Reticulated livedoid skin patterns after soft-tissue filler–related vascular adverse events

Background: For the treatment of vascular adverse events caused by filler injections, duplex ultrasound imaging may be used. The findings of duplex ultrasound examination and the clinical features of reticulated livedoid skin patterns were compared with the hemifaces anatomy. Objective: The objective of this study was to link the reticulated livedoid skin patterns to the corresponding duplex ultrasound findings and the facial perforasomes. Methods: Duplex ultrasound imaging was used for the diagnosis and treatment of vascular adverse events. The clinical features and duplex ultrasound findings of 125 patients were investigated. Six cadaver hemifaces were examined to compare the typical livedo skin patterns with the vasculature of the face. Results: Clinically, the affected skin showed a similar reticulated pattern in each facial area corresponding with arterial anatomy and their perforators in the cadaver hemifaces. With duplex ultrasound, a disturbed microvascularization in the superficial fatty layer was visualized. After hyaluronidase injection, clinical improvement of the skin pattern was seen. Normalization of blood flow was noted accompanied by restoration of flow in the corresponding perforator artery. The skin patterns could be linked to the perforators of the superficial fat compartments. Conclusion: The livedo skin patterns seen in vascular adverse events may reflect the involvement of the perforators.</p

Reticulated livedoid skin patterns after soft-tissue filler–related vascular adverse events

Background: For the treatment of vascular adverse events caused by filler injections, duplex ultrasound imaging may be used. The findings of duplex ultrasound examination and the clinical features of reticulated livedoid skin patterns were compared with the hemifaces anatomy. Objective: The objective of this study was to link the reticulated livedoid skin patterns to the corresponding duplex ultrasound findings and the facial perforasomes. Methods: Duplex ultrasound imaging was used for the diagnosis and treatment of vascular adverse events. The clinical features and duplex ultrasound findings of 125 patients were investigated. Six cadaver hemifaces were examined to compare the typical livedo skin patterns with the vasculature of the face. Results: Clinically, the affected skin showed a similar reticulated pattern in each facial area corresponding with arterial anatomy and their perforators in the cadaver hemifaces. With duplex ultrasound, a disturbed microvascularization in the superficial fatty layer was visualized. After hyaluronidase injection, clinical improvement of the skin pattern was seen. Normalization of blood flow was noted accompanied by restoration of flow in the corresponding perforator artery. The skin patterns could be linked to the perforators of the superficial fat compartments. Conclusion: The livedo skin patterns seen in vascular adverse events may reflect the involvement of the perforators.</p

Functional and Aesthetic Outcome Enhancement of Head and Neck Reconstruction through Secondary Procedures

The foundation of head and neck reconstruction is based on two pillars: the restoration of function and the restoration of aesthetics. The objective of this article is to provide insight into how to prevent undesirable functional and aesthetic outcome after the initial procedure and also to provide solutions for enhancement of functional and aesthetic outcome with secondary procedures. Functional and aesthetic outcome enhancement is discussed in relation to the individual structures within the oral cavity, for the mandible, and for facial reconstruction. Normal prerequisites for all individual structures are described, and key points for restoration of these functional and aesthetic issues are proposed. In addition, further suggestions to improve suboptimal results after initial reconstructive surgery are presented. Understanding the function and aesthetics of the area to be reconstructed will allow appropriate planning and management of the initial reconstruction. Secondary enhancement should be attainable by minor procedures rather than a requirement to redo the initial reconstruction

Restoring wholeness: Women’s embodied experiences in considering post-mastectomy delayed breast reconstruction

This qualitative inquiry reports on the embodied experience of women with breast cancer considering post-mastectomy delayed breast reconstruction (DBR). In a pilot randomized controlled trial evaluating an educational workshop on decision-making about DBR, a purposeful sample of eight women participated in telephone semi-structured interviews. The concept of embodiment guided thematic analysis. The decision whether to undergo DBR involved four embodiment-related themes: living with an altered body, losing a sense of self, taking charge to reclaim the body and self, and rebuilding the body and self. Embodiment thus played a significant role in women’s decision-making. Other psychosocial factors, however, may compete with embodiment motivations. Healthcare providers can help support women to see breast reconstruction as a legitimate means to restore their body and sense of self