足部あるいは趾部外傷，または，疼痛などを主訴に受診した患者のＸ線画像検査において，主訴とは別の部位の第５趾遠位趾節間関節に骨性癒合をみることが多い。さらに，時に第５趾と第４趾，または第３，４，５趾の遠位趾節間関節にも骨性癒合をみる症例を経験する。これらの症例は，骨性癒合の趾に明らかな外傷などの既往はなく，さらに，生下時よりそれらの趾の形態，機能異常を自覚していない。われわれは2015年ころより，このような遠位趾節間関節の骨性癒合を観察していた。われわれの施設で，2020年10月１日より2021年９月31日までの１年間に足部Ｘ線撮影を行い，第１趾から第５趾のすべての趾の趾節間関節を確認できる撮影画像を対象症例として，趾の遠位趾節間関節癒合について検索した。
 わが国での足多趾症は外側（軸後性，腓骨側）がほとんどであることは周知である。形成外科領域では多指（趾）症手術の術式を決定する際は，指（趾）節骨の形態，形成，関節運動，手術創痕などを考慮して行われている。機能的，形態的異常はなく，趾の外傷歴もない遠位趾節間関節癒合の存在を考慮した場合に，足多趾症の術式の決定には発育抑制の少ない選択が望まれる。

 序論：脂肪由来幹細胞（ASCs）を付加した脂肪移植を複数回行う乳房再建術（Step-CAL）は，多量の脂肪が必要となるため適応範囲は狭かった。本研究では，培養自家ASCsを用いたStep-CALによる乳房再建の安全性と有効性を検討した。
 方法：乳房切除術後の５名の被験者を対象に単群非盲検試験を実施した。ティッシュ・エキスパンダー挿入後，４～６ヵ月の間隔で培養自家ASCsによるCALを３回実施し，最終治療の６ヵ月後に最終観察を行った。安全性の評価のため治療中のすべての有害事象を記録した。再建乳房の体積を3D画像分析によって測定し，体積復元率と整容性を評価した。
 結果：５名の患者すべてにおいて，治療期間を通して臨床検査の異常および治療に起因する有害事象はなかった。再建乳房の形状は全体的に良好であり，治療に必要な脂肪量を大幅に削減し，手術時間を短縮することができた。
 考察と結論：培養自家ASCsを使用したStep-CALは安全で有用な乳房再建術であると考えられる。

 Chronic expanding hematoma (CEH) is a rare complication that persists and enlarges for more than 1 month after surgery or trauma. It can occur anywhere in the body and is occasionally misdiagnosed as neoplasm. It may result from the irritant effects of blood and its breakdown products, leading to repeated bleeding from fragile capillaries. As treatment for CEH has yet to be established, surgical excision or aspiration has commonly been performed, with a high recurrence rate. In recent years, triamcinolone acetonide injection has been reported as a better alternative treatment. We report a case of CEH following cesarean section that was successfully treated with the local injection of triamcinolone acetonide. For CEH after cesarean section, treatment with triamcinolone acetonide injections is considered to be superior regarding several points, so we report it with a review of the literature.

 Sternal clefts (SC) are rare congenital malformations that result from failure of sternal bar infusion. When the cleft is complete, it is often associated with ectopia cordis and requires early correction due to its abnormal respiratory and circulatory dynamics. It also needs correction to protect the mediastinal organ and from an esthetic viewpoint. In infants, the sternum is pliable and easy to repair directly, but it becomes rigid as they grow. Therefore, selecting an appropriate method for correction in each case is important. We herein report two cases of SC that underwent correction with different surgical methods.

 We report the case of an intraneural lipoma of the right wrist joint arising from the median nerve involving a 45-year-old man. Histopathological analysis after excision demonstrated that the tumor was located within the epineurium of the median nerve, and a diagnosis of intraneural lipoma was made. There are only 31 reported cases of intraneural lipoma arising from the median nerve in the literature, showing that the condition is rare. Patients should be informed before surgery that neuropathy is a possible complication, and detailed assessments of neurological symptoms both before and after surgery should be made. Removal of the lipoma under a microscope is advised, and carpal tunnel release is considered acceptable to prevent carpal tunnel syndrome after surgery.

 Acute infectious purpura fulminans (AIPF) is the most severe complication of septic shock, associated with disseminated intravascular coagulation by infection, rapidly progressing to ischemic changes in the extremities. We report a case of AIPF involving a living renal transplant patient with perioperative diabetic foot ulcer. The patient was a 68-year-old woman taking methylprednisolone and cyclosporin post-renal transplantation. She had a right foot ulcer which failed to resolve even after multiple operations, and so she eventually underwent a below-knee amputation. On the eighth postoperative day, she suddenly developed septic shock due to emphysematous pyelonephritis of the transplanted kidney, as well as ischemic necrosis of the extremities. She survived with her transplanted kidney preserved, but required further limb amputations.

 The periosteal ganglion, first described by Tillmanns in 1895, is a mucous-filled cystic lesion arising from the periosteum. The ganglion is a common cystic lesion arising from periarticular soft tissues and tendon sheaths, but rarely from the periosteum. Periosteal ganglions are believed to be caused by degeneration of the mucous of the periosteum.
 In the present study, we observed a case of metatarsal periosteal ganglion with a fracture, and concluded that it was caused by mass compression. However, a history of trauma may induce mucous degeneration of the periosteum, and it is possible that the fracture occurred first and was followed by periosteal ganglion development. In this report, we discuss the relationship between a periosteal ganglion and fracture by comparing our observations with those of previous reports.