Distal nerve transfer has been widely used to treat upper limb paralysis; however, its application in lower limb paralysis remains limited. Here, we report three cases of common peroneal nerve palsy treated with partial tibial nerve transfer. The patients developed foot drop following total hip arthroplasty, traumatic hip dislocation, and endovenous laser ablation for varicose veins. The mean patient age was 73 years, and the preoperative manual muscle test (MMT) grade of the tibialis anterior muscle was 0 in all cases. Nerve transfer was performed at a mean of 6.0 months after injury. A motor fascicle of the tibial nerve containing branches to the soleus or toe flexor muscles was transferred to the motor branch of the tibialis anterior muscle or the deep peroneal nerve using end-to-end neurorrhaphy. At a mean follow-up of 32 months, the MMT grade of the tibialis anterior improved to 3, 3, and 4. All patients were able to walk independently without an ankle–foot orthosis, and no donor nerve deficits were observed. Tibial nerve transfer may represent a useful surgical option for common peroneal nerve palsy.

　I investigated the long-term results over a 20-year follow-up period after free scapular flap transfer for pediatric dorsal foot run-over injuries. The study included four cases: three male and one female, with ages at injury ranging from 3 years and 3 months to 7 years and 7 months. Hypoplasia, pes cavus deformity, and toe movement disorders were observed on the affected side. Radiographic examination revealed ankle joint osteoarthritis, metatarsal bone defects, and growth disorders. As children grow, they tend to adapt to foot deformities resulting from severe trauma, and their limited toe movement and deformities did not interfere with activities such as walking. The ankle joint is susceptible to developing osteoarthritis due to daily weight-bearing loads, which can cause pain. No functional impairment or significant cosmetic concern was observed at the donor-site shoulder joint.

　Background: Medical students have few opportunities to experience microsurgery during clinical clerkships. We introduced manga into a microsurgical training session. This study aimed to evaluate the educational impact of this program, with particular attention to the role of microsurgical training and manga as learning tools.
　Methods: Students participated in a microsurgery session comprising a short lecture, microsurgical training, and reading TENOGEKA. After the lecture, students were divided into two groups and alternated between hands-on training and manga reading. During the training session, students practiced needle handling under an operating microscope. Task completion time was recorded. A questionnaire assessed participants’ familiarity with microsurgery and TENOGEKA, the usefulness of each component, and the most interesting component.
　Results: Fifty-five students participated in this study. Of these, 18.2% were familiar with microsurgery and 5.5% were familiar with TENOGEKA. The proportion of students who rated the lecture, microsurgery training, and TENOGEKA as “very useful” differed significantly among the three components (p < 0.05) . The mean task completion time was 198±117 s and showed a weak negative correlation with training order (p < 0.05) .
　Conclusions: Microsurgery training and TENOGEKA may help increase medical students’ interest in microsurgery. The use of manga as an educational resource may improve the efficiency of practical training.

　Background: The deep inferior epigastric perforator (DIEP) flap is widely used in breast reconstruction. Venous congestion is a critical complication, often due to insufficient venous drainage. Although the deep inferior epigastric vein (DIEV) is the main venous outflow, some flaps show superficial inferior epigastric vein (SIEV) dominance. Superdrainage using the SIEV can improve perfusion in such cases. This study aimed to describe cases requiring SIEV superdrainage and evaluate intraoperative findings, including indocyanine green (ICG) angiography and SPY-Q analysis.
　Methods: Among 230 DIEP breast reconstructions (240 flaps) performed between 2008 and January 2025, four flaps (1.7%) developed venous congestion requiring SIEV superdrainage. The recipient veins, intraoperative ICG angiography findings, and SPY-Q-derived parameters, including the ingress rate, were descriptively analyzed.
　Results: Superdrainage was performed to the cephalic vein (n=1) , internal mammary vein (n=1) , and DIEV branches (n=2) . All flaps survived completely. ICG angiography revealed delayed or heterogeneous perfusion in all cases. In cases for which SPY-Q analysis was available, the ingress rate tended to be lower than that reported in previous studies.　
　Conclusion: SIEV superdrainage may be effective in managing venous congestion in selected DIEP flap cases. These cases showed a decreased ingress rate in the congested flaps, suggesting its potential as an adjunctive indicator. Further studies with larger cohorts are required to validate these findings.

