In patients with neurofibromatosis type 1 (NF1), neurofibromas are resected for pain relief and cosmetic improvement. If the tumor has invaded a major nerve, preservation of the nerve is desirable to prevent postoperative disabilities. Herein, we report a patient with a large neurofibroma in the wrist, which was partially resected with the assistance of the nerve integrity monitoring (NIM) system.
 A 26-year-old woman presented with a wrist tumor. She had previously undergone partial resection of the same tumor and was diagnosed with localized NF1. Plain radiography revealed bone resorption in the triquetrum and hamate as well as pisiform dislocation toward the ulnar side. Magnetic resonance imaging was unable to confirm the course of the ulnar nerve within the tumor; therefore, NIM-assisted partial resection was performed. The patient experienced immediate postoperative paralysis of ulnar nerve motor function; however, this resolved within 1 month. NIM is useful not only for facial nerve repair but also for extremity surgery.

 Despite advancements in improving overall survival rates and quality of life through limb preservation, long-term follow-up data is limited. Herein, we present three cases of pediatric upper arm malignant tumors treated with wide resection and free fibula graft reconstruction, with a follow-up period of over nine years. We retrospectively examine the diagnoses, surgical techniques, and postoperative functions. Although bone elongation after flap transplantation cannot be guaranteed, all three patients were able to perform daily activities independently. Postoperative fractures were observed in two cases.

 The majority of intrascrotal tumors are testicular tumors, and other intrascrotal soft tissue tumors are rare. Herein, we report a 50-year-old man who had an intrascrotal leiomyosarcoma, with a review of the literature. The patient presented to our hospital with a right intrascrotal mass that had been gradually enlarging over the previous year. An elastic and hard tumor measuring 33×15×17 mm, with good mobility was found. Diagnostic tumor excision was performed, leading to a diagnosis of leiomyosarcoma. Additional wide resection with radical orchiectomy and postoperative radiation therapy were performed. At five years postoperative follow-up, there was no evidence of recurrence or metastasis. Most reported cases of intrascrotal leiomyosarcoma have been treated by urologists; however, plastic surgeons may increasingly manage tumors, such as soft tissue sarcomas, in the future.

 When playing wind instruments, musicians with stress velopharyngeal insufficiency (SVPI) may demonstrate a persistent air leak through the nasal cavity. Although SVPI does not interfere with daily life, including articulation, it can make playing wind instruments difficult. Consequently, SVPI can be a serious problem for musicians. Moreover, SVPI is not recognized as a condition, and the appropriate treatment remains to be elucidated. Herein, we report a 13-year-old boy who developed SVPI after a submucous cleft palate surgery, which interfered with his ability to play music. As well as SVPI treatment, we performed a posterior pharyngeal wall augmentation using costal cartilage to address nasal air leak. This procedure was successful and 10 months after surgery, the patient could play music without issues.

 The usefulness of free flaps in head and neck reconstructions has become widely recognized in recent years. Moreover, high survival rates have been reported with their use. Herein, we report two cases of external jugular venous thrombosis that occurred at our institution. In these cases, an anterolateral thigh flap reconstruction was performed after tumor resection and neck dissection. In Case 1, the drain compressed the external jugular vein, leading to thrombosis. In Case 2, excessive dissection of the external jugular vein during the neck dissection caused vessel twisting and breakage, which may have contributed to thrombus formation. It is necessary to devise drain placement and fixation methods tailored to the extent of loss of the surrounding tissue to reduce vessel damage. Moreover, recipient vessel selection and venous anastomosis quantity should be carefully considered.