Introduction: Epifix^® has been covered by insurance since 2022, but the method for its optimal use remains unclear. This study evaluated the effectiveness of Epifix^® based on our institutional experience.
 Methods: We applied Epifix^® to 17 patients (18 wounds) admitted to our Limb Salvage and Wound Care Center. Diabetic foot ulcers (DFUs) with ischemia underwent revascularization before Epifix^® application, whereas venous leg ulcers (VLUs) were treated with compression therapy.
 Results: The cohort included 15 DFU (16 wounds) and two VLU (mean age; 65.1±8.8 years) patients. No complications were observed. Among DFU patients, 66.7% had SPP of ≥50 mmHg and 43.8% showed >50% ulcer reduction. The effective group included significantly more patients with SPP ≥50 mmHg (p=0.034), whereas NPWT showed no significant impact (p=0.615). VLU patients exhibited a 75-100% ulcer reduction. Two DFU patients with high SPP but poor healing were eventually diagnosed with osteomyelitis.
 Conclusion: Epifix^® was more effective in DFU patients with SPP of ≥50 mmHg. DFUs with SPP ≥50 mmHg and inpatient-managed VLUs may be good indications for Epifix^®.

 Introduction: Poromas are benign skin-appendage tumors, and preoperative diagnosis is often challenging because of their diverse macroscopic findings.
 Methods: Herein, we aimed to determine the preoperative accuracy of diagnosing poromas. We analyzed 35 patients with poromas, and classified them into four histological types and a mixed type based on Ackerman's classification.
 Results: The Pinkus-type poroma was the most prevalent (21/35 lesions, 60%). The preoperative diagnostic accuracy rate was 38.1% (8/21 lesions), with 52.4% (11/21 lesions) including fibroma as a differential diagnosis. The correct preoperative diagnosis rate for the Smith-Coburn type was 40% (2/5 lesions). In the remaining 60% (3/5) of lesions, other conditions, such Bowen's disease, were included as differential diagnoses. The preoperative rate of correctly diagnosing Winkelmann-Macleod type (1 lesion) and Mayer type (2 lesions) was 0%. In two patients, the preoperative rate of correct diagnosis was 28.6% because multiple lesions were observed.
 Discussion: Preoperative diagnosis of poromas remains challenging compared with that of other benign tumors. As poromas can develop into porocarcinoma, their resection is recommended. Therefore, we aim to continue accumulating cases and improve the diagnostic accuracy rate.

 CosmoFix^® is a novel patient-specific custom internal fixation plate created by three-dimensional printing using computed tomography data, and it offers high-level strength based on stress analysis. However, its rigidity precludes intraoperative reshaping, thereby necessitating design adjustments before it can be used with free vascularized bone grafts (VBG). Despite the growing adoption of CosmoFix^®, its application with VBG has not been reported to date. In this study, the authors discuss two cases involving the combination of CosmoFix^® with a free fibular flap, a type of VBG, detailing institutional innovations.

 Propranolol is highly effective for infantile hemangioma. Extremely low birth weight infants are more likely to be complicated by infantile hemangioma, but the safety of propranolol use in infants with a corrected age younger than 5 weeks and low birth weight has not been established; thus, clinicians sometimes hesitate to initiate propranolol administration. Herein, we describe our experience involving two extremely low birth weight infants for whom early initiation of propranolol was effective against infantile hemangioma with ulceration. The early initiation of propranolol under intensive monitoring to minimize adverse effects may be effective in infants with a corrected age younger than 5 weeks and very low birth weight. However, careful monitoring and a willingness to discontinue administration in the event of adverse effects remain important.

 Introduction: The facial approach remains a challenge in maxillectomy and reconstruction. Various surgical approaches have been developed to improve cosmetic outcomes. We herein present a novel approach for endoscopic-assisted maxillectomy with minimal facial incision and endoscopic-assisted vascularized fibular osteomyocutaneous flap (VFOF) reconstruction.
 Methods: Between February 2023 and June 2024, six patients who underwent endoscopic-assisted subtotal or total maxillectomy and reconstruction with VFOF using a minimal facial incision approach at a single hospital were reviewed. Transconjunctival incisions were performed in some patients. Fibular bone placement for midface defects was conducted using the stacked fibula method. The exposed bone and titanium plates in the nasal cavity were covered with a nasal septal mucosal flap and fibular skin paddle. The oronasal fistula was closed using another fibular skin paddle in the oral cavity.
 Results and Discussion: All patients with VFOF after maxillectomy were successfully treated, maintained their overall facial contours postoperatively, and were satisfied with their facial appearance.