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Background:. There are many situations in head and neck reconstruction where a pedicled flap must be chosen over free flaps. In such situations, one of our options is a pedicled latissimus dorsi (LD) myocutaneous flap with distally positioned skin paddle with a more distal skin flap design. Methods:. We performed 22 reconstruction cases using a distally positioned pedicled LD myocutaneous flap. When designing the skin paddle more distally than usual, it is important to include the lateral cutaneous branch of the 10th posterior intercostal artery. By splitting the skin paddle sections, the LD flap is flexible for use in complex head and neck defects. It can also be used for mandibular reconstruction by harvesting the flap with costal bone. Results:. In all cases, the skin flaps survived, with a salvage rate of 100%. Conclusions:. Because elevation of this flap is relatively easy, safe, and quick, this flap selection is considered practical in salvage cases after flap necrosis, and in cases after multiple procedures.

Background:. Cutaneous malignancies in the extremities are relatively common, and radical treatment such as ray amputation was performed for certain advanced skin cancer cases in the past. The concept of surgical treatment of primary cutaneous malignant tumor has gradually changed, and preservation of the extremity by performing the appropriate excision and reconstruction became possible. Various reconstructive methods after the resection of malignant tumors such as skin grafts, local flaps, and free flaps, including perforator flaps have been noted. Due to limitations and some disadvantages of these reconstructive materials for extremities, the arterialized venous flap arose as an alternative method. The arterialized venous flap, which has arterial inflow through an afferent vein perfusing the flap and venous outflow through the efferent veins, is considered to function as a great reconstructive material for distal extremities. Although efficacy of this flap has been noted in the past, usage of the flap considering the oncological aspects and application of the flap to the toes and feet have never been reported. Methods:. Thirteen reconstructive cases from October 2005 to October 2016 using venous flaps after excision of primary cutaneous malignancy in the distal extremities were performed in our institution. Results:. For all cases, satisfactory functional and cosmetic outcomes were observed. Conclusions:. Reconstruction using the arterialized venous flap is considered a reliable and versatile method. Careful application of this flap satisfies functional, cosmetic, and oncological aspects of all distal extremities with cutaneous malignancy.

Summary:. The treatment for arterial venous malformation (AVM) of functionally and aesthetically important parts such as the hand is considered to be challenging. AVM existed in the right forearm and the thenar region of 55-year-old man. Combined method with free omentum flap and split-thickness skin flap was performed for hand reconstruction after radical excision of an AVM. The postoperative course was good. Seven years have passed postoperatively, and functional but aesthetical results are satisfying with no recurrence. Our operative procedure with complete resection of AVM with placement of the free omental flap to the resected area and placing back the original skin as a skin graft is considered to be an ideal curative surgical treatment of the AVM.

The resection of malignant tumors in medial canthal region may lead to full-thickness defects including medial canthal ligament and lacrimal duct. There had been reports on various reconstructive methods, but none of those methods succeeded in lacrimal reconstruction with functional lacrimal excretory system. We experienced a case of conjunctival malignant melanoma at the lacrimal caruncle and performed new method of the reconstruction for full-thickness defects of the medial canthal region with the maintenance of the lacrimal drainage function.