Background: This study investigated the recognition and acquisition of specialist and instructor certifications among members of the Japan Society of Plastic and Reconstructive Surgery (JSPRS), focusing on barriers, career paths, and subspecialty certification intentions.
 Methods: We conducted an online survey of JSPRS members from September to October 2023. The questions addressed certification awareness, acquisition plans, challenges, and subspecialty qualifications. Free-text responses were also analyzed to gain insights into systemic issues.
 Results: We collected 943 responses. Awareness of the formalized specialist certification process was 54.3%, with lower recognition among uncertified and specialist-only members. Barriers to certification acquisition included time and case volume constraints, particularly for rural and female physicians. Subspecialty certification intention was low, with significant concerns regarding costs and unclear practical benefits. Free-text responses emphasized the need for improved regional equity, flexibility in training, and streamlined certification processes.
 Conclusion: The findings highlight the challenges in the certification system, including disparities and practical burdens. These insights provide a basis for reforms aimed at enhancing career development and addressing systemic issues in plastic and reconstructive surgery.

 A 79-year-old woman with right mandibular cancer (intraductal carcinoma, T4aN0M0 Stage IVA) underwent right segmental mandibulectomy, neck dissection, and reconstructive surgery using an osteocutaneous fibula flap. After elevating the osteocutaneous fibula flap, we observed that the skin paddle perforator originated from the posterior tibial artery, not the peroneal artery. The intraoral mucosal defect was small; therefore, the skin paddle was not elevated, and reconstruction was performed using the muscle and fibula. The patient experienced no complications or recurrence one year postoperatively.
 We report a rare case in which the skin paddle of the fibula flap was supplied by a posterior tibial artery perforator.

 Due to their rarity and heterogeneity, malignant soft tissue tumors frequently present challenges in diagnosis. This report describes a case in which histopathological findings were consistent with plexiform fibrohistiocytic tumor (PFT), a rare soft tissue neoplasm. A 45-year-old woman first noticed a cutaneous tumor on her left thigh seven years prior, which gradually increased in size. Approximately two months before the initial visit, a biopsy at the referring hospital diagnosed dermatofibrosarcoma protuberans, prompting her referral to our department for further evaluation and management.
 On examination, a 5×3 cm erythematous mass was observed on the left thigh. A second biopsy at our institution raised suspicion of an intermediate-grade malignant soft tissue tumor. Wide excision histopathological examination suggested PFT; however, the diagnosis remained uncertain.
 When clinical and imaging findings are inconclusive, referral to a specialized center for soft tissue tumors should be considered before performing a biopsy.

 Several cases of chronic hematoma around silicone breast implants (SBIs) have been reported; however, there are few reports describing hematoma formation following SBI removal. We encountered a patient who developed a hematoma two years after SBI removal. The hematoma initially resolved with aspiration; however, it recurred 10 years later, resulting in a chronic expanding hematoma (CEH). We performed surgical resection. Although capsule removal is generally recommended in CEH cases, we retained the capsule on the chest wall in this patient due to the risk of pneumothorax. However, the presence of the residual capsule may increase the risk of hematoma recurrence. Further studies are needed to evaluate the implications of capsule retention and to establish appropriate long-term follow-up protocols.

 To achieve cosmetic benefits, local flaps are frequently used in the reconstruction of facial cancers. The abundant blood supply in the facial region confers high reliability and versatility to local flap reconstruction. However, postoperative radiotherapy can induce radiation injury, increasing the risk of flap necrosis. Here, we present the case of a 67-year-old woman who underwent free flap reconstruction after resection of a nasal basal cell carcinoma. We performed nasolabial flaps to correct nasal deformities; however, flap necrosis occurred because of radiation injury. Therefore, we performed revision surgery with the additional free flap. This case emphasizes the importance of careful evaluation of the radiation field and dose in planning reconstruction for irradiated areas.