Mandible reconstruction is one of the major challenges that face any maxillofacial surgeon worldwide. Different approaches and methods are used for mandible reconstruction, including pedicle flaps, titanium reconstruction plates, and bone grafts. A free fibular flap is used commonly and is considered the gold standard in mandibular reconstruction with a good success rate. Advantages of the free fibula flap include the long pedicle, flexible skin island, good length of dense cortical bone, consistent bone shape, minimal donor site morbidity, superior union rate, anti-collapse effectiveness, segmental blood supply, the potential for two skin paddles, and ease of harvest with a flap survival rate up to 95%. This current review aims to illustrate the approach for mandibular reconstruction using a vascularized free fibula flap.

Post-vaccination immune thrombocytopenia (ITP) is a rare but recognized adverse event believed to result from an autoimmune reaction triggered by the vaccine. This case report presents the fourth documented instance of severe ITP requiring splenectomy following the administration of a COVID-19 vaccine. The patient, a 54-year-old previously healthy female with no familial history of autoimmune or hematological disorders, developed ITP two weeks after the first dose of the COVID-19 vaccine. While most ITP cases associated with COVID-19 vaccines manifested after the second dose, this unique case demonstrated symptoms following the initial vaccination. Initially responsive to first-line management, the patient experienced a relapse upon receiving the second dose from a different vaccine manufacturer. Despite exhaustive medical interventions, the refractory nature of the condition persisted, ultimately mandating splenectomy for the achievement of complete remission. This case underscores the potential for serious, refractory ITP with the second dose of a COVID-19 vaccine, particularly in patients who initially developed ITP after the first dose, even if they had seemingly achieved complete remission. These findings emphasize the importance of vigilant monitoring and individualized treatment strategies in such cases, contributing valuable insights to the growing body of knowledge surrounding vaccine-induced ITP.

Mammary myofibroblastoma is a rare benign tumor. It is mainly seen in older men and postmenopausal women. These tumors can be presented with a palpable mass or can be discovered incidentally on routine screening. A 76-year-old male presented with a palpable breast mass that was increasing in size. The patient underwent wide local excision with no postoperative complications. The pathology finding was consistent with myofibroblastoma. Myofibroblastoma is a rare tumor and should be considered one of the differential diagnoses in breast lumps.

Gastric volvulus is a fatal complication that rarely occurs after Nissen fundoplication with organoaxial volvulus being the most common type. We present a case of a 36-year-old male with a surgical history of Nissen fundoplication with hiatal repair three years prior to presentation. He presented with shortness of breath, abdominal pain, and obstipation. CT scan showed no passage of the oral contrast towards the stomach. The stomach is seen completely herniated into the chest suggesting rotation along its long axis worrisome for organoaxial volvulus. Intraoperative findings were a strangulated stomach through the diaphragmatic defect and migration of the entire stomach into the chest, at which division of the diaphragm and retrieval of the stomach after extensive adhesiolysis were successfully performed. The stomach was reduced back to the abdomen but was completely black and gangrenous; thus, total gastrectomy and Roux-en-Y gastric bypass were done, and the hiatus hernia was repaired with chest tube placement. Acute gastric volvulus after laparoscopic fundoplication is a surgical emergency that presents diagnostic challenges. It should be considered in the differential diagnosis of patients experiencing recurrent vomiting following fundoplication.

Aortoenteric fistula (AEF) is an abnormal connection between the aorta and the adjacent gastrointestinal (GI) tract and is often misdiagnosed in clinical practice. We present the case of a 65-year-old male, who presented with upper GI bleeding and melena. The patient underwent upper and lower GI examinations with no conclusive findings. A computed tomography scan of the abdomen was suggestive of an AEF. The patient experienced a sudden episode of hematemesis with hemorrhagic shock in the ward, leading to an emergent surgery for bleeding control and repair of the aortic aneurysm and AEF with straight aortic interposition graft and primary repair of the duodenum along with debridement for whitish mycotic debris. A tissue culture from the aortic aneurysm during surgery revealed Aspergillus species infection. AEF is a life-threatening condition with high morbidity and mortality rates, often making it difficult to diagnose. Early surgical intervention is crucial to prevent a fatal outcome. Although rare, fungal infection should be considered in a primary AEF.

Amyand's hernia is the presence of the vermiform appendix within the inguinal hernia sac, while a sliding hernia involves the herniation of a retroperitoneal organ outside the abdominal cavity. The hernia sac can contain various intraabdominal organs, including the small bowel, cecum, appendix, omentum, or ovary and fallopian tube. A hernial sac containing the appendix on the left side is rare, and the presence of other organs in combination is also uncommon. We are presenting a case of a 45-year-old male who presented with irreducible left inguinal swelling and obstructing symptoms. Interestingly, a large left indirect hernia sac was seen intraoperatively containing incarcerated cecum, terminal ileum, appendix, and sliding sigmoid colon. Left-sided incarcerated terminal ileum, cecum, appendix, and sliding hernia can be challenging because the symptoms are often nonspecific. However, surgery is often the only way to definitively diagnose these types of hernia.