We previously reported the use of a digital artery perforator (DAP) flap for reconstruction of soft tissue defects of the hands and digits. Herein, we report the use of DAP flaps in our department. The study analyzed 34 fingers from 29 patients. Target diseases were as follows: skin defects in 14 fingers (41%) after fasciectomy for Dupuytren’s contracture, 10 fingers (29%) with trauma-related skin defects, five fingers (15%) with skin defects caused after contracture release following camptodactyly, and five fingers (15%) with skin defects resulting from other joint contractures.
  Complications, such as skin necrosis or flap contraction, were not observed during follow-up. Moreover, all donor sites were closed linearly. DAP flap is a pedicled flap that does not require dissection of neurovascular bundles; therefore, surgery can be performed safely and relatively easily. DAP flaps are often used for post-traumatic skin defects; however, our findings suggest their suitability for skin defects following joint contracture dissection.

　 Elevation of the radial forearm flap is considered a relatively simple procedure. However, the conventional method of including the deep fascia of the flexor carpi radialis and brachioradialis tendons in the flap has a risk of graft loss at the donor site. Herein, we report the treatment outcomes of eight patients who were treated using the suprafascial dissection technique for radial forearm flap reconstruction at our hospital between January 2017 and October 2024.
　 The patients consisted of six males and two females, with an average age of 46 years. There were no reoperations due to vascular anastomosis complications, and all flaps completely survived. The donor site treatment period ranged from 13 to 38 days (average of 21 days) . Completely preserving the deep fascia was challenging, with partial damage occurring in three of eight cases. This highlights the need for a meticulous surgical technique.
　 Although the number of cases was small, the suprafascial dissection technique showed good flap survival rates and no donor site complications, suggesting it may be a reliable method.

　Neurorrhaphy for traumatic high ulnar nerve injury presents a challenge due to the long distance for axonal regeneration. As a result, functional recovery of the intrinsic muscles innervated by the ulnar nerve is poor. Supercharged end-to-side (SETS) anterior interosseous nerve-to-ulnar motor nerve transfer is becoming widespread. We performed SETS to treat a case of traumatic high ulnar nerve injury in which the left elbow was injured by a piece of glass. The patient was followed for 8 months postoperatively. Atrophy of the adductor pollicis muscle and first dorsal interosseous muscle was observed; however, the claw deformity was mild. Nerve conduction velocity (NCV) test revealed a flat potential in the abductor digiti minimi muscle. Interestingly, there was a dissociation between the degree of claw deformity and the NCV test results, which may be attributed to the consistent use of a dynamic splint by the patient to prevent claw deformity. The effectiveness of SETS remains to be elucidated; however, our findings suggest that wearing a splint after ulnar nerve repair is essential.

　Free-flap reconstruction is essential for managing soft tissue defects of the extremities with exposed bone or tendon. Vascular anastomosis is a particularly challenging procedure in free-flap reconstruction, and hand-sewn venous anastomosis is considered more difficult than arterial anastomosis. Venous thrombus is a more common cause of flap necrosis than arterial complications. Thus, achieving a secure venous anastomosis is critical for improving the survival rate of free flaps.
　Venous couplers are microvascular devices widely used for venous anastomosis in free-flap reconstruction after cancer resection and trauma. These devices streamline venous anastomosis, thereby reducing procedure time. When an anastomotic microvascular device is used for anastomosis in free-flap reconstruction, an additional fee of 2,500 points can be calculated, except in extremity reconstruction cases. In our experience of 19 cases using anastomotic microvascular devices for extremity reconstruction following extremity trauma and malignant tumor resection, we observed no vascular complications related to the devices. Herein, we report our findings of the usefulness of anastomotic microvascular devices for extremity reconstruction.

　Balancing a career as a microsurgeon and the responsibility of motherhood is challenging but achievable. As the mother of a young child, I have continued to perform surgeries. In our department, which has two full-time physicians, I carried out 33 of 51 reconstructive surgeries involving vascular anastomosis in 2021. On average, I left work at 8:44 p.m. on surgery days. I contributed to housework and childcare on non-operative days as well as 55% of operative days. Nurses were delegated to monitor free flap blood flow; therefore, I was only called in twice in a year. I also took five parental leave days to care for my child during sickness. By performing surgeries efficiently and reliably, avoiding over-scheduling on non-operative days, and delegating the postoperative workload among team members, it is possible for leading microsurgeons in microsurgery to successfully raise a small child and manage housework responsibilities.