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The rotation of the flap pedicle is usually discouraged in reconstructive surgery because it could affect the patency of both the pedicle artery and vein. Propeller flaps usually require pedicle rotations of 180°, raising the risk of venous and arterial occlusion. We present a technical trick which consists of a serial rotation of the perforator flap, reducing the rotation angle of the pedicle, thus reducing also the effective strain and stress. We applied this technique on seven propeller flaps in seven patients, from July 2010 to April 2012. The patients healed without relevant complications and further surgical procedures. Neither partial nor complete necrosis of the flap was observed. In one case, suture dehiscence along with partial graft take at the flap donor site occurred; in another case, a mild venous congestion was observed and healed uneventfully in 2 days. Our technique in positioning propeller flaps is able to reduce the twisting of the pedicle, issue which affects the patency of both pedicle artery and vein. This trick reduces the odds of flap ischemia. In our case series, flap necrosis, both partial and complete, was not observed. This technical trick is able to make propeller flaps more reliable and extensively applicable, especially in lower limbs and extensive trauma, where tissue elasticity is reduced leaving unaltered the reconstructive potential of propeller flaps.

Soft-tissues defects of the hand still represent a surgical challenge for plastic surgeons, due to paucity of local tissues, especially in case of post-traumatic extended wounds. Up to now, many surgical reconstructions have been proposed, such as skin grafts, local o free flaps and dermal substitutes. We present the case of large defect of the hand, reconstructed with a dermal substitute based on a hyaluronan acid scaffold. The result was satisfactory and the patient healed in 30 days.

Background Chronic lower limb ulcers still represent a huge cost for health care systems. In addition to traditional surgical and medical techniques, several bioengineered products have been introduced. We report a case of a post-traumatic wound of the leg, complicated by tendon exposure treated. Due to general conditions of the patient, we chose to avoid major surgical operations and we used an allogeneic keratinocyte sheet on a hyaluronan acid device to improve the wound healing.