A 62-year-old woman exhibited a Gustilo type IIIc open fracture of the right humerus with a long defect of the brachial artery. The injury was due to the patient's upper extremity protruding through a window during a motor vehicle rollover. The patient's overall health status was stable, and reconstruction was attempted. After debridement and external fixation of the humerus, the brachial artery was reconstructed with a reverse great saphenous vein graft of 220 mm in length. The duration of ischemia was 6.5 hours. Graft patency was demonstrated by ultrasonography 10 months after the injury. Most of the brachial artery injuries were caused by puncture wounds to the upper extremity. Our case involved a “hand-out-the-window” injury during a traffic accident. Although there was good collateral circulation around the elbow joint, the patient had a large soft-tissue injury including the brachial artery and its branches; therefore, revascularization with a vein graft was needed for limb salvage.

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The patient was a 34-year-old man whose left foot was severely injured by a one-ton boiler. He was diagnosed with a Gustilo type ⅢB open fracture from the forefoot to midfoot and calcaneus fracture. We observed a degloving injury and laceration of the pedal artery at the dorsum of his left foot. We performed guillotine amputation and negative-pressure wound therapy for the amputation stump. At 22 days after initial surgery, we performed definitive reconstruction. First, we fixated the calcaneus fracture using headless compression screws. Second, we performed Chopart’s amputation, and the extensor tendons and plantar fascia were sutured together to prevent equinovarus foot. Third, we elevated a latissimus dorsi flap and covered the amputation stump. We anastomosed the thoracodorsal artery to the pedal artery and their respective accompanying veins to each other. At 28 months after injury, the patient is able to ambulate inside the house. He is also able to move around outdoors using his orthosis. We were able to avoid limb length discrepancy using a combination of Chopart’s amputation, suturing of extensor tendons and plantar fascia, and a free latissimus dorsi flap.

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We reviewed the clinical results and anastomosed veins in cases of head and neck reconstruction at our institution. Fifty-four patients with malignant tumors of the head and neck that were reconstructed using free flaps were included (39 males and 15 females, with a mean age of 60.7 years) . Two veins were anastomosed in 30 of 54 patients and one vein was anastomosed in the remaining 24.　
Complete survival of the flaps was achieved in 50 of the 54 patients, but partial and total necrosis occurred in 3 and 1, respectively. Partial necrosis was due to congestion of the external jugular venous system in all cases, and total necrosis was caused by obstruction of the artery. Of the 24 patients with one venous anastomosis, partial necrosis occurred in 2 of the 7 patients with external jugular venous system anastomosis.　
Nearly half of anastomosis were to a single vein and cases of anastomosis to the external jugular venous system had a higher incidence of necrosis. When using the external jugular venous system, it is necessary to avoid excessive dissection and to pay attention to vessel placement.

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　肘部管症候群手術症例を対象に，臨床的特徴や電気生理学的所見，術後成績に及ぼす因子について検討を行った．対象は71肘で，平均年齢59歳，男性44肘，女性27肘，利き手44肘，非利き手27肘，平均BMI 25kg/m2，平均罹病期間13か月，糖尿病合併11肘，頚椎疾患合併19肘，変形性肘関節症18肘，McGowan分類はI度 9肘，II度 23肘，III度 39肘，術者5名，術式は単純除圧16肘，King変法5肘，前方移動術50肘であった．術後2年時点におけるMessina評価基準は優7肘，良28肘，可30肘，不可6肘であり，統計学的に有意な相関を認めたのは術前McGowan分類のみであった．また，電気生理学的検査では7例がインチング法のみで伝導異常を認めた．術前重症度が手術成績に影響することが示され，また，肘上下の伝導速度や振幅に異常を認めない場合にはインチング法が有用であると考えられた．

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 The usefulness of free flaps in head and neck reconstructions has become widely recognized in recent years. Moreover, high survival rates have been reported with their use. Herein, we report two cases of external jugular venous thrombosis that occurred at our institution. In these cases, an anterolateral thigh flap reconstruction was performed after tumor resection and neck dissection. In Case 1, the drain compressed the external jugular vein, leading to thrombosis. In Case 2, excessive dissection of the external jugular vein during the neck dissection caused vessel twisting and breakage, which may have contributed to thrombus formation. It is necessary to devise drain placement and fixation methods tailored to the extent of loss of the surrounding tissue to reduce vessel damage. Moreover, recipient vessel selection and venous anastomosis quantity should be carefully considered.

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