Misdiagnosed epidermoid cyst appears Potts Puffy Tumor: A case report and literature review.

INTRODUCTION: Although nowadays rare, Potts Puffy Tumor (PPT) is a rare but serious diagnosis characterized by osteomyelitis of the frontal bone. The introduction of broad-spectrum antibiotics made PPT an uncommon diagnosis in modern medicine, and it is mostly seen as a complication of frontal sinusitis in children and adolescents. CASE PRESENTATION: We report a case of PPT in an elderly man with a sudden and increasing swelling of the forehead, which was initially diagnosed as an epidermoid cyst. Subsequent surgical exploration revealed osteomyelitis of the underlying frontal bone. Medical imaging by computed tomography (CT) and magnetic resonance imaging (MRI) was done, and treatment with Functional Endoscopic Sinus Surgery (FESS) and reconstructive surgery of the frontal bone was conducted. DISCUSSION: PPT is a rare, yet serious condition which is usually seen as a complication of chronic sinusitis which causes osteomyelitis and a subperiosteal abscess. Despite the atypical presentation of symptoms, the reported case underlines the importance of rapid deployment of medical imaging, referral, and administration of broad-spectrum antibiotics. Furthermore, surgical intervention is indicated in most cases. When left untreated, PPT can result in severe intracranial complications. CONCLUSION: The diagnosis PTT is still relevant and may have a nonspecific presentation. A persisting epidermoid cyst after drainage should lead to the suspicion of a PTT. Immediate imaging and adequate treatment are required to prevent serious, potentially lethal intracranial complications.

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study.

PURPOSE: No previous study reported the use of a fasciocutaneous anterolateral thigh (ALT) flap combined with a biological mesh for abdominal wall reconstruction (AWR) after enterocutaneous fistula (ECF) in a single-staged procedure and the use of Indocyanine Green Angiography (ICGA) intraoperatively. The purpose of this study was to determine the feasibility and safety of this procedure and to examine the added value of ICGA in minimizing postoperative complications. METHODS: A single-institution review of a prospectively maintained database was conducted at Maastricht University Medical Center. To evaluate the feasibility and safety of this procedure, early (≤ 30 days) and late (> 30 days) postoperative complications were assessed. ECF recurrence was considered the primary outcome. To examine the added value of ICGA, complications in the ICGA group and the non-ICGA group were compared descriptively. RESULTS: Ten consecutive patients, with a mean age of 66.7 years, underwent a single-staged AWR with fasciocutaneous ALT flaps. Mean follow-up was 17.4 months (4.3-28.2). Two early ECF recurrences were observed. Both restored without the need for reoperation. A lower rate of early complications was observed in the ICGA group compared to the non-ICGA group. CONCLUSION: The combination of a biological mesh and fasciocutaneous ALT flap is feasible and safe in AWR after ECF repair in a single-staged approach, with an acceptable complication rate in a cohort of complex patients operated in a dedicated center. ECF closure was achieved in all patients. ICGA seems to be of great added value in minimizing postoperative complications during AWR.

Breast sensibility after mastectomy and implant-based breast reconstruction.

PURPOSE: The aim of the study is to evaluate the level of sensible impairment after mastectomy or implant-based breast reconstruction (IBBR). In addition, factors influencing breast sensibility were evaluated. METHODS: A cross-sectional study was performed in Maastricht University Medical Center between July 2016 and August 2018. Women with unilateral mastectomy with or without IBBR were included. Objective sensory measurements were performed using Semmes-Weinstein monofilaments. Their healthy breast served as control, using a paired t test. Differences between mastectomy with and without IBBR were evaluated using the independent t test. Linear regression was performed to evaluate the association between patient characteristics on breast sensibility. The paired t test was used to evaluate in which part of the breast the sensibility is best preserved. RESULTS: Fifty-one patients were eligible for inclusion. Sixteen patients underwent IBBR after mastectomy. Twenty-three patients received radiotherapy and 35 patients received chemotherapy. Monofilament values were significantly higher in the operated group compared to the reference group (p < 0.001). Linear regression showed a statistically significant association between IBBR and objectively measured impaired sensation (p = 0.008). After mastectomy, the cutaneous protective sensation is only diminished. After IBBR, it is lost in the majority of the breast. The medial part of the breast was significantly more sensitive than the lateral part in all operated breasts (p < 0.001). CONCLUSION: IBBR has a significantly negative impact on the breast sensibility compared to mastectomy alone. This study shows that the protective sensation of the skin in the breast is lost after IBBR. To our knowledge, this is the first study to evaluate the level of sensible impairment after mastectomy or IBBR. More research is necessary to confirm these results.