Skin leg ulcers with Achilles tendon exposure are refractory to conventional treatments. These ulcers are caused by conditions such as diabetes, venous insufficiency, arterial sclerosis, and collagen disease. We encountered two cases of refractory skin leg ulcers with Achilles tendon exposure. These patients have venous insufficiency and take a long time to cure at other hospitals. We used an artificial dermis, namely Pelnac-Gplus^®, combined with a basic fibroblast growth factor (bFGF) formulation to treat these ulcers following negative pressure wound therapy for a month. A good result was obtained two weeks after the skin graft was performed. One year postoperatively, the lesion was followed a good course, and the ulcers did not recur.

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Distal mucous cysts (DMCs) occur in the distal interphalangeal finger joints or the interphalangeal thumb joints. Current treatment regimens include surgical cyst excision, which may involve skin flap elevation. More recent approaches include osteophytectomy or joint capsule removal (with or without cyst excision). In the present case series, the authors excised five DMCs with thinned skin, conducted osteophytectomy when necessary, and then covered the wounds with the Integra^® Dermal Regeneration Template-Single Layer (IDRT-SL) system. There were no postoperative complications, including limitation or deterioration in the joints' range of motion, and recurrence was not detected. The cosmetic outcomes were excellent. This may reflect the ability of IDRT-SL to facilitate untrammeled epithelialization and reduce myofibroblast activity, thereby limiting wound contracture. While IDRT-SL is relatively costly, it is considered cost-effective due to the length of the procedure (15 min), low recurrence rates, fast healing, and favorable appearance. Therefore, simple excision and coverage with IDRT-SL may be a beneficial treatment option for DMCs.

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In cases of infectious thoracic aortic aneurysm in which the omentum is unavailable, the aortic graft can be wrapped with a latissimus dorsi muscle (LDM) flap. However, it is difficult to use a simple LDM flap to wrap the proximal descending thoracic aorta owing to its curved and linear form. Here we describe a case in which splitting the LDM flap into two separate hemiflaps with two vascular branches achieved full-circumference wrapping closure with the curved portion enveloped by the horizontal hemiflap and the straight portion enveloped by the vertical hemiflap. The infection was well controlled, and no anastomotic failure occurred during 18 months of follow-up. Our findings suggest that split LDM flaps may be a good alternative for covering the proximal descending thoracic aorta when the omentum is unavailable.

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Pelvic organ prolapse (POP) has a high risk of recurrence and poses challenges for surgeons in terms of reconstruction.
A 77-year-old woman was admitted to the plastic and reconstructive surgery unit at our hospital. She complained of a mass on the external genitalia that caused pain and effusion. Axial computed tomography (CT) showed a prolapse lesion from the pubic bone to the outside of vagina, which did not affect the pelvic organs. During examination, the patient was found to have ascites due to liver cirrhosis.
Based on clinical and imaging findings, the patient was diagnosed with POP due to increased abdominal pressure from ascites, which was difficult to manage due to the patient undergoing maintenance dialysis. The remaining peritoneal defect was closed and fascia collected from the left thigh was transplanted to close the pelvic floor. A gluteal fold flap was created to fill the defect. One year after the operation, no recurrence was observed, and CT images showed no ascites in the genital area.
These findings suggest that fascia lata transplantation and reconstruction via the gluteal fold flap can effectively counter the increase in intra-abdominal pressure caused by ascites.

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Intrathecal drug delivery systems are widely used to treat intractable cancer and chronic pain. However, they are rarely used in cases that require pain control in the acute phase, such as Fournier's gangrene. Here, we report a case, in collaboration with our pain management department, in which an intrathecal drug delivery system was effective in controlling pain in an individual with a skin defect caused by Fournier's gangrene. A 71-year-old man with diabetes and alcoholic cirrhosis presented with fever in our emergency department and was diagnosed with a urinary tract infection. However, the subsequent development of Fournier's gangrene due to infection with preexisting hidradenitis suppurativa necessitated pain management. This was successfully achieved by injecting bupivacaine following the placement of an intrathecal drug delivery system via a port on the lateral chest wall. The resulting pain relief permitted adequate debridement, wound care, and skin grafting. The patient was rehabilitated and discharged on the 89^th day of hospitalization with an independent gait. The favorable outcome of this case demonstrates that intrathecal drug delivery systems may be instrumental in providing pain relief, even in the acute phase, and facilitating enhanced patient care.

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Desmoid tumors are relatively rare, locally invasive mesenchymal tumors classified as benign or malignant. Patients with desmoid tumors in the abdominal wall that progress during active surveillance may be considered for surgical resection with adequate margins to prevent recurrence. Following radical resection of abdominal wall desmoids, the resulting defect leads to abdominal wall closure difficulties or increased risk of herniation. Herein, we report a case of a desmoid tumor within the rectus abdominis muscle that was treated radically by resection and subsequent reconstruction of the abdominal wall with a synthetic mesh.

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