An Unusual Case of Thigh Swelling.

Lymphangiomas are benign tumours, almost exclusively found in children. Primary work-up includes imaging. We report a case of lymphangioma in the leg in an adult patient, initially masked as a myxoma. Our patient underwent ultrasound, computerised tomography, and magnetic resonance imaging, which were suggestive of myxoma. Treatment for lymphangioma varies from sclerotherapy to definitive surgical management. In our case, surgical management was selected under consideration of myxoma; however, histopathology confirmed lymphangioma. Lymphangiomas in adult patients can be masked by other conditions and should be considered as a differential in lower leg swellings.

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP.

AIM: The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. METHODS: The review was based on current national and international guidelines and a literature search. RESULTS: Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. DISCUSSION: The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.