This report presents the outcomes of treating Kienböck’s disease with vascularized bone graft (VBG) and temporary scaphocapitate fixation at our institution. Seven patients with Lichtman stageⅢa orⅢb were included. Pre- and postoperative assessments included palmar and dorsal flexion, pronation-supination range of motion, grip strength, wrist pain, Japanese Orthopedic Association wrist score, carpal height ratio (CHR) , Stahl’s lunate index (STI) , radioscaphoid angle (RSA) , and radiolunate angle. The surgical technique involved harvesting a VBG from the distal radius using the 4-5 extensor compartmental artery (4-5 ECA) as the pedicle, followed by temporary fixation between the scaphoid and capitate using two 1.5 mm K-wires, which were removed at an average of 16.0 weeks postoperatively. Postoperative improvements in grip strength and wrist function were observed across all stages . However, no significant differences were noted in CHR, STI, or RSA before and after surgery. No progression of lunate bone collapse was observed at the final follow-up visit. Combining VBG with temporary scaphocapitate fixation is a viable option for treating Kienböck’s stagesⅢa andⅢb.

　We investigated the relationship between flap surgery techniques for amputated fingers and the corresponding injury level and injury pattern. A total of 150 fingers treated with flap surgery between 2019 and 2024 were retrospectively analyzed. The oblique triangular flap was the most frequently used technique (68%) , applied across all injury patterns in Tamai zonesⅠtoⅢ. In contrast, in zonesⅢto V, cases commonly involved heat press injuries, degloving injuries, and avulsion amputations. For these severe soft tissue injuries, pedicle groin flaps were preferred due to their suitability. Accurate assessment of injury level and pattern is critical for selecting the most appropriate flap surgery and optimizing treatment outcomes.

　Fingertip replantation at the SubzoneⅡlevel has become more feasible with advances in microsurgical techniques. However, this replantation remains technically demanding due to the narrow operative field, complexity of vessel dissection, and risk of thrombosis when injured arteries are inadequately debrided. We report three cases of complete SubzoneⅡfingertip amputations treated with arterial anastomosis using interpositional vein grafts, without venous or nerve repair. In each case, the injured artery was thoroughly trimmed, and a vein graft harvested from the palmar wrist or thenar region was used to allow tension-free, precise anastomosis. All replanted fingertips survived without signs of venous congestion. Only one case showed partial superficial necrosis, which healed with conservative management. Postoperative sensory recovery, assessed via the Semmes Weinstein monofilament test, was near normal in all cases. Patient-reported outcomes, such as Q-DASH and Hand 20 scores, were favorable. These findings suggest that vein grafting is a useful technique for extending the indications of fingertip replantation in SubzoneⅡinjuries, enabling flexible vessel alignment and reliable arterial reconstruction.

　We report a rare case involving a 40-year follow-up of a patient who underwent bilateral free gracilis myocutaneous flap transfers for circumferential scar contracture of the right lower leg due to a childhood burn injury. A flap from the right thigh was transplanted at age 10, followed by a similar flap from the left thigh at age 12. Both the flaps exhibited proportional growth with surrounding tissues and remained supple and elastic. The patient reported no subjective muscle weakness or motor impairment in the lower limbs. Although detailed surgical records were unavailable, ultrasonography and contrast-enhanced computed tomography provided insights into vascular anastomoses and flap perfusion. Sensory evaluation revealed protective or better sensation throughout most of the flaps, with diminished sensitivity only in locally thickened regions near vascular anastomosis sites, likely due to preserved nutrient vessels during debulking procedures. This case presents a rare opportunity to assess the long-term morphological and sensory outcomes of free flap reconstruction, offering valuable insights into flap durability and patient satisfaction over four decades.

　We report a case of cartilage destruction of the lunate bone caused by gouty tophus, treated with a medial femoral trochlear osteochondral flap. The patient was a 45-year-old man presenting with swelling and pain in the right wrist. Radiography and computed tomography revealed bone erosion and marginal sclerosis of the lunate. Based on these findings, Kienböck’s disease (Lichtman stageⅢA) was suspected, and surgical intervention was planned. Intraoperatively, a white, chalk-like substance was observed upon joint incision. The proximal articular surface of the lunate was removed and sent for pathological examination. Using a preoperatively constructed three-dimensional bone model for guidance, an osteochondral flap was harvested from the medial femoral trochlea and transplanted to reconstruct the proximal cartilage surface of the lunate. Pathological examination showed no evidence of bone necrosis but revealed eosinophilic fibrous deposits surrounded by foreign body giant cells, consistent with gouty tophus. Postoperatively, the symptoms resolved, and the osteochondral flap was successfully integrated.

　In the treatment of peripheral nerve injuries with nerve defects, collagen conduits have shown the potential for promoting nerve regeneration. However, there is concern related to the weak material properties. This study aimed to investigate the tensile strength and failure patterns in nerve defect models bridged with Renerve^® conduits through biomechanical research. Using fresh chicken sciatic nerves, we examined the maximum failure load and failure patterns of four groups: bridging models using Renerve^® with one suture（group A）, with two sutures（group B）, with three sutures（group C）, and end-to-end neurorrhaphy models with two sutures（group N）. Each group had eight specimens. As a results, group N showed a significantly higher maximum failure load（0.96±0.13 N）than groups A（0.23±0.06 N, p < 0.0001）, B（0.29±0.05 N, p < 0.0001）, and C（0.40±0.10 N, p < 0.0001）. Regarding failure patterns, all specimens in group A showed nerve end dislocation from the conduit. Specimens in group B and C failed due to circumferential cracks or cutting out of sutures from the conduit. This study suggests that the number of sutures in synthetic collagen nerve conduits has little effect on the tensile strength.