SLNDAR seems to be a feasible procedure in locally recurrent breast cancer and can spare a clinically significant number of patients an unnecessary ALND and the following risk of sequelae. In patients who had previous ALND, SLNDAR identified metastases that would have been overlooked following the current guidelines. A large proportion of patients had aberrant drainage, suggesting a need for lymphoscintigraphy.

This paper describes a novel approach to the treatment of otherwise refractory seromas by applying vacuum-assisted closure (VAC) to the seroma cavity. Foam is inserted in the cavity thru an incision in the skin, and the VAC is applied with a continuous suction, which presumably makes the open lymph vessels collapse. When the lymphatic output declines, the size of the sponges and hereby the size of the cavity is reduced successively. We present a 74-year-old man with a malignant melanoma suffering from seroma in the axilla after an axillary lymph node dissection. The lymph production decreased after 2 days resulting in closing of the cavity and cure of the seroma. Level of Evidence: Level V, therapeutic study

Summary:An 8-year-old boy had the caudal part of his nose bitten off by a dog. Nasal reconstruction with a forehead flap was performed initially with success, and 9 years later, the reconstructed nose was found to have grown equally in size with the underlining tissue, resulting in a continuous satisfactory cosmetic result.

Background The usage of dermal fillers has increased significantly in recent years. Soft tissue augmentation with fillers helps to diminish the facial lines and to restore volume and fullness in the face at a relatively low cost. With the increasing number of treatments, the number of complications is likely to increase as well. Methods A total of 37 patients with complications were collected retrospectively during a period of 13 years using original data files. Information on the type, date, number and location of the injections, type and date of complications, treatment, bacteria, and pathology were registered. Results The most commonly injected material in this series was Polyacrylamide (35.1 %) and Hyaluronic Acid (18.9 %). Most of the patients had filler injected in the lips (54.1 %), periorally (40.5 %), and in the cheek area (29.7 %). The median period between filler injection and complications was 2 years (range 1 day-8 years). The most common reported complications were edema (81 %), noduli (67.7 %), infections (54.1 %), discoloration (51.4 %), and granuloma formation (48.6 %). Surgical removal of the filler material was attempted in four patients. ConclusionsWith the increased use of dermal fillers and the derived complications, there is a need to determine the optimal treatment for those patients, as a wrong treatment strategy can lead to scarring. This study suggests general recommendations for the referral and treatment of patients with more severe complications associated with dermal filler injection. Level of Evidence: Level IV, therapeutic study.