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Riot S.,Toulouse University Hospital Center | Riot S.,Lapeyronie University Hospital | Riot S.,Edouard Herriot University Hospital | Riot S.,University of Rennes 1 | And 46 more authors.
Plastic and Reconstructive Surgery | Year: 2015

Venous problems are the most frequent causes of flap failure and surgical revision in free flap surgery. Double venous anastomosis can be used to improve flap drainage, but this procedure has not been adopted universally and remains controversial. The authors evaluated the benefits of double venous anastomosis in terms of venous thrombosis rate, surgical revision of flaps, and flap failure rate. Methods: A systematic literature review was conducted searching the MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and July of 2014. Data analysis consisted of evaluating the pooled relative risks of single and double venous anastomoses in fixed and random-effects models. Results: The final analysis included 27 articles involving 6842 flaps. The overall success rate was 97.48 percent. Single venous anastomosis was performed in 4591 flaps versus two anastomoses in 2251 flaps. The failure rate was 3.1 percent for single anastomosis versus 1.3 percent for double anastomosis (OR, 0.511; 95 percent CI, 0.349 to 0.747; p = 0.001). The respective thrombosis rates were 3.1 percent versus 2.3 percent (OR, 0.586; 95 percent CI, 0.390 to 0.880; p = 0.010). In addition, more single venous anastomoses were revised: 7.7 percent versus 6 percent (OR, 0.601; 95 percent CI, 0.469 to 0.770; p < 0.0001). Stratified analysis by flap type did not show any significant differences. Conclusions: Although the physiologic mechanisms remain poorly understood, the data strongly support double venous anastomosis, considering the reduction in flap failure, microsurgical venous thrombosis, and surgical revision. The authors recommend double anastomosis whenever it is feasible in free flap surgery. © 2015 by the American Society of Plastic Surgeons.

Missaoui N.,French Institute of Health and Medical Research | Missaoui N.,Research Unit 03 UR 08 13 | Missaoui N.,Farhat Hached University Hospital | Hmissa S.,Research Unit 03 UR 08 13 | And 4 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2010

Introduction: Persistent human papillomavirus (HPV) infection is the primary causal agent in the development of the uterine cervix carcinoma. Nevertheless, only a minority of high-risk HPV-associated lesions progress to cervical cancer, suggesting involvement of other molecular alterations. Among putative changes, aberrant methylation might be a crucial event. Design: Paraffin-embedded samples of benign lesions, cervical intraepithelial neoplasia (CIN) and invasive squamous cell carcinomas (SCC) were analyzed for DNA 5-methylcytosine content by immunohistochemistry with anti-5-methylcytosine antibodies and by high-performance liquid capillary electrophoresis (HPCE). Results: No significant difference of DNA 5-methylcytosine content was observed between normal tissues, benign lesions, low-grade lesions and high-grade lesions (p=0.6). In contrast, DNAs extracted from invasive SCC were hypomethylated when compared with normal and preneoplastic lesions (p=0.0004). An association between global DNA hypomethylation and the SCC stage was confirmed by HPCE. Conclusions: The transition from CIN lesions to invasive carcinoma seems to be closely linked to global DNA hypomethylation, which could be a useful marker of invasive uterine cervical lesions.

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