　Retrosternal gastric conduit necrosis after esophageal bypass is a rare but serious complication requiring complex salvage reconstruction. Here, we report a case successfully treated with free jejunal transfer combined with a pectoralis major muscle flap.
　A 68-year-old man with unresectable advanced thoracic esophageal cancer underwent esophageal bypass using a Y-shaped gastric conduit via the retrosternal route. Postoperatively, he developed pneumonia, cervical infection, and anastomotic leakage, followed by partial necrosis of the gastric conduit extending to the posterior surface of the sternum. Salvage surgery was performed on postoperative day 25. Limited hemisternectomy resulted in insufficient operative exposure and intraoperative injury to the gastric conduit during sternal division, necessitating reconstruction using a free jejunal graft. Microvascular anastomoses were performed to the transverse cervical artery and the external jugular vein. A pectoralis major muscle flap was used to cover the anastomotic site and prevent local complications.
　This case highlights the importance of adequate surgical exposure during sternal resection and demonstrates the usefulness of the pectoralis major muscle flap in high-risk salvage esophageal reconstruction.

　The reverse superficial sural artery flap is highly useful for reconstructing small skin defects in the distal lower leg and hindfoot. However, this flap is prone to circulatory instability because it relies on retrograde blood flow through small-caliber feeding vessels and has a blind-ended venous system. To address these issues, a delay procedure, in which flap transfer is performed in two stages, and superdrainage, involving an anastomosis of the small saphenous vein to a recipient vein at the defect site, have been proposed.
　In this study, we evaluated the usefulness of these two techniques using transcutaneous carbon dioxide (TcpCO₂) monitoring, which enables noninvasive and continuous assessment of tissue perfusion.
　Our results suggest that superdrainage may contribute to the stabilization of flap hemodynamics. Furthermore, in some cases treated with superdrainage, the delay procedure may be omitted.
　TcpCO₂ monitoring may serve as a useful tool for determining whether to proceed to the next stage at each step of treatment.

　Background: The wrap-around flap is an established surgical technique that provides functional and aesthetic reconstruction for thumb defects. Although postoperative infection is uncommon, it can severely compromise surgical outcomes. This report presents two cases of delayed infection following thumb reconstruction using a wrap-around flap.
　Case presentation: Case 1 involved a 45-year-old man who developed an infection 6 years after thumb reconstruction. Case 2 involved a 29-year-old man who presented with purulent discharge 9 months after thumb reconstruction. Both patients sought medical attention 1 week after symptom onset. Radiographs confirmed osteolysis around retained Kirschner wires (K-wires) , suggesting that their prolonged retention contributed to the delayed infection. The infections were successfully managed by removing the fixation wires, performing repeated debridement, and placing antibiotic-impregnated cement.
　Conclusions: Prolonged retention of K-wires may contribute to delayed infection after wrap-around flap reconstruction. Careful determination of the duration of internal fixation and patient education regarding early consultation are essential to prevent and manage such complications.

　We treated three cases of thumb tip defects with distal phalangeal exposure using a reverse homodigital flap based on the radial proper digital artery of the thumb. Preoperative ultrasonography confirmed the presence and patency of both the radial and ulnar proper digital arteries. The flap was designed along the radial midaxial line of the thumb, centered on the metacarpophalangeal joint, with the pivot point at the interphalangeal joint. The radial digital nerve was identified and preserved, and retrograde arterial flow was confirmed intraoperatively before flap elevation. The donor site was primarily closed in all cases. Complete flap survival was achieved in one case. Transient distal vascular compromise occurred in one case, and partial distal flap necrosis occurred in another; both cases healed with conservative treatment. No deep infection or osteomyelitis developed. Mild postoperative numbness was observed in all cases; however, it did not interfere with activities of daily living or return to work. This flap may represent a useful reconstructive option for thumb tip defects because it uses local thumb tissue and avoids donor-site morbidity in other digits. However, careful patient selection and flap design are essential because the flap relies on retrograde blood flow.

　The free fibula flap is widely used for mandibular reconstruction, allowing simultaneous reconstruction of bone and soft tissue. However, anatomical variations of the perforator supplying the skin paddle may complicate its preservation.
　Here, we report a case in which the perforator originated from the tibioperoneal trunk instead of the peroneal vessels. The perforator was dissected proximally and transected after branching from the tibioperoneal trunk and was then anastomosed to the distal end of the peroneal vessels, enabling preservation of the skin paddle as a chimeric flap.
　The flap survived completely, and no postoperative complications, including infection, were observed. This technique may be a useful option for preserving the skin paddle in cases with anatomical variations of the perforator.