The three-dimensional structure of living organisms is influenced by various physical factors, including gravity, atmospheric pressure, and water pressure. Thus, mechanobiology is important in the field of wound surgery. Mechanobiology is an emerging field of science which focuses on the way that physical forces and changes in cell or tissue mechanics contribute to development, physiology, and disease. Cells convert intrinsic and extrinsic mechanical stimuli into electrical signals through mechanoreceptors (mechanosensors) such as mechanosensitive ion channels, cell adhesion molecules, and actin filaments in the cytoskeleton. This signal conversion results in accelerated cell proliferation and matrix maturation during the course of tissue growth. Skin and soft tissues are organs those are always affected by mechanical forces, thus wound surgeons need to know the mechanobilogy and mechanotherpay for surgery, wound healing and tissue repair and regeneration.

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Adequate debridement combined with antibiotics is very important to treat chronic sternal osteomyelitis. Although Magnetic Resonance Imaging (MRI) has been recognized as an effective imaging tool for the assessment of osteomyelitis, the difference in the wound healing process is still unclear. We report the characteristics of MRI in two patients with chronic sternal osteomyelitis. Marrow replacement by low signal intensity on T1-weighted images and corresponding high signal intensity on STIR images is characteristic of osteomyelitis. However, these signals decreased over the course of the wound healing process. In the case of a dead bone, the signal became unclear because of insufficient fluid.
In conclusion, although the present study included a limited number of subjects, it demonstrated that, in chronic sternal wounds, osteomyelitis can be reliably detected by MRI. The change of image corresponded to the wound healing process.

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The autologous cultured epidermis, JACE, which is the first cellular product in Japan, provides a new therapy for the wound closure of major burns. Data on its safety and efficacy are being collected in post-marketing surveillance of all cases in which this product was used under national health insurance coverage since 2009. The average area of skin biopsy obtained from a patient to make the product was 8 cm² and the average number of products grafted on a patient was 24 sheets, whose area was approximately 240-fold larger than the biopsy area. The average period that elapsed from injury to biopsy was 8.6 days, and in a few cases with delayed biopsy, contamination occurred in the process of cultivation. In the ongoing survey, the rate of cases in which an artificial dermis was used to reconstruct the dermis for graft beds was greater than that of cases in which cadaver skin was used. The use of a combination graft called the hybrid method, in which the products simultaneously cover the meshed split-thickness autograft, increased recently. It will be necessary for the efficacy of the combination graft to be verified and the procedures achieving wound healing with an artificial dermis or cadaver skin to be standardized in the treatment of burns using this product.

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A key to successful breast reconstruction with a breast expander is the creation of an appropriately sized cavity at a proper position for implanting a breast prosthesis. With an appropriate cavity, it is normally unnecessary to add extra dissection in the replacement of the breast expander with a breast prosthesis. No addition of extra dissection reduces the risk of capsule contracture by hematoma and breast prosthesis malposition by unexpected movement. Moreover, accurate expansion with an expander could achieve an appropriate breast prosthesis choice without specialized equipment or seat-of-the-pants decision-making. However, one important point to remember is that an expander itself has a volume of over 60ml, depending on the type or size. The volume of the expander itself may produce serious asymmetry of the breasts.

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In the treatment of critical limb ischemia, revascularization of the affected extremity through surgical bypass or endovascular therapy plays a crucial role in limb salvage. There is no evidence on the choice of revascularization, making the decision difficult for plastic surgeons who are not adept at revascularization. We analyzed whether or not the conditions of leg ulcers （extent and infection） could be used as selection criteria for revascularization. For foot ulcers distal to MTP joints and for uninfected ones, EVT should be the first option. On the other hand, for those extending proximal to MTP joints, on the heel, or that are infected, bypass surgery should be the first option, especially in that the rate of major amputations is higher in EVT cases.

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Negative pressure wound therapy（NPWT）has been shown to accelerate wound healing. We applied NPWT to eight patients who had fingertip injuries with bone exposure. Rehabilitation of finger joints was continued under NPWT. The treatment period, sensation, range of motion, and fingertip shape were evaluated after the treatment. The average treatment duration decreased from 75.0 days ( non-NPWT, ointment therapy only ) to 53.8 days ( 17.9 days under NPWT + 35.9 days under ointment therapy ). The mean S-2PD of the fingertip after 6 months was 3.8mm, and the mean M-2PD was 2.6mm. The length of fingers treated by NPWT was maintained because there was little absorption of the bone in the distal phalanx. The shape of fingertips was acceptable and the nail plates were partially regenerated in all patients. A donor site is not required using this method. NPWT for fingertip injuries appeared to be an excellent technique and not invasive to the uninjured fingers.

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The standardization of wound treatment has been difficult since it is hard to set clear outcomes. An increased average duration of wound treatment can cause an increasing average length of stay in acute-care hospitals.
We attempted to standardize wound treatment using the VAC ATS^® therapy system (KCI Inc.) by building a clinical pathway, and also verified the economic effects by calculating the medical expenses.
The study period was 21 months (Oct. 2011 to Jun. 2013), and we investigated 27 patients who received VAC therapy. We added a VAC-therapy template to our electronic medical records (NEC Corporation) for efficient recording and data collection, and also built an overview of the clinical pathway according to the algorithm of wound treatment that was established in the Wound Management Committee in our hospital.
It is believed that the standardization of wound treatment could shorten the average duration of wound treatment for patients.
However, since the wound healing process differs between acute wounds and chronic wounds, the clinical pathway needs to be built for each type of wound.

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