This study retrospectively examined 13 hands of 13 patients with severe hand injuries involving palmar defects who underwent free flap reconstruction during the acute phase. Concomitant injuries of the dorsal hand and fingers were common. The medial plantar artery (MPA) flap, the first-choice method for palmar reconstruction, was used in five cases; however, in many patients, it could not be applied because of extensive injury or complex flap design. In such cases, a superficial circumflex iliac artery perforator (SCIP) flap was actively used as a second-line option. Arterial anastomosis was performed within the palm in approximately half of the patients, whereas venous anastomosis was often performed outside the palm. Sensory nerve coaptation was performed in only two cases. These findings highlight that careful flap selection and planning of recipient vessels, considering the extent of the defect and flap design, are critical for successful free flap reconstruction in acute severe palmar injuries.

　A free vascularized medial femoral trochlear (MFT) osteochondral flap, based on the descending genicular artery, is an effective surgical technique for reconstructing the scaphoid proximal pole. It provides excellent blood flow and sufficient structural strength, along with healthy hyaline cartilage and subchondral bone. We treated three male patients with advanced avascular necrosis of the scaphoid proximal pole using an MFT flap. The patients included two cases of Preiser disease and one case of scaphoid nonunion. The average patient age was 55 years (range, 34-70 years) . All patients underwent a dorsal approach with excision of the necrotic proximal pole, followed by MFT flap reconstruction. Clinical and radiological evaluations included assessment of bone union, visual analog scale (VAS) , grip strength, range of motion, QuickDASH scores, scapholunate angle (SLA) , and carpal height ratio (CHR) . Bone union was achieved in all cases at an average of 12 weeks (range, 11-13 weeks) . The VAS score improved from 63 to 8, grip strength increased from 56% to 76% of the contralateral side, and the QuickDASH functional scores improved from 16.2 to 4.9. The SLA improved from 84° to 73°, and the CHR improved from 0.48 to 0.49. The MFT flap provides reliable revascularization and structural reconstruction, offering an effective alternative to salvage procedures for advanced scaphoid avascular necrosis.

　Lymphedema after solid organ transplantation is rare but may become clinically significant under immunosuppressive therapy. We report the case of a 56-year-old woman who developed bilateral lower-extremity lymphedema (LEL) after heart transplantation for idiopathic dilated cardiomyopathy. The patient was maintained on prednisolone, tacrolimus, and everolimus. Despite compression therapy and lymphatic drainage, the edema progressed. Preoperative assessment showed LEL indices of 287.8 (left) and 238.6 (right) . Lymphoscintigraphy demonstrated dermal backflow patterns in both lower legs, while lymphatic flow to the venous angle was preserved, excluding central obstruction. Under general anesthesia, lymphaticovenous anastomosis (LVA) was performed, with five anastomoses on the left and two on the right. The patient was discharged without complications. At 12 months, the LEL indices improved to 247.8 (left) and 230.4 (right) , with a marked reduction in dermal backflow. Cardiac function remained stable. This case represents the first report demonstrating both clinical and imaging improvement of post-heart transplant lymphedema following LVA. Careful preoperative imaging to guide surgical planning and long-term follow-up are essential to achieving and maintaining favorable outcomes.

　Venous malformations (VMs) are the most common type of vascular malformation and often cause pain, swelling, coagulopathy, and severe impairment of quality of life. Conventional treatments, including partial resection or sclerotherapy, may be insufficient for extensive lesions with skin involvement owing to bleeding risks and limited efficacy. We report the case of a 57-year-old man with an extensive thoracoabdominal VM involving the skin, subcutaneous tissue, and muscles. A two-stage surgical approach with serial excision and bilateral free anterolateral thigh (ALT) flap reconstruction was performed. The first surgery removed the dorsal lesion (26×25 cm) , followed by reconstruction using a right ALT flap. The second surgery was performed 11 months later, and the ventral lesion (20×15 cm) was resected, followed by reconstruction with a left ALT flap. Both flaps survived without major complications. Postoperatively, pain resolved, cosmesis improved, and the patient resumed normal activities. ALT flaps provide sufficient tissue volume and long pedicles for safe anastomosis away from diseased areas and allow reconstruction without repositioning. This case demonstrates that staged excision followed by free ALT flap transfer can achieve effective functional and aesthetic outcomes for giant VMs with skin invasion while minimizing complications.

　At the 51st Annual Meeting of the Japanese Society for Reconstructive Microsurgery held in 2024, the Supermicrosurgery Vessel Anastomosis Contest was held for the first time in three years. A total of 33 teams applied, and after a pre-screening video review, preliminary rounds, and finals, the winning team was “Plastic surgery top team,” which had also won the previous competition. Frozen chicken wings were used as the vascular material, and the anastomosis techniques and evaluation criteria were consistent with those used in previous studies. In terms of organization, there were challenges related to venue availability and schedule adjustments; however, the event concluded successfully with great enthusiasm. The contest holds multifaceted significance, including the promotion of education, research, and human resource development, as well as fostering international exchange. Continued hosting and development of the event are highly anticipated in the future.

　Recent advances in minimally invasive perforator flaps, such as the superficial circumflex iliac artery (SCIP) flap, have increased the demand for anastomosing vessels with diameters less than 0.8 mm. However, discrepancies in size can occur, underscoring the significance of end-to-side anastomosis. Nevertheless, the conventional interrupted end-to-side suturing technique with vessel turnover presents challenges in situations with a limited operative field, short vascular pedicle, and tiny vessels. Therefore, we developed an intravascular flipping technique for end-to-side microvascular anastomosis with an “inside” rotation method or a “rotation-outside” method. The study involved 20 rats, with 15 arteries in 10 rats undergoing the flipping technique using inside or outside rotation. Both the inside and rotation-outside techniques exhibited a 100% immediate patency rate in rats; however, after 1 week, this decreased to 80% and 86%, respectively. The SCIP flap and replantation procedures were successfully performed. The flipping technique offers several advantages, including ease of vessel manipulation using nylon threads and vascular clips, improved vessel visualization, and spontaneous widening of the vessel lumen.

　The anastomosis of vessels < 0.5 mm in diameter is challenging. We developed a supermicrosurgical anastomosis method, the dual intravascular stent flipping technique, which uses a 7-0 nylon intravascular stent and either a double or single microclip. In rats, the double-clip technique was performed on 20 saphenous and 15 superficial inferior epigastric arteries, assessing immediate and 1-week patency, and the single-clip technique on 10 epigastric arteries. Clinically, the dual flipping technique was applied to 21 vessels in 9 cases of digital replantations and flap surgeries. Using the double-clip technique, immediate patency was 90% (saphenous) and 93% (epigastric) , and 81% at 1 week; with the single-clip, immediate patency was 100%. All clinical replantation and flap cases were successful. Advantages of this technique include easy stent insertion, minimal slippage, spontaneous vessel dilation by the flipped stent, and easier posterior-wall suturing (even without reversing clips) . The dual flipping technique enables relatively easy anastomosis when insertion of forceps into the lumen is difficult.