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.

Nerve transfer of the anterior interosseous nerve to the thenar branch of the median nerve - an anatomical and histological analysis.

OBJECTIVE: Nerve transfer has become a vital method in the reconstruction of hand function. Reconstructing the motor function to the thenar musculature has proven to be difficult and is rarely satisfactory following direct anatomic repair. The aim of this investigation was to describe the anatomic results obtained by transferring the anterior interosseous nerve to the thenar branch of the median nerve and analyze the histomorphometric results. MATERIAL AND METHODS: Nerve transfers were performed in 15 fresh anatomic specimens. Nerve samples were excised from 13 fresh specimens and histologically investigated. The nerve diameter, fascicle number, and cross-sectional area of the individual fascicles were measured. RESULTS: The results of this investigation revealed that the anterior interosseous nerve and the thenar branch of the median nerve could be identified at their expected locations and a tension-free coaptation could be achieved. The anterior interosseous branch had a mean number of 606 ± 254 axons vs. 2160 ± 1326 in the thenar branch (p < 0.001). The anterior interosseous branch had a mean density of axons per fascicle mm2 of 2398 ± 829 vs. 3012 ± 740 in the thenar branch (p = 0.390). The ratio of axons between the thenar branch of the median nerve and the anterior interosseous nerve yielded a mean of 1:4.16. CONCLUSION: Nerve transfer of the anterior interosseous nerve to the thenar branch of the median nerve should be considered as a viable option but remains a subject of investigation owing to its critical axon ratio. Furthermore, larger clinical studies will be required to validate or neglect this nerve transfer.