There is a growing demand for small-diameter artificial vascular grafts to replace damaged vessels. Due to poor patency rates due to the small diameter and susceptibility to bacterial colonization among current synthetic vascular grafts, a tissue-engineered vascular graft (TEVG) presents a potential solution for the future of vascular surgery. This article describes the history of vascular replacement and TEVGs. The various approaches to generate TEVGs, including cell-based, scaffold-based, and luminal functionalization methods, are described, along with the results of clinical trials. In addition, focusing on the field of microvascular surgery, whether TEVGs can be an alternative to autologous blood vessels and be considered as the gold standard for microvascular reconstruction or replacement is discussed. Recently, we developed an acellular small-diameter TEVG that was modified with the integrin α4β1 ligand, REDV. The luminal modification had high patency rates in both the decellularized ostrich-carotid artery (2-4-mm diameter) and decellularized rat tail artery (0.6-mm diameter) in animal models. The potential application of TEVG to microsurgery is also discussed.

　The assistive surgical robot da Vinci (Intuitive Surgical, Inc.) is a device that enables delicate manipulation through stabilization and motion scaling in a three-dimensional magnified field of view. These features are expected to have many advantages for applications in microsurgery. Herein, we report our current investigations on robotic microsurgery as a new technology for microsurgery. Using da Vinci, we investigated anastomosis in pseudo-vascular models and porcine vessels.　
　We were able to perform stable anastomosis in the pseudo-vascular model; therefore, we performed anastomosis in porcine vessels with diameters of 2 and 3 mm. We were able to anastomose the femoral artery and deep iliac artery and vein.　
　Microsurgery and robotic microsurgery have many similarities. Therefore, it was thought that microsurgeons could adapt to robotic surgery more easily than to surgeons in other fields. In addition, the features of the surgical assist robots reduce the stress on the surgeon and enable a smooth operation. In the future, if the performance of the camera is improved and special devices are developed, anastomosis of vessels with a diameter of 1 mm or less will become easier, and robotic microsurgery will become even more useful.

　In recent years, the decreasing number and availability of surgeons as well as the availability of microsurgery has become a problem. This study aimed to investigate the ability and interest of medical students undergoing clinical clerkship to learn microsurgery techniques. The study included 47 undergraduate medical students and assessed the time and the quality of sutures performed on silicone tubes under a microscope. The study design included two groups. The first group performed the sutures without previous training and the second group had practiced skin sutures beforehand. The level of interest in orthopedics was surveyed before and after the training. The results showed no correlation between age, sex, or training time. There was no difference in time or scores between the trained and untrained groups. After the training, 74.5% of the students developed increased interest in orthopedics. These results suggested that it is possible for inexperienced medical students to start microsurgery training, which can lead to an interest in taking up microsurgery.

　The goal of the weight-bearing plantar reconstruction is to enable the patient to wear shoes and walk without pain. It is desirable to reconstruct using tissues that can maintain durability against the shearing force associated with loading; thus, a medial plantar flap is preferable from a functional standpoint. In severe foot trauma with moderate or greater soft-tissue defect, free flap transfer is the first choice, and pedicled flap reconstruction is considered only under limited conditions. We report a case of extensive heel degloving injury in which the soft-tissue defect at the heel loading area was reconstructed with a pedicled medial plantar flap and a pedicled posterior tibial artery perforator flap, as a free flap was not an option.

　The fourth and fifth carpometacarpal joints of the hamate bone have been found to possess much greater range of motion than the other carpometacarpal joints. The fourth and fifth carpometacarpal joints have a range of motion of 15 degrees and 30 degrees. Therefore, malunited hamate intra-articular fractures may lead to decreased grip strength, chronic pain, and osteoarthritis, which may lead to irreversible and serious disability. We present a case of a 31-year-old man surgically treated with corrective osteotomy with vascularized pedicled bone graft from the dorsal aspect of the distal radius based on the fifth extensor compartment artery and external fixation, leading to excellent results. Vascularized bone grafts are efficacious in these fractures and are recommended as a surgical treatment.

　Several procedures have been reported for pharyngoesophageal reconstruction following total pharyngolaryngectomy, of which we perform free jejunal transfer in our facility. In the present case, a patient requiring pharyngoesophageal reconstruction underwent spontaneous isolated superior mesenteric artery dissection. Adverse events with respect to the dissection led us to select a free anterolateral thigh flap instead of the free jejunal transfer. The operation was performed uneventfully with moderate blood pressure control. When opting for jejunal transfer reconstruction, careful history-taking is important. Abdominal enhanced computed tomography should be performed to evaluate the visceral vessels and the risk of general atherosclerosis.

　The 48th Annual Meeting of the Japanese Society for Reconstructive Microsurgery and the 5th Congress of the Asian Pacific Federation of Societies for Reconstructive Microsurgery were held as a joint conference from December 1 to 4, 2021. We held the Second Supermicrosurgery Vessel Anastomosis Contest at this annual meeting. As a result of issues raised in the first contest, we made changes to the rules related to matters such as the equipment used, time limit, and evaluation process. As more applications were received than expected this year, we think that many members are anticipating that this contest will be held from next year onwards and that some teams will participate again. The contest is difficult to hold and organize, and some aspects of its management have to be considered; however, the contest has been well received by many academic members and is a valuable opportunity to publicly evaluate microsurgical techniques, so we hope that it will continue to be held.

　Background : It is still controversial whether 3D microscope is an alternative tool for microvascular anastomosis instead of traditional binocular microscope in supermicrosurgery. We compared the usefulness of a 3D microscope (Kestrel View II, Mitaka Kohki Co., Tokyo, Japan) and a binocular microscope (MM51/YOM, Mitaka Kohki Co.) for evaluating microvascular anastomosis of chicken wing training models. 　
　Methods : Three microsurgeons were asked to perform five end-to-end anastomoses on the ulnar artery in a chicken wing using each type of microscope. We evaluated the time and quality of anastomosis, and the students completed a questionnaire about the visibility, ease of anastomosis, tiredness, and general impression after a total of 30 procedures.　
　Results : The average time required for anastomosis in each microsurgery was 10.3, 12.0, and 12.5 minutes with Kestrel View II, and 8.5, 10.9, and 11.3 minutes with MM51/YOM. The required time tended to be shortened as the number of procedures increased. The anastomotic qualities were almost the same in both microscopes. In the questionnaire, Kestrel View II was scored higher in the ease of surgical operation, but lower in visibility and general impression.　
　Conclusions : Our study found that a 3D microscope can be used for supermicrosurgical anastomosis.