Prof. Koushima, president of World Society for Reconstructive Microsurgery, proposes an innovative concept and technique of the multi-stage ‘Orochi’ combined flaps (sequential flaps in parallel). The technique opens a new vista in reconstructive microsurgery.

This is a case report with a comprehensively systematic review on juxtacortical chondrosarcoma in the head and neck area (HNJCS). According to the study, only nine cases of HNJCS have been adequately described. HNJCS have relatively consistent clinical and diagnostic profile regardless of location in the body. Surgical management yields excellent outcomes with low recurrence rates.

A higher titer of IA-2Ab reflects a reduced pancreatic size in the patients with Type 1 diabetes (T1D), especially in those with the acute-onset form of the disease. The potential mechanisms underlying the reduced pancreatic size might differ between acute-onset T1D and slowly progressive insulin-dependent diabetes mellitus. The authors investigated the relationship between islet autoimmunity and pancreatic size in the Japanese patients with T1D.

Air gun injuries normally present with a wide variety of clinical forms from minor to life-threatening injuries. The rare case of an air gun pellet retained in the pterygopalatine fossa has the risk of immediate or delayed haemorrhage as illustrated by our patient. Gunshot injuries must be considered as potentially life-threatening and raising awareness regarding its potential threats are required in order to minimize the air gun injuries, especially in children.

Otolaryngologists and gastroenterologists seem to differ in their definitions and management of laryngopharyngeal reflux (LPR). In this review article, the author suggests a multidisciplinary approach to LPR diagnosis. Based on the latest findings, the author proposes an algorithm to facilitate the assessment and management of LPR.

This case report demonstrates an important supermicrosurgical technique for lymphedema, which was established by Isao Koshima in 1994. So far, over 2,000 cases of limb edema have been treated by this surgical method.

Oxytocin and magnesium sulfate are high-alert medications with risks for significant patient harm. This paper describes experiences of 25 Labor and Delivery (LD) units which sought to apply safety science principles such as standardization, learning from defects, independent checks, teamwork and communication, and in situ simulation training for safe administration of oxytocin and magnesium sulfate. This effort was part of the Agency for Healthcare Research and Quality’s Safety Program for Perinatal Care.

Immediate limb compression following the LVA procedure facilitates lymphatic drainage and increases the surgical efficacy by increasing the number of functioning anastomoses, and is a recommended postoperative practice.

Cleft lip/palate (CLP) in children is psychologically stressful for family members and debilitating for the patients themselves. The author reviews the pathogenesis, clinical manifestations, and diagnoses of OME in children with CLP as well as the controversies surrounding treatment. He also provides a flowchart to guide the management of OME in children with CLP.

An evidence-based guideline for managing the second stage of labor can improve outcomes in women with epidural anesthesia.