Retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) is a rare but potentially fatal complication. We report a case of very late-onset RTAD occurring 9 years after hybrid aortic arch repair. An 81-year-old man with a history of TEVAR with cervical debranching for subacute thrombosed RTAD, which later developed an ulcer-like projection, presented with dizziness and back pain. Acute RTAD with cardiac tamponade was diagnosed, and emergent ascending aortic replacement with resection of the entry tear-located at the proximal edge of the stent on the lesser curvature-was performed. Postoperatively, the patient required prolonged ventilatory support for respiratory failure and developed pyothorax secondary to aspiration pneumonia. He was ultimately discharged home on postoperative day 188 after rehabilitation. This case underscores the importance of a distinct pathophysiology in late RTAD, in which progressive aortic wall degeneration and biomechanical fatigue over time-rather than procedural factors-may contribute to dissection. Continuous imaging surveillance and strict cardiovascular risk factor management are essential, even in the absence of early complications.

Peripherally inserted central catheters (PICCs) were introduced as an alternative to centrally inserted central catheters (CICCs) inserted into the jugular vein to provide central venous access. In head and neck reconstructive surgery, PICCs are preferred over CICCs because they do not obstruct surgical access, such as during neck dissection. Additionally, PICCs offer a safer option than peripheral access for the infusion of vesicants, irritants, hyperosmolar solutions, antibiotics, prolonged parenteral nutrition, and chemotherapy agents. We present a case of perforation of the internal jugular vein caused by PICC migration in the early postoperative days following neck dissection and free flap reconstruction. During surgical exploration, a large cervical hematoma was evacuated. Bleeding was traced to multiple lacerations of the internal jugular vein, the largest measuring 15 mm. The venous anastomosis of the radial forearm free flap was intact. The internal jugular vein was temporarily clamped, repaired with sutures, and the PICC was removed intraoperatively. Despite the lacerations being caudal to the anastomosis, the free flap was preserved, and the patient was discharged without further complications. An increase in thoracic pressure, such as that resulting from a forceful cough or vomiting, can lead to the displacement of PICC lines. In patients who have undergone neck dissection, episodes of vomiting or severe coughing should be carefully monitored for the risk of PICC tip migration. This migration could cause simultaneous laceration of the vessel wall, leading to potentially life-threatening hematomas. Monitoring the tip position of PICCs in this type of patient could be performed at the bedside at least weekly during scheduled dressing changes and/or sutureless system changes. In this way, secondary malpositions of the tip could be identified early and potentially life-threatening complications such as those in this report could be avoided.

An 81-year-old woman underwent total hip arthroplasty for a femoral neck fracture. Five days after surgery, she fell and sustained a periprosthetic fracture, for which she subsequently underwent revision surgery. Her postoperative course was uneventful; however, 4 years after surgery, she noticed redness and warmth over her left hip several days after receiving acupuncture. Purulent discharge subsequently developed, prompting her to visit our hospital. Imaging studies revealed abscess formation and osteolysis around the left hip, leading to a diagnosis of periprosthetic infection. After conservative treatments failed, surgical debridement and continuous local antibiotic perfusion therapy were performed. Her condition improved, and she was discharged home, ambulatory with a cane. Although serum inflammatory markers remained mildly elevated, suggesting a low-grade infection, there has been no recurrence of purulent discharge, and she has returned to her usual daily activities. Periprosthetic infection is a highly challenging complication, often resulting in the removal of implants and leading to a significantly diminished quality of life. Although acupuncture is generally regarded as safe, this case illustrates that deep infection can occur in patients with prosthetic joints. While a complete cure was not achieved in this case, the use of CLAP therapy contributed to clinical improvement and functional recovery, highlighting its potential role as an adjunctive treatment strategy. Given the potential risks of infection, physicians should inform patients with artificial joints about the potential infectious risks of acupuncture.

Injury to the marginal mandibular nerve (MMN) as an isolated complication of posterior cervical spine surgery performed in the prone position is exceedingly rare, with only a handful of documented instances in indexed surgical literature. We present the case of a 60-year-old gentleman who developed unilateral lower facial deviation immediately following a seven-hour posterior cervical decompression and multilevel instrumented stabilization procedure. The deficit was confined entirely to the distribution of the MMN, with no involvement of other facial nerve branches or adjacent peripheral nerves. The clinical findings were most consistent with positional MMN neuropraxia, and the patient was managed conservatively with physiotherapy and ENT guidance, with early evidence of recovery before discharge. This report aims to draw the attention of spine surgeons to a complication that is probably underrecognized and underreported and to underline the anatomical and technical considerations that can reduce its occurrence.