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Highlights Nerve Sheath Myxoma can present in the pediatric hand. MRI and USS cannot correctly diagnose NSM. Surgical excision by a pediatric hand surgeon is the mainstay of treatment. Complete excision of the NSM with the capsule reduces the rate of recurrence.

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Summary: Lower limb reconstruction of the distal third following tumor extirpation or trauma is a complex procedure. The use of free flaps to cover lower limb defects is a common practice in our department. Vascular kinking or compression resulting in thrombosis is the leading cause of venous congestion and free flap failure in lower limb reconstruction. We describe a simple and inexpensive technique to avoid venous kinking during microvascular anastomosis in free flap reconstructions in the lower leg, which has proved safe in a cohort of patients.