Surgical management of peripheral nerve disorders aims to prevent recurrent compression caused by adhesion and scarring following neurolysis or nerve repair. Conventional approaches include neurolysis, removal of scar tissue, and prevention of perineural adhesion. Coverage of the nerve with well-vascularized tissue has been considered essential to minimize re-adhesion, and various wrapping techniques using muscle flaps, skin flaps, and adipofascial flaps have been developed.
　Numerous procedures have been reported for recurrent cases after carpal tunnel release, for which neurolysis of the median nerve is required. Historically, nerve wrapping using muscle flaps began in the 1980s with the pronator quadratus muscle flap, followed by the palmaris brevis flap in the 1990s. Subsequently, radial artery–based fascial flaps, vein wrapping, and hypothenar fat pad flaps were introduced.
　More recently, perforator-based adipofascial and adipose flaps that preserve the major artery have gained attention. This article reviews the evolution of these techniques and highlights the clinical utility of pedicled perforator adipose flaps for nerve wrapping.

　Background: The maxilla is a complex anatomical unit responsible for mastication, speech, swallowing, orbital support, nasal airway function, and midfacial esthetics. After maxillectomy, particularly in cases with extensive alveolar defects, simple defect closure alone is often insufficient for functional recovery, emphasizing the need for integrated skeletal reconstruction and prosthetic rehabilitation. Methods: This exploratory case series involves 10 patients who underwent computer-aided design and manufacturing (CAD/CAM) -assisted maxillary reconstruction using vascularized fibular flaps between 2019 and 2025. Surgical planning based on the buttress theory aimed to reconstruct the infraorbital rim, alveolar buttress, nasomaxillary buttress, and zygomaticomaxillary buttress. We retrospectively analyzed prosthetic goals, postoperative prosthetic status, and postoperative oral intake assessed using the Functional Oral Intake Scale (FOIS) . Results: Complete reconstruction of all buttresses was achieved for six patients, resulting in skeletal morphology comparable to that of the native maxilla. Alveolar buttress reconstruction enabled prosthetic rehabilitation in most cases. Prosthetic outcomes included removable dental prostheses, implant-supported prostheses, and ongoing prosthetic treatment for three, two, and three patients, respectively. Implant-supported rehabilitation was associated with favorable oral intake (FOIS, 6, 7) . Conclusions: CAD/CAM-assisted fibular flap-based maxillary buttress reconstruction enables anatomically oriented skeletal reconstruction and supports effective prosthetic rehabilitation, potentially improving functional and esthetic outcomes after maxillary reconstruction.

　Successful microvascular anastomosis is crucial for achieving favorable outcomes in procedures such as free tissue transfer and digit replantation, and various microsurgical anastomotic techniques have been described. Most surgeons rely predominantly on their dominant hand for needle holder manipulation, but this approach may be challenging in certain clinical situations. Therefore, we developed the hand-switch technique. in which the needle holder is switched between the dominant and non-dominant hands during suturing. In this study, we aimed to describe this technique and evaluate its feasibility by using a chicken wing artery model under a tabletop microscope and comparing it with a conventional dominant-hand technique. End-to-end arterial anastomoses were performed on a chicken wing ulnar artery model using a conventional technique and the hand-switch technique, with 10 anastomoses in each group. Anastomosis time and quality were assessed using the medication adherence rating scale 10 (MARS 10) score. No statistically significant differences in anastomosis time or MARS 10 scores were observed between the two groups. The hand-switch technique did not compromise anastomotic quality compared with the conventional technique performed by an experienced microsurgeon. The hand-switch technique may be a feasible option for microvascular anastomosis under the present experimental conditions.

　While mandibular reconstruction procedures using a free fibula flap are well-established, intraoperative bone cutting and plate adjustment remain technically demanding and time-consuming. Recent reports demonstrate the efficacy of computer-aided design and manufacturing (CAD/CAM) systems in reducing operative time and complications, but their use is often limited owing to high costs and dependence on commercial vendors. We created a low-cost surgical cutting guide using free three-dimensional (3D) computer graphics software and applied it to mandibular reconstruction surgery for a 63-year-old woman. Computed tomography data were converted into stereolithography (STL) format using Synapse Vincent and imported for virtual reconstruction planning. A cutting guide, designed with gripping holes, was fabricated using a 3D printer. In clinical application, the guide fit well to the fibula, allowing accurate osteotomies. Shaping the bone and fixing the plate took 23 minutes (conventional average time, 104–132 minutes) , and ischemia time was reduced to 86 minutes. Postoperative plain radiographs confirmed correct bone alignment of the reconstructed mandible and no complications were observed during postoperative follow-up. This workflow enabled efficient and accurate mandibular reconstruction without the use of costly CAD/CAM systems and could serve as a practical alternative for institutions not able to purchase expensive, commercially available software.

