Several authors have reported the usefulness and benefits of lymphoscintigraphy. However, it is insufficient to indicate microvascular treatment based on lymphedema. Here, we present the relationships between lymphoscintigraphic types and indications for lymphatic microsurgery. Preoperative lymphoscintigraphy was performed in 142 limbs with secondary lymphedema of the lower extremity. The images obtained were classified into five types. Type I: Visible inguinal lymph nodes, lymphatics along the saphenous vein and/or collateral lymphatics. Type II: Dermal backflow in the thigh and stasis of an isotopic material in the lymphatics. Type III: Dermal backflow in the thigh and leg. Type IV: Dermal backflow in the leg. Type V: Radiolabeled colloid remaining in the foot. Lymphaticovenous anastomosis was performed in 35 limbs. The average number of anastomoses per limb was 3.3 in type II, 4.4 in type III, 3.6 in type IV, and 3 in type V. The highest number of anastomosis was performed in type III. In conclusion, type III is suggested to be the best indication for anastomosis compared with types IV and V.

Despite the great demands for treating craniofacial injuries or abnormalities, effective treatments are currently lacking. One promising approach involves human elastic cartilage reconstruction using autologous stem/progenitor populations. Nevertheless, definitive evidence of the presence of stem cells in human auricular cartilage remains to be established. Here, we demonstrate that human auricular perichondrium, which can be obtained via a minimally invasive approach, harbors a unique cell population, termed as cartilage stem/progenitor cells (CSPCs). The clonogenic progeny of a single CD44 + CD90 + CSPC displays a number of features characteristic of stem cells. Highly chondrogenic CSPCs were shown to reconstruct large (>2 cm) elastic cartilage after extended expansion and differentiation. CSPC-derived cartilage was encapsulated by a perichondrium layer, which contains a CD44 + CD90 + self-renewing stem/progenitor population and was maintained without calcification or tumor formation even after 10 mo. This is a unique report demonstrating the presence of stem cells in auricular cartilage. Utilization of CSPCs will provide a promising reconstructive material for treating craniofacial defects with successful long-term tissue restoration.

CRR of the HA was considered efficacious in selected patients; however, long-term outcomes of the VR-A group seem unsatisfactory. Treatments additional to surgery may be necessary in cases requiring CRR of the HA.

Therapeutic, IV.