It is a plastic surgeon's mission to cure a wound with the best aesthetic outcome.
However, plastic surgeons are often involved in late post-trauma treatment, when serious deformities such as scar contracture have already arisen. In these cases, plastic surgeons must manage collaboration and communication with other specialists. To achieve that goal, it is important to clarify the treatment plan regarding the size, shape, depth, area of contamination and characteristics of the anatomic defect. In addition, the anticipation of a secondary repair must be considered.
Here, we present multiple dog-bite injury cases, which have increased in incidence due to the recent pet boom. These injuries often involve the naso-labial area where early fundamental treatment and advanced reconstruction are important.

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Leg and foot are known as regions with relatively poor blood circulation. Diabetic foot ulcers have complex causes and are difficult to heal. Because recovery from a diabetic foot ulcer is thought to be very difficult, amputation below or above the knee is sometimes selected. The main etiologies of diabetic foot ulcer are divided into three categories : neuropathic (45%), neuroischemic (24%), and ischemic ulcers (16%). Finding the main etiology of a diabetic ulcer is very important and the first thing to be done before treatment. When the foot ulcer is due to ischemia, the obstructed portion in the artery should be found. Revascularization by surgical bypass procedure or percutaneous transluminal angioplasty can be performed for good healing of the ulcer. When the patient has a neuropathic DM ulcer that does not show significant arterial disease, free flap transfer after debridement can be performed using side-to-end or flow-through arterial anastomosis to avoid amputation of the limb. Microsurgical flap transplantation was useful for minimum amputation of diabetic foot in our experience. Postoperatively, attention has to be paid to neuropathy in these patients because the causes of their foot ulcers include sensory and motor disturbances.

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Artificial dermis (AD) is beneficial for the resurfacing of wounds. However, it has been used experimentally by surgeons without standardization. We studied clinical cases of AD to investigate its effective usage. A total of 120 patients with a wound were treated with AD in our medical center from 2006 through 2010. Their diagnoses included trauma (28%), anomaly (28%), neoplasm (14%), and burn (8%). AD can reduce the severity of Gustilo-AndersonⅢB or C to Gustilo-AndersonⅢA, which may allow resurfacing with a free skin graft. Even bone-exposing wound could be resurfaced, and showed less contraction after application onto the mucoperiosteal denuded hard palate. AD can protect the wound long enough to prevent the open wound from resurfacing immediately until secondary surgery can be performed after biopsy. Combination treatment with basic fibroblast growth factor and AD has been shown to prepare a wound bed suitable for free skin grafting, This method is straightforward, leads to minimal morbidity, and is thus useful for the treatment of all wounds including complex chronic ulcers.

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Since we developed an artificial dermis (Pelnac^®, Gunze, Ltd., Kyoto, Japan), we have created improvements based on problems encountered in clinical use.
During the period until secondary grafting, low resistance to infection is a clinical problem. To overcome this issue, topical application of basic fibroblast growth factor (bFGF) is beneficial to induce neovascularization and accelerate the regeneration of dermis-like granulation tissues in the artificial dermis. There fore, combination therapy using artificial dermis and bFGF has been established. However, since the in vivo half-life of bFGF is very short, repeated application into the artificial dermis is required in this combination therapy. We have developed a novel artificial dermis for sustained release of bFGF. In this paper, we report the deployment circumstances and the future role of this novel matrix.

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Surgical site infections (SSIs) are important complications that cannot be prevented completely. We evaluated our wound therapies and the period required to obtain wound closure.
We retrospectively investigated 15 consulted cases, of which 8 cases were deep incisional SSI and 7 cases were organ / space SSI.
The mean periods of wound closure were 53.1 days in the deep incisional SSI group and 110.3 days in the organ / space SSI group. The mean lengths of hospital stay were 39.3 days and 72.7 days. The mean periods of our wound therapy were 49.1 days and 90.6 days. Negative pressure wound therapy was performed in 73% of cases and combined with skin graft and flaps.
Deep incisional SSI wounds could close in about 50 days by a plastic surgeon's interventions.

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Treatment of skin necrosis after arthroplasty often poses a challenge, especially when it is accompanied by exposed prostheses. The standard treatment for this complex wound is to remove the prosthesis and perform a second arthroplasty after the infection is controlled. Patients in whom a second arthroplasty is difficult could lose joint function. We treated skin defects and retained the once- or non-exposed prostheses to maintain joint function when we judged that the infection was limited to the wound and could potentially be controlled.
We present our algorithm for the treatment of ulceration after arthroplasty and the clinical outcomes of 4 patients with 5 ulcerations. Good outcomes were obtained for 4 joints with exposed prostheses after successful flap coverage during the clinical course (range, 18-61 months) ; however, we failed to treat one wound reaching the fascia in depth after total knee arthroplasty, and removed the prosthesis because of deep infection. Hence, from on our clinical experience, we believe that a flap cover could be useful for exposed prostheses after the infection is controlled.

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