs. avulsion trauma). However, we were not able to re-establish the venous drainage, which was managed through medicinal leeching. Both replantations resulted in an aesthetically pleasing result and no additional surgery was needed. A microsurgical replantation attempt should always be attempted in nasal amputations and the inability to perform venous anastomosis should not preclude the replant attempt.