Many surgical procedures, such as skin grafts, local flaps, z-plasties, regional flaps, free flaps and perforator flaps, can be used for anterior neck scar contracture reconstruction. Moreover, there are now numerous choices available, such as flap prefabrication, preexpansion and super-thin flaps. However, it is still difficult to make algorithms of treatments of anterior neck scar contracture reconstruction. Thus, we reviewed existing papers and discussed current problems and future perspectives for this field.
It can be considered that short linear contractures can be released using single z-plasty or a small local flap. However, long linear contractures that extend to the next unit should be reconstructed using multiple z-plasties, local flaps or skin grafting. With respect to skin grafting, FTSG should be selected to prevent re-contracture. Broadband contracture should be released completely and reconstructed using FTSG or thin flaps. If the platysma is missing, thin flaps should be used instead of skin grafting. Broadband contracture extending to the next unit should be reconstructed using a sheet of large and thin flaps, such as perforator supercharged super-thin flaps. It can be concluded that we should study the advantages and disadvantages of each type of flap using strict evaluations.

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Acute wound-related pain (WRP) has a protective role. It alerts the body to damage and promotes rest to allow tissue regeneration. However, chronic WRP such as hyperalgesia and allodynia reduces patients' quality of life and negatively affects wound healing. Healthcare professionals have to understand the physiology of pain and recognize the differences between acute and chronic WRP.
Although patients' most important concern is the relief of pain, WRP is often underestimated and considered to be a lower priority than other wound healing issues. “Principles of best practice Minimizing pain at dressing-related procedures: Implementation of pain relieving strategies” was published in 2007 in preparation for the World Union of Wound Healing Societies' Congress 2008. It presents ten consensus statements involving strategies for minimizing pain during dressing-related procedures. Through each statement, this article describes how WRP can be reduced by employing a combination of accurate assessment, suitable dressing choices, skilled wound management, and pharmacological / non-pharmacological approaches.

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Infants and children can suffer problems such as pressure sores and wounds following medical treatment. We report 1805 cases at the National Center for Child Health and Development in Japan from 2003 to 2007. The number of wounds that resulted from medical treatment was 4 times greater than the number of pressure sores. The pressure sores mostly occur on the heads of younger children, and in the sacral region in older children. Wounds due to medical treatment include extravasation injuries and skin damage from adhesive tapes.

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We investigated outcomes of early reconstruction for open fracture of upper and lower extremities. From January 2000 through December 2007, we performed early reconstruction for open fractures to upper and lower extremities using 24 free flaps including 14 cases with anterolateral fasciocutaneous flap, 6 cases with latissimus dorsi myocutaneous flap, and 4 cases with rectus abdominis myocutaneous flap. Even though complications occurred, including congestion in 2 cases and partial necrosis in 1 case, all flaps survived. Deep infection occurred in 2 cases: 1 case was stable with only debridement, and the other case was a Gustilo type IIIC open tibial fracture with the application of a rectus abdominis myocutaneous flap. An infection subsequently occurred at the calcaneus and eventually required a below-knee amputation. Early reconstruction for open fracture using a well-vascularized free flap reduces the complication of postoperative osteomyelitis and necessity for amputation. Therefore, it is important for plastic surgeons to recognize the need for reconstruction of complex soft tissue defects and treat them in cases of severe open fractures of the upper and lower extremities immediately after injury.

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In the case of severe wounds on the extremities requiring closure of skin defects as an emergency procedure, we do not transfer emergency free flaps. In these cases, we cover the skin defect with a temporary flap or wet dressings, and more recently we use artificial dermis before reconstruction with a free flap. Since the wound is covered with artificial dermis, and it is not necessary to suture the skin defect with excessive tension, skin ischemia due to excessive tension does not occur. If debridement of the wound is insufficient and tissue necrosis becomes more extensive, further debridement of the necrotic tissue was performed at the time of secondary reconstruction. After artificial dermis was applied to exposed bone and tendon, dermis-like granulation tissue formed, and these tissues were salvaged from necrotic change due to desiccation. The advantage of this method is that we utilized many reconstructive methods in the interval between injury and reconstruction. The disadvantage is the wound may be susceptible to infection. To prevent infection, we made drainage holes in the artificial dermis.

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Recently omental flaps have widely been used in clinical practice. A few experimental studies, however, have examined the effect of omental flaps in wound healing. We examined its effect using a gastric wall defect model. We created an omental flap lining a 2.0-mm defect perforating a rat stomach and created a silicon sheet lining as a control. We examined the tissue response during gastric wall regeneration on postoperative days. Immunohistochemical study was also performed using proliferating cell nuclear antigen (PCNA) and fibroblast growth factor-2 (FGF-2). In the omental group, granulation tissue proliferated by day 3 and stratified villi completely covered the defect by day 7. In the control group, little granulation tissue was observed and the defect had not yet been covered by day 10. In the control group, some PCNA- and FGF-2-positive cells were observed on the edges of the epithelium. In the omental group, many PCNA- and FGF-2-positive cells were observed in the granulation tissue near wound edges and in the center of the omental granulation as well as the edges of the epithelium.
This study confirmed that the omental flap accelerated gastric wall wound healing by cell proliferation.

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