We have frequently encountered patients with critical limb ischemia demonstrating severely intractable ulcers and gangrene. Such wounds cannot necessarily be healed by standard procedures including skin grafting and flap transfer since adequate blood supply to the grafts cannot be anticipated. In this review, we present our therapeutic strategies for the treatment of ischemic wounds particularly those using regenerative medical approaches. We have performed therapeutic angiogenesis by either autologous bone marrow cells implantation or controlled release of basic fibroblast growth factors using hydrogel injection into ischemic limbs that had no other options for improving the blood supply. In addition to angiogenesis, wound bed preparation was also carried out with the same cells or growth factors in conjunction with collagen sponge matrices. The results of our clinical trial showed that most of the intractable ulcers were healed by wound contraction, spontaneous epithelialization or subsequent skin grafting. These findings suggest that such therapeutic approaches might be considered to contribute to the patients' ambulation and quality of life. Since the incidence of such disorders might increase in the future, this therapeutic approach should play an important role in the preservation of ischemic limbs with severe ulcers.

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Despite the widespread use of silicone gel sheet for the treatment of hypertrophic scars and keloids, its mechanism of action and effective usage remain undetermined. Here, previous papers are reviewed and clinical application and action mechanisms of silicone gel sheets are discussed.
Based on our analysis, tensile reduction and protection from external mechanical forces are important mechanisms of silicone gel sheeting. Moreover, it was found that the materials of gel sheets should not be limited to silicone. Ideal gel sheets should (1) keep adequate moisture on the skin, (2) protect against external mechanical forces and attach to the skin tightly but not cause contact dermatitis, and (3) have similar thickness and softness to skin (thick and soft or thin and hard).

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In the treatment of secondary deformities of anophthalmic orbits after severe trauma, free flap transfer is adopted for patients with eyelid and / or orbital rim defects. For some, however, free flap transfer is a requisite although no such defects are present. Here, we retrospectively review cases for which free flap transfer was carried out for secondary deformities of post-traumatic anophthalmic orbits without eyelid / orbital bone defects. From 1999 to 2008, seven patients with secondary deformities of post-traumatic anophthalmic orbits without eyelid or orbital bone defects were treated at Kobe University Hospital. Of the seven, three were treated with free flap transfers: two with a free forearm flap because of the inability to wear an eye prosthesis subsequent to the sudden onset of severe contracture of the eye socket, and one with a denuded DIEP flap for upper eyelid depression attributed to severe lack of and contracture of subcutaneous tissue. Even when the eyelid and the orbital bone are not injured, progressive contraction of the eye socket and severe lack of subcutaneous tissue are indications for free flap transfer in the treatment of secondary deformities of post-traumatic anophthalmic orbits.

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Background: We present the usefulness of MDCT in the planning of “Propeller flaps”.
Methods: We retrospectively analyzed all cases in which perforator CT angiography (P-CTA) by MDCT was performed before reconstruction using propeller flaps. The examined parameters were: the diagnosis, area that needed reconstruction, pedicled perforator, type of pedicle, size and shape of the flap, donor site, flap survival area, the sensitivity and specificity with which the perforators were identified by MDCT and the surgical duration.
Results: In total, eleven patients underwent reconstruction with thirteen propeller flaps. The reconstructed sites ranged widely: the chest, axilla, vulva, buttocks, and lower legs. The pedicles were subcutaneous pedicles in three patients (five flaps) and complete perforators in eight patients (eight flaps). Nine flaps were oval flaps, three were bi-lobed, and one was quadri-lobed. The minimum and maximum flap sizes were 6.5×2 and 27×8 cm, respectively, and the donor site was closed primarily in all but two cases. All flaps except one survived completely. The pedicled perforators identified by MDCT preoperatively were located accurately without any errors during the harvesting procedure. Furthermore, in all cases except one, surgery was completed on or before the scheduled time.
Conclusions: As a preoperative perforator assessment tool, MDCT is superior to other methods in that comprehensive imaging can be achieved in a short time, it is highly accurate, and it provides high-resolution images. In addition, the actual surgical duration in our series was 21% less than that without MDCT. Thus, MDCT is a highly effective tool for the preoperative study of propeller flaps that makes it possible to harvest these flaps safely.

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Since there are no medical departments or physicians who specialize in the foot as an organ in Japan, it is necessary to establish guidelines for the treatment of foot disease so that nonspecialized physicians can provide treatment after fully understanding its process. We have been promoting regional alliances to provide strategic remedies and treatment of the lower extremities in patients with foot lesions in our region. For patients with diabetic foot lesions who consult Saga University Hospital and other related hospitals, treatment using a common therapeutic algorithm has been performed. We investigated 221 patients with diabetic foot lesion who received treatment between January 2006 and December 2008.The cure rate for the overall patient group was 62%, and 89% of patients underwent revascularization. The treatment of diabetic foot lesion could be standardized using a common therapeutic algorithm.

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