Background: Improvement in blood flow is essential for the treatment of chronic limb-threatening ischemia. Historically, low-density lipoprotein apheresis has been employed as a treatment for peripheral blood flow and dyslipidemia. The introduction of a novel kind of low-density lipoprotein apheresis in 2021 has provided a more accessible and repeatable treatment option. However, there have been very few reports of novel kind of low-density lipoprotein apheresis for chronic limb-threatening ischemia.
Methods: Nineteen patients (Rutherford grade 5, 10 cases; Rutherford grade 6, 9 cases) treated with novel kind of low-density lipoprotein apheresis were included in this study. Four weeks after the initiation of treatment, the condition of the wounds was assessed.
Results: The number of treatment sessions ranged from 2 to 22 (mean 9.8 ± 6.3). Eleven out of 19 cases (57.9%) were assessed as “good”, including 80.0% (8/10) of the Rutherford 5 cases and 33.3% (3/9) of the Rutherford 6 cases. Those cases assessed as poverty-poor included five cases of disease progression leading to major amputation (Rutherford 5, 1 case; Rutherford 6, 4 cases) and three cases of treatment interruption by patient request. Apart from significantly lowered blood pressure in 11 cases, bleeding was the only adverse event observed, being seen in 2 cases.
Conclusions: Given its simple implementation and therapeutic effectiveness, novel kind of low-density lipoprotein apheresis should be considered as a treatment option for chronic limb-threatening ischemia. Initiation of such treatment at the early stage of Rutherford stage 5 yielded positive results.
(A) At the time of hospitalization. (B) Before skin graft. (C) Four months after skin graft.

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We herein report successful cancellous bone grafting with minimally invasive surgery using a linked wire-type external fixator (Ichi-Fixator System). A 40-year-old woman presented with an open comminuted fracture of the middle phalanx of the right index finger. The patient had undergone multiple surgeries, including an iliac strut bone graft, by a previous physician; however, nonunion occurred at the index phalanx. We observed that the soft tissue distal to the non-union site was atrophic. This indicated that the tissue surrounding the nonunion site developed circulatory disturbances as a result of previous surgeries. We applied the Ichi-Fixator System as an external wound fixator and performed cancellous bone grafting at the nonunion site. The fixator pins of the Ichi-Fixator System fell off unexpectedly six weeks postoperatively. An extension splint on the palmar side of the index finger was used continuously to immobilize the finger for two months postoperatively. Osteogenesis progressed, and the area of nonunion was completely ossified six months postoperatively. The minimally invasive surgery in this case was considered to have led to good results. (a) At 12 days after surgery. (b) At one month after surgery. (c) At two months after surgery. (d) At six months after surgery.

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Once developed, traumatic neuromas cause persistent and intense pain and disrupt daily life. When the distal end of the nerve is available for surgical management of neuromas, nerve reconstruction is performed after excision. We herein report a case in which bridging of the nerve using a collagen nerve conduit filled with collagen filaments was employed for neuroma-in-continuity involvement in the finger. This intervention resulted in pain reduction. Bridging nerve defects after neuroma excision using a collagen nerve conduit facilitates axonal regeneration and prevents axon infiltration into the surrounding skin. Utilizing a collagen nerve conduit for nerve reconstruction is a crucial option in the surgical treatment of neuromas and has the potential to prevent neuroma recurrence. (a) A neuroma-in-continuity was identified in the digital nerve on the palm side. The figure shows the neuroma after being cut in the middle. (b) After the neuroma was excised, the nerve was bridged using Renerve® .

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A 47-year-old female presented with an intractable ulcer caused by external decompression during treatment of a massive stroke in the right middle cerebral artery. On the first admission to the previous hospital, a baseline platelet count of > 10 × 10⁵/μL and JAK2V617F mutation were observed, which revealed untreated essential thrombocythemia. The patient underwent cranioplasty with a free anterolateral thigh flap after external decompression for cerebral swelling, which was unsuccessful due to suspected thrombosis and infection. An intractable skin ulcer gradually formed and deteriorated in the right temporal region, leading to a referral to our department for further surgical treatment. We performed a free latissimus dorsi flap after cytoreduction therapy with hydroxyurea to reduce platelet counts below 4.0 × 10⁵/μL, while closely monitoring side effects under hematologist supervision. The flap was engrafted without any postoperative complications. Thus, the involvement of a hematologist and preoperative management with cytoreduction therapy should be considered in essential thrombocythemia patients undergoing reconstructive surgery. (a) Debridement of the ulcer. Grafted skin and ulcer were debrided. (b) Harvested latissimus dorsi flap. The sliding-shaped latissimus dorsi flap was designed and harvested. (c) Grafted free latissimus dorsi flap. The flap was grafted to the defect elliptically on the left temporal region. (d) Engrafted free latissimus dorsi flap. No postoperative complications have been observed.

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The long-term use of surgical masks to combat coronavirus disease 2019 may irritate the skin. A 67-year-old man developed a laceration on the auricle due to prolonged wearing of a mask. The patient had poor self-management skills and was required to wear masks. The torn auricular cartilage was surgically repaired. At four months post-operation, the auricular morphology had improved, and the scar was no longer visible. Continuous wearing of surgical masks can increase the risk of lacerations on the auricle, which can be sutured and healed within a short period. The proper use of regular breaks from masks is recommended. A medical device-related pressure ulcer of the auricle associated with surgical mask use is likely to occur in the left auricle of men with psychiatric disorders. (a, b) Left auricle: auricular cartilage is torn. (c) Right auricle: fistula in the triangular fossa.

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