The medial sural artery perforator flap (MSAP) is useful for reconstructing thin, pliable regions such as the palm and foot and can include the great saphenous vein as a donor vein or be converted into a free muscle flap using the medial gastrocnemius. We reviewed four free MSAP performed between December 2023 and June 2025. Patients (three men, one woman; aged 54–77 years, mean 65.8) had defects caused by infection (palm 1, foot 1) , frostbite (1) , and trauma (1) . Flap sizes ranged from 10×5 cm to 18×7 cm. One flap developed venous congestion on postoperative day 1 and necrosed, requiring transfer of an anterolateral thigh flap. The other three survived; in one case, perforator injury required conversion to a medial sural artery free muscle flap followed by delayed skin grafting. Donor veins were venae comitantes in three cases and the great saphenous vein alone in one. Necrosis likely resulted from kinking at the dorsoplantar junction and vascular compression. Adequate flap length and gentle positioning are essential. Even with a single great saphenous vein, flap survival was satisfactory, confirming its reliability as a drainage route.

　A 55-year-old man sustained a right elbow sideswipe injury in a car accident, resulting in loss of the lateral collateral ligament (LCL) , extensor tendons, and the bony origin of the LCL. Emergency debridement and negative-pressure wound therapy were performed on the day of injury, followed by delayed reconstruction. A vascularized bone graft, a cancellous bone block, and the intermuscular septum were harvested from the medial femoral condyle. The cancellous and vascularized bones were used to sandwich the septum, which was interposed under tension at the lateral epicondyle to reconstruct the origin of the LCL. Active range-of-motion exercises began four weeks postoperatively. Bone union was achieved within three months. At final follow-up, the patient achieved elbow extension to –15°, flexion to 130°, supination to 90°, pronation to 75°, and grip strength of 36 kg, without instability on stress radiography or donor site complaints. This case demonstrates that a vascularized bone graft combined with a cancellous bone block can effectively reconstruct the origin of the LCL in elbow sideswipe injuries. Vascularized grafts may reduce the risk of bone resorption and nonunion in blind-ended bone defects, contributing to stable and functional recovery.

　Background: A patient underwent extensive resection of a malignant soft-tissue tumor located anterior to the elbow, resulting in extensive loss of skin, the brachial artery, the median nerve, and the elbow flexor muscle. Functional reconstruction was performed using a combination of plastic and orthopedic surgical techniques, with excellent outcomes.
　Case Report: A 59-year-old man underwent wide resection of a high-grade soft tissue sarcoma involving the brachial artery, median nerve, and elbow flexor muscle, resulting in extensive soft tissue loss. First-stage reconstruction included vascular reconstruction using a great saphenous vein graft, elbow flexion reconstruction using the Zancolli method, and soft tissue coverage with a latissimus dorsi musculocutaneous flap.
　At 3 months postoperatively, second-stage reconstruction included tendon transfers to restore flexion of the thumb to middle finger and sensory reconstruction using very distal sensory nerve transfer with the dorsal radial sensory branch.
　At 1 year, elbow flexion reached manual muscle test 5. Finger flexion and protective sensation were restored, and daily function improved significantly. The patient reported high satisfaction.
　Conclusion: The combination of plastic and orthopedic techniques achieved successful functional restoration. This case supports the utility of an orthoplastic approach in complex oncologic reconstruction.

　Soft tissue reconstruction is crucial in Gustilo typeⅢB open lower leg fractures, free flap reconstruction is indicated when defects are extensive. In lower leg soft tissue reconstruction, the anterior tibial artery (ATA) or posterior tibial artery is commonly selected as the recipient vessel for free flaps among the major arteries of the lower leg. However, no consensus exists regarding reconstruction methods or the selection of recipient vessels and anastomotic techniques when these major arteries are occluded. In this case, we performed free flap reconstruction using a latissimus dorsi muscle flap with the medial sural artery (MSA) as the recipient vessel in a Gustilo typeⅢB open lower leg fracture complicated by ATA occlusion, achieving favorable results. The MSA may be a useful option as a recipient vessel for reconstruction of open lower leg fractures complicated by occlusion of major arteries or in single-vessel limbs.

　We report a case of partial injury of the lateral antebrachial cutaneous nerve treated with neurolysis and nerve wrapping using a slit-type collagen conduit. A 78-year-old male experienced pain in his right antecubital fossa after blood sampling. He presented with persistent pain and hypesthesia of the lateral forearm. Neurolysis and nerve wrapping were performed six months after the injury. Intraoperatively, the lateral antebrachial cutaneous nerve was adherent to the surrounding tissue, and its fascicle was injured. The nerve was released and wrapped with a slit-type collagen conduit. The patient returned to work six weeks after surgery. Fourteen months postoperatively, grip strength increased from 27 kg to 35 kg, and the Hand20 score improved from 54 to 1.5. Neurolysis and nerve wrapping using a slit-type collagen conduit is a relatively simple technique that is easy to use for partial nerve injury and can reduce adhesion to surrounding tissues and scar formation.