Background: Propeller perforator flaps (PPFs) have gained increasing popularity in lower limb reconstruction. While their use in elective settings is well described, their role in acute post-traumatic reconstruction remains less defined. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Cochrane Library were searched on 2 June 2025, for studies reporting on the use of propeller flaps in lower limb reconstruction after trauma. Only studies rated as “good” quality using the NIH quality assessment tool were included. Data on anatomical location, flap survival, complications, reinterventions, and functional and patient-reported outcomes were extracted and analyzed descriptively. Results: Twenty-eight studies published between 2008 and 2024 were included, accounting for 619 propeller flaps in a population of 838 patients. The majority of flaps were fasciocutaneous, with the posterior tibial artery being the most commonly used source vessel. Among the flaps included, 422 (68.2%) achieved complete survival without necrosis, 84 (13.6%) developed partial necrosis, and 23 (3.7%) failed completely. Considering all flaps that remained viable after any required revisions or conservative management, the overall survival rate was 97%. Venous congestion was the leading cause of flap compromise. The overall complication rate was 21.8%, increasing to 35.1% in acute trauma cases. A statistically significant correlation was found between wide rotation angles (≥150°) and higher complication rates (p = 0.015). The mean follow-up duration was 12.5 months. Functional and aesthetic outcomes were poorly reported, but when available, they were generally favorable. Conclusions: PPFs represent a valuable option for lower limb reconstruction, providing reliable coverage while preserving major vascular axes. Their application in acute trauma settings appears promising, although current evidence is limited by small verified cohorts and predominantly retrospective study designs. Despite higher complication rates in acute cases, flap survival remains consistently high, supporting their use in carefully selected patients. Further prospective studies with standardized outcome reporting are needed to clarify long-term functional results and refine selection strategies.

Background: The nose is the most critical aesthetic element of the face and even the smallest loss of substance can create a deformity of concern. The forehead flap has been the workhorse for nasal reconstruction for centuries but requires multiple surgical steps and leads to prominent donor-site scarring. The nasolabial flap allows a single-step reconstruction with a donor-site scar concealed in the nasolabial crease but is conventionally designated for small defects involving the ala. Methods: The authors analysed all surgical records of patients undergone nasal reconstruction by nasolabial flap between May 2005 and December 2021 by the Plastic Surgery Unit of a major regional hospital in Lombardy. Defects were classified according to Burget's subunit principle and the 3-component approach. Reconstruction features and finesses were reported and analysed. Results: In the 16-year period under analysis, 378 patients with nasal defects of various aetiologies received nose reconstruction by nasolabial flap. All nasal subunits were involved; 20 patients had multisubunit defects. In all the cases the reconstruction with nasolabial flap, alone or combined with other solutions, was intended to be one-stage. Conclusions: The authors present several tips and tricks about preoperative planning and design, choice of the pedicle, flap harvesting and sculpting with preservation/restoration of grooves and convexities, conjoining multiple flaps, downsizing extensive defects by a rhinoplasty-like framework reduction. With a careful planning and refined technique, the range of application of the nasolabial flap can include defects involving any nasal subunit and larger and/or multisubunit defects.

Cutaneous squamous cell carcinoma, which makes up for 25% of keratinocyte carcinomas, is the second most frequent skin cancer worldwide. Surgical excision via a clinical and microscopic complete resection is the treatment of choice. Incomplete excisions carry the risk of local recurrence, deep subclinical progression, and metastasis. This retrospective cohort study aimed to investigate the risk factors associated with the incomplete excision of cutaneous squamous cell carcinoma. This series included 837 patients who underwent surgical treatment for 1082 primary cutaneous squamous cell carcinoma in the Plastic Surgery Department of the Papa Giovanni XXIII Hospital in Bergamo, Northern Italy between 2012 and 2021. Patient-, procedure-, and tumor characteristics were collected and analyzed. Incomplete excision rate was 11.8% (n=128). The Pearson chi-squared test and univariable logistic regression showed tumor diameter [cm] (p<0.001), tumor thickness [mm] (p<0.001), tumor location (ear p=0.006, peri-orbital, p=0.029), differentiation grade (G3=0.005), infiltration level (hypodermis, p<0.001; muscle, p=0.013; bone/ cartilage p<0.001), presence of perineural invasion (p=0.041), ulceration (p=0.010), no prior diagnostic biopsy (p=0.041), and additional samples taken (p<0.001) with additional samples not free of tumor cells (p<0.001) to be significant risk factors/ predictors for incomplete excision. Risk factors should be considered in the management of cutaneous squamous cell carcinoma. This study documented several key contributions and confirmations regarding the risk factors associated with incomplete excision in cutaneous squamous cell carcinoma by comprehensively analyzing of one of the largest cohort studies in the field.