[in Japanese]

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[in Japanese]

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 Recommendation: Compression therapy is recommended for patients with leg edema due to chronic venous insufficiency.（Class I, Level B）
 Review of the evidences: Four reports were extracted through a systematic review. Meta-analysis revealed that elastic compression stockings with an interface pressure of 10–20 mmHg reduced leg edema more than placebo or no compression stockings. A prospective study demonstrated a dose-dependent（20-40 mmHg）reduction in leg edema with leg compression. Two randomized controlled trials compared elastic compression stockings（median 36 mmHg）and adjustable compression garments（median 52 mmHg）with inelastic multilayer bandages（60-87 mmHg）. After seven days of application, elastic compression stockings exerted similar effects, and adjustable compression garments exerted a larger edema reduction compared to that by inelastic multilayer bandages.
 Summary: To reduce leg edema due to chronic venous insufficiency, compression therapy at a pressure of 10-50 mmHg is recommended.

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 Previous guidelines have addressed the treatment and prevention of post-thrombotic syndrome in the chronic phase of deep vein thrombosis, but the effectiveness of compression therapy for CEAP classification C4 cases in chronic venous insufficiency（CVI）has not been clearly established. CQ4 was established to clarify the effectiveness of compression therapy for CEAP classification C4 cases in chronic venous insufficiency. Evidence for compression therapy in stasis dermatitis has been supported by one randomized controlled trial. This evidence suggests that compression therapy is highly effective in improving stasis symptoms and reducing the area of lipodermatosclerosis（LDS）. Therefore, the guidelines recommend compression therapy for stasis dermatitis（Class IIa recommendation, Level C evidence）and LDS（Class IIa recommendation, Level B evidence）associated with CVI. In practice, the use of multi-layer bandaging or elastic stockings with a target pressure of at least 40 mmHg has been shown to be effective. It is crucial to observe the condition, manage skin lesions, and apply the most appropriate compression method for the patient. Since the treatment duration is often long-term, it is essential to ensure the continuation of compression therapy and adherence according to the patient’s condition.

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[in Japanese]

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[in Japanese]

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 Our hospital is one of the few hospitals in the Izu area that has a Department of Plastic and Reconstructive Surgery. Since 2011, we have operated a foot care outpatient clinic. We have treated many cases of chronic limb-threatening ischemia and have experienced many cases requiring major lower limb amputation（LLA）. Low adherence has led to a noticeable incidence of LLA due to infection. To address this, we implemented interventions in patient education methods aimed at improving adherence.
 We included a total of 109 LLAs performed at our hospital. Those conducted after the start of the intervention in August 2022 were designated as the intervention group, whereas those performed between January 2018 and July 2022 were categorized as the non-intervention group.
 We created a flow chart to identify patients who received LLA and performed treatment at home.
 We issued a “Foot Treatment Prescription” to share multidisciplinary treatment plans in a paper format.
 We found that cases where infection was involved in amputation decreased from approximately 10 cases/year in the non-intervention group to 3 cases/year in the intervention group.
 Our findings suggest that standardizing the quality of patient education and improving adherence contribute to reducing LLA caused by infection.

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 A 51-year-old male was admitted to our hospital due to swelling and heat in the left lower leg and deformity of the left foot. Bone destruction and valgus deformity of the left ankle joint were observed, leading to a diagnosis of diabetic Charcot foot and cellulitis. After antibiotic treatment, traction was applied to the left ankle joint using a circular external fixator（Taylor Spatial Frame^® : Smith & Nephew）, and the valgus deformity was gradually corrected over a 4-week postoperative period. Ankle arthrodesis was performed 11 weeks after external fixation, using the ipsilateral fibula as a graft. The circular external fixator was removed 12 weeks after ankle arthrodesis. Three years and six months post-surgery, the patient was able to walk without a brace, and X-rays showed no ankle joint deformity, and evidence of bony union was found.
 Deformity correction using circular external fixation is an effective treatment modality for diabetic Charcot foot with risk of infection and contracture. It is important to prevent contracture of the toes during external fixation and to select footwear and orthotics appropriate for the foot and gait after removal of the external fixator. Moreover, rehabilitation focusing on gait training is necessary.

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 Great toe or lesser toe salvage secondary to soft tissue ulceration and underlying osteomyelitis is a challenging procedure, and amputation is more frequently chosen than similar procedures for the thumb or finger. Although toe amputations seem cost-effective, those significantly increase the risk of recurrent ulceration and more proximal amputation over time. Herein, we present an observational case series involving retrospective review of salvage procedure for two great toes and four second toes using the new mini-external fixator（ICHI-FIXATOR System）. Each patient underwent initial resection of the involved soft tissue ulceration and underlying osseous lesion with application of the external fixator to stabilize the osseous stumps. We enrolled one man and three women with a mean age of 76 years. Three patients had rheumatoid arthritis（RA）, including one with malignant RA; one had diabetes mellitus; one had chronic limb-threatening ischemia; and one had an unrelated malignancy. There were two MTP joints of left great toes, three PIP joints of left second toes, and one PIP joint of right second toe. The mean follow-up period after the latest procedure was 8.8 months. The external fixator was removed 2-3 months after the operation once osseous union was confirmed radiologically or when the segments were judged as stable（in cases of pseudoarthrosis）. All procedures were successful, achieving local stability with no recurrence of soft tissue ulcerations, osteomyelitis, or toe deformity.

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