Vascularized lymph node transfer with submental free flap.

Limb lymphoedema is common in patients who have undergone inguinal or axillary lymph node dissection. Lymphoedema seriously impacts the patient's quality of life by inducing adipogenesis, fibrosis and repeated episodes of lymphangitis and cellulitis. Following failure of compression therapies, several curative or symptomatic surgical options have been proposed over recent decades, such as liposuction or lymphovenous anastomosis. Vascularized lymph node transfer techniques have recently been described, with promising results. Vascularized lymph node transfer with submental free flap appears to be the most reliable of these technique, associated with the lowest morbidity. The flap harvesting technique presents several specific differences compared to conventional submental free flap. A good knowledge of neck anatomy is essential and multimodal and multidisciplinary management is often required. In the light of a case report, we describe the basic submental free flap technique for vascularized lymph node transfer for the treatment of lower limb lymphoedema. This technique may be used by head and neck surgeons performing flap harvest, as well as plastic surgeon surgeons or gynaecologists ensuring long-term management of these patients.

Violent responses to strain: an examination of conditioning influences.

Past research on General Strain Theory (GST) has not widely examined the application of the theory for understanding violent responses to strain. Additionally, the theory suggests there may be varying effects of strain on possible deviant outcomes across individuals differentiated on their dispositions toward deviance. In the current analysis, we examine violent responses to strain using original data collected from a sample of college-aged youth. Moreover, we specifically examine whether the effects of strain and anger on possible violent outcomes are invariant across individuals differentiated on their level of exposure to deviant peers and moral constraints against deviance. Using structural equation modeling, our results suggest that a composite measure of strain increases respondents' intentions to engage in assaultive behavior net of other predictors. Additionally, the results reveal that anger mediates the impact of strain on possible violent responses. Finally, the results of our subgroup analyses suggest that the basic form of the GST model is invariant across groups.