The radial forearm flap, characterized by thin and flexible tissue, a large and long pedicle, and stable blood supply, had been frequently used. However, complications such as donor-site tendon exposure, aesthetic deformities resulting from skin graft closure, and the development of perforator flaps have led to a gradual decline in its usage. A radial forearm flap without skin grafting holds promise as a potential solution to these problems. In this study, we aimed to achieve primary closure of the donor site and cover the tissue defect of the hand by harvesting a radial forearm flap using the extended and divided latissimus dorsi flap technique. The flap was harvested using the conventional radial forearm flap harvesting method, and the skin island was divided into two parts along the fascia, which were then used to cover the defect. The flap donor site was closed primarily. This is a useful and simple method for covering extensive tissue defects of the hand while avoiding donor-site complications.

　We investigated soft tissue reconstruction cases treated with muscular, perforator, and myocutaneous flaps using the medial sural arteries. Seven cases of soft tissue reconstruction treated with muscular (n=3) , perforator, (n=2) and myocutaneous (n=2) flaps were performed at our institution between 2012 and 2024. All flaps survived, and no postoperative infections occurred. Skin grafts were required in all muscular flap cases and in the donor site of the perforator flap, which was harvested 6 cm wide; however, no skin grafts were required in the myocutaneous flap cases. Pedicled and free medial sural artery perforator flaps are both effective reconstruction methods. Myocutaneous flaps are useful because they can expand the coverage area while retaining the characteristics of the muscular flap and do not require skin grafts.

　A 79-year-old male underwent partial pancreatectomy for an intraductal papillary mucinous tumor, and seven years later, a residual pancreatectomy for pancreatic head cancer. Two months after the second surgery, the patient developed abdominal distension, and an ascitic puncture revealed 3 L of chylous ascites. Conservative treatments, including a low-fat diet and somatostatin analog therapy, were ineffective, leading to referral.　
　Lymphoscintigraphy indicated an abdominal lymphatic duct injury, with lymph flow from the lower extremities contributing to the ascites. Surgical ligation of the leaking lymphatic duct via laparotomy was considered; however, the precise leakage site was difficult to identify, making direct ligation impractical. As an alternative, lymphaticovenular anastomoses (LVAs) were performed in the lower extremities. Four LVAs were successfully completed, resulting in the resolution of chylous ascites within three months postoperatively.　
　This case demonstrated that the LVAs created effective bypasses distal to the leakage point, reducing lymphatic flow at the lesion and enabling its closure. LVAs offer a minimally invasive and effective treatment for refractory chylous ascites, particularly in cases in which lymphatic flow from the lower extremities contributes to this condition.

　For Gustilo typeⅢB open fractures, early flap coverage is recommended to prevent infection. We report a case of a Gustilo typeⅢB open tibial fracture with ipsilateral hip fracture-dislocation and distal femur fracture that had a good outcome after staged treatment. The patient, a 54-year-old male, was injured in a traffic accident and diagnosed with right hip fracture-dislocation, right distal femur fracture, and open right tibial fracture. Emergency debridement of the wound, external fixation of the fracture, reduction of the hip dislocation, and traction were performed. Pelvic osteosynthesis was performed on day 6, and that of the femur and tibia on day 9. A free anterolateral thigh flap was performed on day 17. Ten months post-injury, the patient was able to walk without pain, and bone union was achieved. In this case, we considered performing early free-flap surgery to prevent infection of the open tibial fracture. However, to promote rehabilitation, we first treated the pelvic fracture and repeated wound debridement. Although a free flap was performed on day 17, infection did not occur, and good results were obtained.

　We report a case of iatrogenic medial calcaneal nerve injury caused by ankle arthroscopy that was repaired using a collagen nerve conduit. The patient was a 16-year-old female who had trained abroad to become a ballerina. She previously underwent two arthroscopic surgeries on her left ankle. She presented to our hospital with progressive pain in the left heel, accompanied by localized point tenderness at the scar posterior to the medial malleolus, with an overlying radiating Tinel’s sign. Exploration of the left medial calcaneal nerve revealed complete division and a neuroma involving the proximal stump. After neurolysis and neuroma excision, the medial calcaneal nerve was reconstructed using a collagen nerve conduit. Nine months post-surgery, the pain disappeared, and she successfully returned to ballet. The collagen nerve conduit is an effective option to recover acceptable sensation and nerve function after sensory peripheral nerve injury in the lower extremity.

　Purpose: This study evaluated the treatment outcomes of soft tissue reconstruction using a free serratus anterior-latissimus dorsi combined flap for Gustilo type IIIB/C open fractures of the lower limb.　
　Methods: A retrospective study was conducted on nine male patients treated at our center between 2013 and 2023. The primary and secondary outcomes were flap survival, flap complications, donor-site morbidity, bone union, walking ability, and NRS scores.　
　Results: The median patient age was 43 years. Soft-tissue defects involved two or three anatomical regions. The flaps survived in eight cases; however, one case had complete necrosis, and another case required an additional flap due to ulcer formation. One patient experienced residual muscle weakness around the shoulder. Bone union was achieved in all the cases. Eight patients were able to walk independently, and the NRS scores ranged from 0 to 2.　
　Discussion: Free combined serratus anterior-latissimus dorsi flaps are reliable and effective for reconstructing extensive soft tissue defects and offer broad coverage and technical simplicity.

　Microsurgery education at Nagoya City University Graduate School of Medical Science includes “Microsurgery Training” for medical students and “Sakurayama Microsurgery Seminars” for trainees and young orthopedic surgeons. In this study, we examined the impact of microsurgery education at the Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, on entry into the orthopedic department and the training of microsurgeons. Although “Microsurgery Training” began in 2010, the number of orthopedic surgeons who graduated from Nagoya City University has not increased. However, continuously providing opportunities for students to be exposed to microsurgery is meaningful. Of the 59 participants in the “Sakurayama Microsurgery Seminars,” 14 specialized in hand surgery, and 1 specialized in plastic surgery. Fifteen participants (25.4%) pursued careers as microsurgeons, which significantly contributed to their training. In conclusion, we recommend continuing to provide microsurgery education, with the goal of increasing the number of microsurgeons, even if incrementally.

　Objectives: Adipose-derived stem cells (ADSCs) are widely used in wound care because they release a variety of cytokines. However, the molecular mechanism of paracrine action remains unclear. It has been reported that basic fibroblast growth factor (bFGF) enhances the therapeutic potential of ADSCs. In this study, we searched for cytokines whose release from ADSCs is enhanced by bFGF stimulation.　
　Results: Quantitative RT-PCR and ELISA analyses revealed that bFGF upregulates CXCL-1 and IL-8 mRNA synthesis and secretion from ADSCs. Both cytokines showed the ability to promote important processes for wound healing, including tube formation of vascular and lymphatic endothelial cells and cell migration of fibroblasts in vitro.　
　Conclusions: These results suggest that bFGF stimulation increases the secretion of CXCL-1 and IL-8 from ADSCs and that these cytokines may promote angiogenesis, lymphangiogenesis, and cell migration, leading to enhanced efficiency of wound healing.