Cristina Aubá

Large full-thickness chest wall reconstruction requires an alloplastic material to ensure chest wall stability, as well as a flap that provides good soft-tissue coverage. The choice not to use perforator flaps over any mesh or inert material is often based on the concern that the vascularization would be inadequate. However, perforator flaps have shown good results in several reconstructive fields, minimizing donor-site morbidity and offering versatility when local tissues are unavailable or affected by radiotherapy. In this study, we present 4 cases of patients with full-thickness chest wall defects that were repaired with a double Marlex mesh, acrylic cement (n = 2) or a double patch of Goretex (n = 2) in combination with perforator flaps (3 deep inferior epigastric artery perforators and 1 lumbar artery perforator flap). The results we obtained are encouraging, and we believe the use of perforator flaps in combination with alloplastic materials should be considered as a reliable option for full-thickness chest wall defect reconstruction.

CD137/TNFR9/41BB was originally described as a surface molecule present on activated T and NK cells. However, its expression is broader among leukocytes, and it is also detected on hypoxic endothelial cells and inflamed blood vessels, as well as in atherosclerotic lesions. Here, we demonstrate that lymphatic endothelial cells (LECs) up‐regulate CD137 expression from undetectable baseline levels on stimulation with TNF‐α, LPS, and IL‐1β. CD137 cross‐linking with an agonistic mAb results in NF‐κB nuclear translocation, followed by up‐regulation of VCAM and a 3‐fold increase in the production of the chemokine CCL21. Accordingly, there is a 50% increase in CCR7‐dependent migration toward conditioned medium from activated LECs on CD137 cross‐linking with the agonistic mAb or the natural ligand (CD137L). Such an enhancement of cell migration is also observed with monocyte‐derived dendritic cells transmigrating across CD137‐activated LEC monolayers. Using explanted human dermal tissue, we found that inflamed skin contains abundant CD137 ⁺ lymphatic vessels and that ex vivo incubation of explanted human dermis with TNF‐α induces CD137 expression in lymphatic capillaries. More interestingly, treatment with CD137 agonistic antibody induces CCL21 expression and DC accumulation close to lymphatic vessels. Collectively, our results demonstrate that the inflammatory function of lymphatic vessels can be regulated by CD137.—Teijeira, A., Palazón, A., Garasa, S., Marré, D., Aubá, C., Rogel, A., Murillo, O., Martínez‐Forero, I., Lang, F., Melero, I., Rouzaut, A. CD137 on inflamed lymphatic endothelial cells enhances CCL21‐guided migration of dendritic cells. FASEB J. 26, 3380–3392 (2012). www.fasebj.org

The purpose of this work was to report our initial experience with lymphaticovenular anastomoses (LVA), a controversial technique for lymphedema treatment. Although LVA technique was described many years ago, the procedure is not as widespread as it was supposed to be, taking into account the high impact that lymphedema has in the quality of life of patients. Thus, 12 patients, 5 with lower limb and 7 with upper limb lymphedema, underwent LVA surgery under local anesthesia. Two patients were excluded from the study due to the lack of follow‐up. At 18 months, 8 out 10 patients showed a variable objective reduction of the perimeter of the limbs and 9 patients presented a subjective clinical improvement. These results joined to the outcomes of the most experienced surgeons in this field are encouraging, although there are still many issues that need to be addressed with research to optimize the efficacy of this technique. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Free transplant of gracilis muscle is the criterion-standard technique in dynamic rehabilitation of long-standing facial paralysis in which the facial musculature is atrophied. When the facial nerve is not available because of a bilateral lesion, other sources are the masseteric, hypoglossal, or accessory nerves. Although the use of hypoglossal nerve has been relegated to the background because of the morbidity caused by its loss, there are special situations in which the hypoglossal nerve should be considered the first option as donor motor nerve. The present article discusses the case of a patient with dynamic reanimation of bilateral facial paralysis with free-muscle transfer neurotized to the hypoglossal nerve. End-to-side coaptation of gracilis motor nerve and hypoglossal motor nerve allows neurotization of the transplanted muscle with minimum repercussion in speech or swallowing and can provide an adequate spontaneous smile with time.

OBJECTIVE. To determine whether or not administration of brain-derived neurotrophic factor (BDNF) with osmotic pumps at the site of the proximal stump o