The history of strategic treatment for severe extremity trauma began with Godina’s study in 1986. In Japan, standardization of severe extremity trauma treatment has progressed since the publication of the Japan strategy in 2017 by Tsuchida. Satisfactory results are expected in many cases with prompt treatment at specialized facilities.　
  Although the severity and patient background vary from case to case, the important points that must be cleared for smooth treatment are “infection” and “skin flap troubles,” which can be prevented by “adequate debridement” and “reliable bone and soft tissue reconstruction” according to the strategy.　
  At our institute, we take the following measures. After debridement, we perform CLAP therapy to prevent infection. Before soft tissue reconstruction, we confirm the zone of injury using ultrasound to select the site where vascular anastomosis can be safely performed. During the reconstruction, we check the presence of fibrosis around the recipient’s vessels and the patency of the vessels. We perform end-to-side vascular anastomosis whenever possible, and consideration is given to both the flap and the recipient’s condition. After the reconstruction, TcpCO₂ is monitored for real-time objective evaluation of flap blood flow.

  We retrospectively investigated preoperative symptoms and postoperative complications in 29 patients who underwent surgery for schwannoma in extremities.　
  The average age was 45.8 years, and the average postoperative follow-up period was 6.1 months.　
  Twenty-two upper extremities and seven lower extremities were investigated. The nerves of tumor origin were as follows: median, six cases; radial, two cases; ulnar, two cases; digital nerve, four cases; sural nerve, one case; and other cutaneous nerves, 14 cases. Preoperatively, spontaneous pain was observed in 12 patients, tenderness in 12, and sensory deficits in five.　
  We performed enucleation under a microscope in 15 cases involving main nerves and simple resection using a surgical loupe in 14 cases involving cutaneous nerves.　
  Postoperatively, all patients experienced relief from spontaneous pain. At the last follow-up, 12 patients had sensory disturbances, of which eight had disturbances of the upper arm and forearm.　
  Microscopic enucleation was performed for schwannomas in major nerves; however, 41.4% of patients reported experiencing sensory disturbances at the last follow-up.　
  Sensory disturbance may occur after surgery when the preoperative symptoms are mild.

  Background: This retrospective study aimed to assess the surgical impact of lymphaticovenous anastomosis (LVA) in lower extremity lymphedema by excluding the influence of conservative therapies and self-management. Instead of limb circumference, magnetic resonance imaging (MRI) was employed for quantitative analysis to minimize potential measurement bias.　
  Methods: A total of 77 patients (87 limbs) with no previous lymphedema surgeries were divided into two groups: multisite LVA (M-LVA, n = 34) and single LVA (S-LVA, n = 53) . Plain MRI was obtained preoperatively and 1 day postoperatively. The cross-sectional area of each affected limb was measured at two axial slices, and the MR change rate (%) was calculated using the following formula: (Σpostoperative areas -Σpreoperative areas) /Σpreoperative areas×100.　
  Results: The mean number of anastomoses was 2.9 and 1.0, and the mean MR change rate was -9.5%［±4.90 standard deviation (SD) ］and -6.6% (±2.92 SD) in the M-LVA and S-LVA groups, respectively. MR change rate was significantly higher in the M-LVA group (Welch’s t test, p < 0.005) than in the S-LVA group.　
  Conclusions: We found that LVA had an immediate edema reduction effect in both the M-LVA and S-LVA groups. M-LVA may have greater efficacy than S-LVA.

  There are few reports on the use of surgical microscop in the treatment of Dupuytren’s contracture; however, it has been consistently used at our department. We aimed to investigate the usefulness of surgical microscop in preventing iatrogenic neurovascular injuries during limited fasciectomy for Dupuytren’s contracture. Twenty-four patients with Dupuytren’s contracture who underwent limited fasciectomy between April 2012 and March 2022 and were followed up for at least 3 months were included. Postoperative complications included neurapraxia in two patients (8.3%) and nerve injury in one patient (4.2%) . There were no arterial injuries. We found that the incidence of neuropraxia and arterial injury were lower than the median reported in previous studies. Our findings suggest that surgical microscopy is useful for preventing neurovascular complications during surgery for Dupuytren’s contracture. In addition, surgical microscop has the advantages of facilitating immediate nerve and arterial repair in cases of nerve or arterial injury and easy identification of the boundary between the cord and normal tissue.

  The importance of soft tissue reconstruction using early free tissue transfer for severe injuries of the upper extremity to restore and maintain limb function has been reported. In this study, we report four cases of severe injuries of the upper extremity at the forearm level in which soft-tissue reconstruction using early free tissue transfer was performed, with a review of the literature. Two patients who underwent free tissue transfer within 72 hours of injury did not develop wound infection during the course of the procedure, whereas two patients who did not undergo reconstruction developed wound infection. Wound healing, time to bone union, and hospitalization were all prolonged in the two patients who did not undergo early free tissue transfer. Soft tissue defects in severe trauma to the forearm require blood-rich soft tissue coverage of exposed bone, tendons, and nerves, even if the extent of necrosis is small, and secondary complications such as soft tissue necrosis and deep infection are probable. It is important to perform soft tissue reconstruction using free tissue transfer within 2-3 days, if the patient’s general condition permits.

  Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. The WIfI classification system was introduced for CLTI evaluation and treatment. Major amputation is a common treatment for CLTI of the foot with deep wounds and/or severe infection. In the case of ischemic limbs, revascularization (surgical bypass or endovascular treatment) is essential before wound treatment. However, there are a limited number of vascular surgeons capable of performing distal bypass procedures, and most interventional cardiologists in our country are not proactive in revascularizing lower leg arteries. When major amputation is indicated, plastic surgeons have to decide to salvage or amputate the limb depending on the patient’s condition and background. Microsurgical free flap transfer is a viable option in properly selected CLTI patients, and is used as a final option for limb salvage before major amputation. We present our experience with microsurgical reconstruction in CLTI cases. Before microsurgical reconstruction, complete vascular (cardiac and peripheral) workup is needed. The reconstructive microsurgeon must identify recipient arteries and veins, both deep and superficial, around the foot. Furthermore, they should participate in the 1st stage of the debridement operation and check and preserve promising vessels.