Background Secondary lymphedema, caused by oncologic surgery, radiation, and chemotherapy, is one of the most relevant, nononcological complications affecting cancer survivors. Severe functional deficits can result in impairing quality of life and a societal burden related to increased treatment costs. Often, conservative treatments are not sufficient to alleviate lymphedema or to prevent stage progression of the disease, as they do not address the underlying etiology that is the disruption of lymphatic pathways. In recent years, lymphatic surgery approaches were revolutionized by advances in microsurgical technique. Currently, lymphedema can effectively be treated by procedures such as lymphovenous anastomosis (LVA) and lymph node transfer (LNT). However, not all patients have suitable lymphatic vessels, and lymph node harvesting is associated with risks. In addition, some data have revealed nonresponders to the microsurgical techniques. Methods A literature review was performed to evaluate the value of lymphatic tissue engineering for plastic surgeons and to give an overview of the achievements, challenges, and goals of the field. Results While certain challenges exist, including cell harvesting, nutrient supply, biocompatibility, and hydrostatic properties, it is possible and desirable to engineer lymph nodes and lymphatic vessels. The path toward clinical translation is considered more complex for LNTs secondary to the complex microarchitecture and pending final mechanistic clarification, while LVA is more straight forward. Conclusion Lymphatic tissue engineering has the potential to be the next step for microsurgical treatment of secondary lymphedema. Current and future researches are necessary to optimize this clinical paradigm shift for improved surgical treatment of lymphedema.

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Introduction Severe burns are devastating injuries affecting multiple organ systems. Little is known about the influence on the hepatic system and its physiology. This systematic review aimed to assess the current state of research on morphologic liver damage following severe burns. Methods A search was conducted in Pubmed, Web of Science and Cochrane databases using PRISMA guidelines. Outcomes included serum levels of transaminases, fatty infiltration and necrosis. Weighted individual study estimates were used to calculate pooled transaminase levels and necrosis/fatty infiltration rates using a random-effects approach. Risk ratios (RRs) or Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors. Results The literature search retrieved 2548 hits, of which 59 studies were included into qualitative synthesis, and finally ten studies were included into meta-analysis. Studies were divided into those reporting autopsies and those reporting changes of serum transaminase levels. The majority of liver autopsies showed fatty infiltration 82% (95% CI39%-97%) or necrosis of the liver 18% (95% CI13%-24%). Discussion Heterogeneity in studies on hepatic functional damage following severe burns was high. Only few were well-designed and published in recent years. Many studies could not be included because of insufficient numerical data. There is a high number of patients deceasing from burns that present with fatty infiltration or necrosis of hepatic tissue. Transaminases were elevated during the first days after burn. Further research on how severe burns affect the hepatic function and outcome, especially long-term, is necessary.

Sixty patients (30 men, 30 women, mean age 45.5 [18-71] years) with various forms of spasmodic torticollis were treated with local injections of botulinus A toxin. The results of treatment were assessed on an arbitrary scale (0-4) by the patients, by an examiner and by a neurologist who studied video recordings without knowing at what stage they had been recorded. After the first course of injections (a maximum of three injections of 10-40 ng in four weeks) 50 patients (83%) reported a better than 50% improvement; the mean score on the four point scale fell from 3.6 to 1.85 (P less than 0.001). The severity of the disorder as judged from the video recordings fell from a mean of 3.23 to 1.71 (P less than 0.001). The effect lasted for an average of 14 weeks. 6 patients developed mild dysphagia, in two further cases severe dysphagia occurred which lasted for up to four weeks. Twenty patients were followed up for more than one year: in nine of them the interval between courses of injections, the dose being unaltered, remained the same (12-14 weeks), but thereafter the abnormal movements returned with the same severity as before treatment. In eight patients the intervals between courses grew longer and the abnormal movements became less severe. Two patients have been symptom free for 20 and 13 months respectively, but one female patient failed to respond owing to the presence of antibodies against botulinus A toxin. The results indicate that local injection of botulinus toxin is a successful treatment for spasmodic torticollis.