Lymphedema is the clinical manifestation of impaired lymphatic transport. It remains an under-recognized and under-documented clinical condition that still lacks a cure. Despite the substantial advances in the understanding of lymphatic vessel biology and function in the past two decades, there are still unsolved questions regarding the pathophysiology of lymphedema, especially in humans. As a consequence of impaired lymphatic drainage, proteins and lipids accumulate in the interstitial space, causing the regional tissue to undergo extensive and progressive architectural changes, including adipose tissue deposition and fibrosis. These changes are also associated with inflammation. However, the temporal sequence of these events, the relationship between these events, and their interplay during the progression are not clearly understood. Here, we review our current knowledge on the pathophysiology of lymphedema derived from human and animal studies. We also discuss the possible cellular and molecular mechanisms involved in adipose tissue and collagen accumulation during lymphedema. We suggest that more studies should be dedicated to enhancing our understanding of the human pathophysiology of lymphedema to pave the way for new diagnostic and therapeutic avenues for this condition.

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Purpose. To describe a variant of intertrochanteric fracture not well-characterised in the existing classification systems. Methods. 10 women and 2 men aged 59 to 98 (median, 80) years with intertrochanteric fractures characterised by a low intertrochanteric fracture, a basicervical fracture fragment, and a thin or fractured lateral wall with greater trochanteric comminution were reviewed. Results. The 12 fractures were classified as A2.1 (n=1), A2.2 (n=7), A2.3 (n=1), and A3 (n=3) according to the AO/OTA classification, and as type 3 (n=2), type 5 (n=7), and type 6 (n=3) according to the Evans classification. The fractures were characterised by greater trochanter comminution and a coronal plane fracture extending into the greater trochanter resulting in a loss of superolateral support.

Our meta-analysis is the first reported study and serves as an indication that free perforator flaps in lower extremity are as reliable as their traditional nonperforator counterparts. This does come with the prerequisite appreciation of the anatomical variations, the delicate handling of these flaps, and a low threshold for reexploration.

PCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit.