Introduction: Reconstructive surgery for sacral and ischial pressure ulcers carries a high risk of surgical site infection (SSI) owing to contamination from the perineum. In this study, patients underwent a staged reconstruction, which involved flap reconstruction after debridement and wound bed preparation. The aim of this study was to identify risk factors for SSI in patients who underwent perforator-based transposition flap reconstruction for sacral and ischial pressure ulcers.
 Method: Eighty-three flaps in the study cohort were assessed for patient age and sex, flap size, operative time, bacterial species in the wound, and other potential SSI risk factors.
 Result: In the group affected by SSI, larger flap size (p = 0.04; odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.00-1.06) and longer operative time (p = 0.04; OR: 1.02; 95% CI: 1.00-1.03) were significant risk factors. Methicillin-resistant staphylococci (Staphylococcus aureus or coagulase negative staphylococci, p = 0.03) and Bacteroides fragilis group (p = 0.03) detected in the wound were also risk factors.
 Discussion and Conclusion: Flap size should be considered. The risk of bacterial contamination increases with long surgery time. Thorough debridement and appropriate antibiotic selection are necessary.

 Ten patients who underwent surgery for thoracic radiation ulcers were divided into recurrent and non-recurrent ulcer groups. We investigated clinical courses and complications, with a focus on ectopic calcification, aiming to identify features associated with recurrence. The recurrence rate of the seven patients treated at our department was 28.6%. Recurrence occurred in an atrophic area of the skin between the initial surgical site and the regional lymph nodes in all patients. Although regional lymph node irradiation was not examined in this study, we hypothesize that it causes osteonecrosis and sternoclavicular joint damage. Ectopic calcifications that continue to grow under atrophic skin near the sternoclavicular joint were associated with osteonecrosis and ulcer recurrence. Therefore, it is necessary to check patients' history of local lymph node irradiation, extend bone removal on the lymph node side, excise ectopic calcifications under atrophic skin, and cover the surgical wound with a thick flap.

 Angiomatoid fibrous histiocytoma (AFH) is an intermediate-grade soft tissue tumor characterized by hemangioma-like histological features. We present a case of a 26-year-old woman with a 10 mm subcutaneous tumor on the left forearm. Initially, the lesion was suspected to be a benign tumor of cutaneous adnexal origin and was resected. Immunohistochemical and fusion gene analysis revealed AFH. Due to uncertainty regarding the extent of the disease, an enlarged resection was performed, followed by wound closure. Histopathological examination of the extended resection margins confirmed the absence of residual tumor cells. One year after surgery, no recurrence or metastasis was observed. This case emphasizes the diagnostic challenges associated with AFH and the importance of careful consideration of the extent of resection, particularly in cosmetically sensitive areas for young women.

 Keloids are red, elevated scars that can develop from wounds because of subsequent dermal inflammation. We report a rare case of keloid formation within the nail mesenchyme of a 13-year-old girl after she sustained an injurious separation of the distal phalanx metaphysis of her toe. The patient was treated conservatively. Twelve months following her injury, she noticed a mass beginning to form within the nail epithelium. The mass was surgically resected 5 months later. The pathological diagnosis was a keloid as no acanthosis or keratosis was observed. Distal phalanx fractures are compound fractures that frequently cause the development of cellulitis and subsequent osteomyelitis, which provide the required conditions for keloid development. The nail mesenchyme comprises two distinct compartments: the hypodermis and matrical dermis. The present case demonstrates keloid development arising from the matrical dermis of the nail mesenchyme after sustaining a compound fracture of the underlying phalanx.

 Toe keloids may develop after syndactyly release. A combination of syndactyly and macrodactyly is associated with postoperative keloids. There is no established treatment for pediatric toe keloids because keloid formation on the toes is relatively rare. Herein, we report a successfully treated 3-year-old boy with a toe keloid after syndactyly release. He had congenital syndactyly with macrodactyly and underwent primary surgery at one year of age. Keloid presence was observed postoperatively, and he was referred to our hospital. At the age of three, we performed surgical excision and skin grafting, followed by postoperative radiotherapy, drug therapy, and compression therapy. Seven years after the operation, recurrence has not been observed.