Lhermitte-Duclos Disease is a rare clinical entity involving a dysplastic lesion of the cerebellum. The dysplastic cerebellar ganglioblastoma is often seen in association with Cowden Syndrome, an autosomal dominant disorder consisting of a mutation in the phosphatase and homologous tensin (PTEN) gene. Characteristic findings on neuroimaging allow for a pre-operative diagnosis to be made, which guides further management of the condition. This report describes the diagnosis and management of Lhermitte-Duclos Disease in a 51-year-old lady, spanning a period of almost seven years. The characteristic radiological and histological findings are presented, along with the clinical features associated with Cowden Syndrome. This patient ultimately underwent surgical intervention for symptomatic relief, which is described here.

Background: The use of PolyNovo NovoSorb biodegradable temporizing matrix (BTM) has become popular for the management of complex wounds, often with the subsequent application of a split-thickness skin graft. To date, there are no published case series describing healing via secondary intention over BTM in the management of small, complex nasal wounds following excision of skin malignancy in the elective setting. Methods: This study consisted of a single-center, consecutive case series. Inclusion criteria consisted of defects with exposed cartilage or bone in wounds located on the nasal dorsum or nasal sidewall resulting from the elective excision of nasal skin malignancies. BTM without skin grafting was used as a single-stage reconstruction in all patients following oncological clearance. After delamination, the wound was left to heal by secondary intention. The Patient and Observer Scar Assessment Scale was used to measure the aesthetic outcome. Results: All 32 cases exhibited 100% integration of BTM and successful wound closure. Two cases required further excision following review of the final histology. The median (SD) overall Patient and Observer Scar Assessment Scale score was 2.7 (±0.81), and the median overall observer score was 3.2 (±0.73). Conclusions: When planning nasal reconstruction following oncological resection, one should consider the patient’s comorbidities; their ability to tolerate the anesthetic, surgery, donor skin deficit, and risks; and the technical ability of the operating surgeon. We suggest that the use of BTM without harvesting a skin graft represents a simple, low-risk option for reconstruction of nasal defects that produces acceptable functional and aesthetic outcomes.

Intraoperative loss of surgical needles represents a rare but significant challenge in operative settings, particularly in microsurgical procedures involving free tissue transfer where fine sutures (8–0 to 10–0) are employed. Current hospital protocols typically use intraoperative portable radiography to localize misplaced needles. However, the diagnostic utility of X-ray imaging in detecting small-caliber needles remains poorly defined.