　A 20-year-old man presented to an outside hospital with bilateral femoral shaft fractures and left sciatic nerve palsy following a motorcycle accident. The femoral fractures were fixed on day 8 post-injury. The left sciatic nerve was surgically explored 7 days later, revealing a defect too large to reconstruct using a sural nerve graft. He was then referred to our hospital for further evaluation and treatment. At 15 weeks post-injury, delayed reconstruction using an ipsilateral common peroneal nerve graft was performed. Intra-operatively, the nerve defect length measured 13.5 cm. After dividing the sciatic nerve into its tibial and peroneal trunks, the peroneal trunk was harvested and used to reconstruct the tibial trunk using a double-cable graft technique. The patient’s postoperative course was uneventful. At a 2-year follow-up, he had achieved grade 4 plantar flexion. At 4 years postoperatively, plantar sensation was present, but Semmes–Weinstein testing showed loss of protective sensation. He was able to run and perform daily activities without requiring the use of an ankle-foot orthosis. The double-cable technique using an ipsilateral peroneal nerve graft may be considered as a salvage option for reconstructing large sciatic nerve defects when sural nerve grafting is not possible.

　A 48-year-old man, who sustained an open tibial fracture in a motorcycle-car collision, presented with two small (approximately 2 cm) wounds on the proximal lower leg, which initially suggested limited superficial injury. Plain radiographs showed an AO/OTA 42C3 comminuted tibial shaft fracture. Emergency surgery with external fixation and wound irrigation was performed, followed by negative pressure wound therapy for severe swelling. Second- and third-look procedures revealed extensive deep muscle damage involving both the anterior and posterior compartments, necessitating staged debridement and resulting in a large 8×15 cm anterior soft-tissue defect with bone exposure. A free latissimus dorsi musculocutaneous flap was used for reconstruction and the area healed without complications, followed by split-thickness skin grafting. Despite the small bone defect, bone union was not achieved, and surgery for nonunion was required at 6 months post-injury. At final follow-up 12 months post-injury, satisfactory bone union and functional recovery were achieved. This case highlights that small open wounds may conceal extensive deep soft-tissue injury in high-energy comminuted fractures, emphasizing the importance of careful zone-of-injury assessment, adequate debridement, and appropriate staged reconstruction.

　Autologous breast reconstruction has an important role in improving post-mastectomy quality of life. With increasing attention to hereditary breast and ovarian cancer syndrome, the number of patients undergoing bilateral mastectomy and requesting bilateral reconstruction is expected to increase. A deep inferior epigastric artery perforator (DIEP) flap is widely used because it allows for sufficient volume reconstruction while preserving the abdominal muscles. Conventionally, bilateral breast reconstruction using DIEP flaps requires the bilateral internal mammary artery and vein (IMA and IMV, respectively) as recipient vessels. Here, we report a case of bilateral breast reconstruction using bilateral DIEP flaps anastomosed exclusively to a unilateral internal mammary vascular system. A 47-year-old woman with hereditary breast and ovarian cancer syndrome underwent bilateral mastectomy, followed by delayed bilateral breast reconstruction using bilateral DIEP flaps. The left IMA and IMV were preserved, and both flaps were anastomosed to the right IMA and IMV. One flap was transferred through a pre-sternal tunnel into the contralateral breast pocket. Both flaps survived without post-operative complications, and satisfactory aesthetic outcomes were maintained during a 2-year follow-up. This case suggests that bilateral DIEP flap breast reconstruction using a unilateral internal mammary vessel system is a feasible and safe option for some patients.

　Our center launched a “Digit Trauma Hotline” on October 1, 2022, in response to Advanced Life Support Center guidelines for “facilities capable of accepting patients with special conditions such as severe trauma, extensive burns, amputated digits, and acute poisoning 24 hours per day.” Prior to establishing the hotline, patients with specific types of trauma, such as amputated digits, were accepted at our center. However, because of the COVID-19 pandemic and resulting frequent instances of difficult-to-transport patients, the Hotline was launched. The Digit Trauma Hotline’s purpose is to reduce the burden on emergency crew members when selecting transport destinations, and to centralize case management. This hotline handles calls relating to a wide range of limb injuries, from minor lacerations to amputated digits and foot injuries. It operates with the goal of accepting all patients, and it relies on the cooperation of various departments and sections. This report summarizes the first 3 years of operation and its current status.

　Peripheral nerve injuries with extensive defects are often challenging to treat. Although second-generation collagen nerve conduit is a promising alternative to autologous nerve grafts, there are concerns about the limited early postoperative range of motion due to the conduit’s weak material properties. This biomechanical study demonstrates the potential weakness of conventional suturing techniques in a nerve defect model using a collagen nerve conduit. We also investigated the effectiveness of a novel suturing technique, the suspension bridge method (SBM) , which directly connects nerves using sutures without relying on the conduit strength. We used fresh chicken cadaver sciatic nerves to compare the maximum tensile strength of SBM using 2 sutures (group A) against traditional suturing methods using 2 and 3 sutures (groups B and C, respectively) , and end-to-end neurorrhaphy with 2 sutures (group D) . We also evaluated the mechanical properties by analyzing the stress-strain curves. Group A exhibited a significantly higher maximum failure load (1.32±0.56 N) than group B (0.29±0.05 N, p < 0.001) and group C (0.40±0.10 N, p < 0.001) , but not significantly higher than that of group D (0.96±0.13 N, p = 0.056) . The stress-strain curve showed steeper slopes in groups A and D than in groups B and C. Our results indicate that SBM offers an improved maximum failure load and better resistance to tension compared to traditional methods. This technique may be an effective alternative to conventional suturing methods using collagen nerve conduits.