Accurate differentiation between epidural hematomas and lumbar disc extrusion is essential due to the potential overlap in clinical presentations. We present a case report highlighting a significant challenge in which a massive lumbar disc extrusion was mistaken for an epidural hematoma. This is a case report of a 38-year-old male patient who developed cauda equina syndrome four days after experiencing an audible cracking in the lower back during weightlifting activity. Magnetic resonance imaging (MRI) was inconclusive, unable to distinguish between an extruded nucleus pulposus and a spinal epidural hematoma. Subsequently, an urgent operation revealed a large herniated disc at the L4-L5 level, ruling out any hematoma. The patient's post-operative follow-up showed significant improvement, with almost complete recovery of motor and sensory functions. This case emphasizes the challenges faced when distinguishing between epidural hematomas and lumbar disc herniations, particularly on MRI. The lumbar disc herniation's substantial size, cranial and caudal migration on multiple levels, and signal intensity contributed to the misdiagnosis, underscoring the importance of careful interpretation and awareness of such complexities.

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving apocrine glands of the skin. It carries out an important burden on the daily life of the patient. Unfortunately, it presents a major concern for medical care management in the absence of clear guidelines for proper medical and surgical treatment. Hence, we report a case of concomitant axillary and perianal HS. We opted for surgical management using a novel technique, which proved efficacy for a year of follow-up recurrence free.

Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of reconstructive options required. Developments in microsurgery and microsurgical technique have brought free tissue transfer ever closer to the comfort zone of the reconstructive surgeon for reconstruction of paediatric traumatic complex wounds. We present our experience of microsurgical reconstruction in Lebanon for complex traumatic wounds in paediatric patients under the age of 10 years using the free anterolateral thigh (ALT) flap.The ALT flap has proven its value as a safe, adaptable, and aesthetically acceptable reconstructive option in paediatric complex trauma.anterolateral thigh flap, complex wound salvage, free tissue transfer, paediatric free tissue transfer, soft tissue reconstruction Key Messages• Paediatric complex wounds pose a challenge to the reconstructive surgeon due to the intricacy of reconstructive options required. • Developments in microsurgery and microsurgical technique have brought free tissue transfer ever closer to the comfort zone of the reconstructive surgeon for reconstruction of paediatric traumatic complex wounds. • In this paper, we present our experience of microsurgical reconstruction in Lebanon for complex traumatic wounds in paediatric patients under the age of 10 years old using the free anterolateral thigh (ALT) flap. • The ALT flap has proven its value as a safe, adaptable, and aesthetically acceptable reconstructive option in paediatric complex trauma.

Mucormycosis is a rare but aggressive and fatal infection that is prevalent in immunocompromised patients. The variation in its clinical presentation and the lack of specificity are misleading and lead to a delay in the diagnosis and management. However, the era of coronavirus disease 2019 (COVID-19) is marked by the increasing emergence of Mucor infections, now identified as coronavirus-associated mucormycosis (CAM). Although many clinical forms exist, the most encountered in CAM is rhino-orbito-cerebral, as already reported in India.We present a case of a 56-year-old male patient with uncontrolled diabetes mellitus and a history of recent SARS-CoV-2 infection treated with IV steroids, presenting for maxillary teeth pain and instability on day 16 of COVID-19 infection. Early diagnosis of CAM is crucial and will help decrease mortality in COVID-19 patients, especially those with comorbidities such as diabetes mellitus. Increasing cases of CAM should prompt clinicians to have a high index of suspicion for rhinocerebral mucormycosis, especially in patients with risk factors receiving steroid therapy.In such patients, baseline glycosylated hemoglobin level and strict glycemic control by frequently measuring blood glucose levels and strictly adhering to insulin protocols would be rational but its efficacy in limiting the numbers of CAM in developing countries still needs to be confirmed.