In the surgical treatment of a pressure ulcer, a surgical method must be selected according to the site, size, and depth of the pressure ulcer. To make a comparative study, 38 cases of sacral pressure ulcers and 13 cases of greater trochanteric pressure ulcers were classified into large or small sizes with a major axis of 5 cm at the tissue defect after removal of necrotic tissue and scar tissue. We examined the characteristics, indications of the surgical method, postoperative local complications, and countermeasures for the closure method of simple suture, local fascia flap, and perforator artery flap in the sacrum, simple suture, local fascia flap, and tensor fascia lata musculocutaneous flap in the greater trochanter.
　Local fascia flaps were safe for small sacral pressure ulcers because there were no serious complications and minor complications developed in less than 10%. Simple sutures were useful to close small sacral pressure ulcers and perforator artery flaps were effective for large sacral pressure ulcers, but countermeasures for serious complications must be considered because they developed in 33%.
　As there were no serious complications with small or large greater trochanteric pressure ulcers, tensor fascia lata musculocutaneous flaps are safe regardless of size.

　In the treatment of meningomyeloceles, plastic surgery is often requested to cover the skin and soft tissue defect after myeloplasty or meningomyeloceles recurrence by neurosurgery. When the extent of the defect is small, primary closure is usually possible; however, when the defect is extensive, reconstruction by skin grafts, musculocutaneous flap, or local skin flap is necessary, and several reconstruction methods have been reported. In this study, we performed a histopathological analysis of the sac membrane in meningomyeloceles, which are usually discarded, in four cases of meningomyeloceles at our department, and examined the possibility of using it as a skin graft for the donor site defect. Based on histopathological analysis, all sac membranes had normal skin structure, whereas the aneurysmal structures contained glial structures, suggesting that they should be closely monitored if used as skin grafts. In addition, there have been reports of good results using sac membranes as skin grafts, thus sac membranes may be useful for temporary wound closure.

　When treating foot diseases, physicians are sometimes confronted by patients’ strong will to preserve their foot even if major amputation is considered inevitable. Physicians cannot force patients to be treated against their will even when it is inconsistent with medical relevance. What should medical staff do when they are caught in a dilemma between the patient’s autonomy and medical indication?
　This article discusses the ethical aspects of the treatment of foot diseases, applying the four principles of biomedical ethics to a hypothetical case of limb ischemia. In this case, as the patient wishes to preserve his foot for as long as possible, the principles of non-maleficence and beneficence conflict with the principle of autonomy. In order to find a practical solution enabling patient-centered decision making in this conflictive case, medical staff must repeatedly ask the patient about his values and reconsider their own values behind medical recommendation. In addition, macroscopic and long-term perspectives are necessary such as the accumulation of medical evidence for foot diseases and improvement of the medical service system.