This study aimed to examine the surgical procedure of and complications associated with soft-tissue reconstruction at the insertion of the Achilles tendon. Five patients with skin defects treated between April 2017 and March 2022 were retrospectively examined. Three patients received a reverse sural artery flap, and two received a free radial forearm flap. Patients with a reverse sural artery flap presented with a sensory disorder in the sural nerve region after the sural nerve was raised in the flap. One of the patients with a free radial forearm flap adopted measures to hide the flap collection region with clothing. In our department, the reverse sural artery flap is the first choice for soft-tissue reconstruction at the insertion of the Achilles tendon. However, in cases where the sural nerve is included in the flap, some patients continue to report sural nerve region problems. Therefore, it is necessary to consider a method for raising a flap that does not include the sural nerve. In addition, a radial forearm flap should be considered as an alternative treatment option; however, selection of a free flap other than the radial forearm flap may be preferred by young female patients.

  Severely obese patients undergoing surgery carry a higher risk for pulmonary thromboembolism than normal weight patients, with a potentially fatal outcome. We present a case of pulmonary thromboembolism occurring after mandibular reconstruction surgery in a severely obese patient. A 48-year-old man (180 cm, 142.4 kg, BMI 43.95 kg/m²) presented with left-side mandibular gingival cancer and underwent mandibular reconstruction with an anterolateral thigh flap and fibular flap. Although heparin was administered for 5 days after the operation, the patient developed a pulmonary thromboembolism 7 days after the operation. Heparin administration was re-started, and the thrombus disappeared within 3 weeks after onset. The patient exhibited good morphological and functional results at 1-year follow-up. In the present case, intraoperative and postoperative management was performed in accordance with the guidelines, but pulmonary thromboembolism nevertheless occurred. Extreme caution must be used when operating on severely obese patients.

  A 75-year-old man was diagnosed with Gustilo IIIB open fracture of forearm with extensor muscle group defect. Irrigation, debridement, and temporarily fixation with Kirschner wire were performed on the same day. On the 8th day of injury, the fracture was internally fixed with locking plates, and soft tissue reconstruction was performed using free latissimus dorsi (LD) flap for extensive muscle loss. Two months after the definitive surgery, reconstruction of the hand extension function was performed by the tendon transfer technique reported by Riordan. Three years after the definitive surgery, bone union and flap survival had been observed, and the functional outcome was excellent. In the present case, free LD flap was selected, but bulkiness was a problem. On the other hand, a relatively thin skin flap with fascia could have been performed as a cosmetic consideration. The advantages of reconstruction of extensor function with a two-stage tendon transfer procedure include obtaining a good range of motion of the fingers and wrist joints during the waiting period, which resulted in a good outcome in the present case.

  Antiresorptive agents, such as bisphosphonate and denosumab, have been used in antiosteoclast therapy to treat metastatic bone cancer, osteoporosis, and other bone diseases. A side effect of these agents is exposure or necrosis of the mandibular bone, which is called antiresorptive agent-related osteonecrosis of the jaw (ARONJ) . Previous literature has mainly supported conservative therapy of ARONJ owing to the high risk of perioperative complication and the recurrence of osteonecrosis.　
  Herein, we report our experience in treating two patients with metastasis of prostate cancer in the mandible. They underwent extensive resection of the mandible and replacement with a titanium plate; however, the titanium plate was subsequently exposed. Therefore, we performed further reconstructive surgery using free fibular flap. No recurrence of osteonecrosis was reported after the reconstructive surgery. Orthopantomography revealed good osteogenesis.　
  Reconstructive surgery using a vascularized free-bone flap is an effective treatment for mandibular necrosis; however, it is necessary to consider the patients’ post-operative performance status.