The Interplay Between Lymphatic Vessels and Chemokines.

Chemokines are a family of small protein cytokines that act as chemoattractants to migrating cells, in particular those of the immune system. They are categorized functionally as either homeostatic, constitutively produced by tissues for basal levels of cell migration, or inflammatory, where they are generated in association with a pathological inflammatory response. While the extravasation of leukocytes via blood vessels is a key step in cells entering the tissues, the lymphatic vessels also serve as a conduit for cells that are recruited and localized through chemoattractant gradients. Furthermore, the growth and remodeling of lymphatic vessels in pathologies is influenced by chemokines and their receptors expressed by lymphatic endothelial cells (LECs) in and around the pathological tissue. In this review we summarize the diverse role played by specific chemokines and their receptors in shaping the interaction of lymphatic vessels, immune cells, and other pathological cell types in physiology and disease.

Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy.

BACKGROUND: Partial tibial nerve transfer to the motor branches of tibialis anterior is an emerging reconstructive technique for the treatment of traumatic common peroneal nerve (CPN) injury; however, few papers in the literature describe clinical outcomes. METHODS: A prospective single-surgeon series of nine consecutive patients who underwent partial tibial nerve transfers to the motor branches of tibialis anterior for traumatic CPN injuries between 2008 and 2014. Eight patients were male and the average age at operation was 28.2 years old (range 21-39). All nine patients experienced high-energy CPN injuries. The average time to operation was 5.8 months (range 1-10) and all patients scored M0 for ankle dorsiflexion preoperatively according to the Medical Research Council (MRC) grading system. Outcome parameters included time since operation, postoperative MRC grade for ankle dorsiflexion, and the use of an orthosis for walking. RESULTS: Seven of nine patients achieved an MRC grade of ≥M4, allowing for active dorsiflexion against gravity and some resistance, by a mean of 16.7 months postoperatively (range 8-26) and no longer required an orthosis for walking. No complications were recorded during the procedures, nor were any compromises to the tibial nerve donor site during follow-up. No patients were lost to follow-up with an average follow-up period of 30.8 months (range 15-61). CONCLUSIONS: This series provides good evidence that this evolving reconstructive technique may achieve excellent results and should be considered in traumatic common peroneal nerve injuries that would traditionally rely on conventional nerve grafting alone.

Skin cancers of the hand: a series of 541 malignancies.

BACKGROUND: Skin cancers of the hand are uncommon and poorly documented. The objective of this study was to review a large cohort of patients with hand skin malignancies to determine tumor characteristics, management techniques, and outcomes. METHODS: A retrospective review of consecutive patients with surgically excised primary cutaneous hand malignancies at the John Radcliffe Hospital between 1993 and 2010 was performed. Records were reviewed to determine tumor characteristics, demographics, and management details. Outcome parameters included margins and completeness of excision, recurrence, metastatic spread, and survival. RESULTS: A total of 407 patients (65.8 percent male; mean age, 72.2 ± 0.7 yr) presented with 541 primary cutaneous hand malignancies and were followed up for a mean period of 24 months. Half the cohort had previous skin cancers and almost one in five developed further hand skin cancers. Squamous cell carcinoma comprised 78.0 percent, basal cell carcinoma 11.3 percent, and melanoma 3.9 percent of cases. Incidence was highest on the dorsum of the hand. Surgical margins were proportionate to tumor size, and most defects required soft-tissue reconstruction. Recurrence was uncommon in melanoma and rare in squamous and basal cell carcinomas. Lymph node metastasis and death were rare in patients with squamous cell carcinoma but relatively common in those with melanoma. CONCLUSIONS: Squamous cell carcinomas are the most common skin malignancy of the hand, frequently require soft-tissue reconstruction, and those occurring in the web spaces or on the dorsum of the proximal phalanges are more sinister malignancies with a greater propensity for metastatic spread. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.