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Rhinoplasty is considered the most challenging chapter of plastic surgery due to its variability and the continuing evolution of surgical maneuvers. Worksheets became essential to unequivocally record surgical steps and to demonstrate their reciprocal effects/interactions during the follow-up period. After 1989, no other software was created to upgrade the Gunter Rhinoplasty Diagrams, the forefather and benchmark of the rhinoplasty "virtual" worksheet maker.The authors built a new standard three-dimensional nasal framework model in STL format. All the basic components were modified to simulate the interaction among sutures, grafts, and the most common maneuvers performed during rhinoplasty. The authors created a total of 669 (99 built-in units and 285 unilateral units) three-dimensional figures which can be selected by the surgeon from among 230 options. The interface for the surgeon is Bergamo 3D Rhinoplasty Software.Bergamo 3D Rhinoplasty Software is made up of the database section, which gathers all the patient's personal information and documents, and the surgery section, which groups multiple selection lists in 10 surgical areas. Eighty percent of the options modify the original shape of the three-dimensional model. Several options help the surgeon to tailor the final result and to export it both in desktop software and in a real three-dimensional printed model.Bergamo Rhinoplasty Software revolutionizes the concept of patient and surgical data storage. Furthermore, the immediacy of three dimensions facilitates communication with patients, allows case sharing with colleagues, simplifies teaching, and encourages the surgeon's self-analysis and professional growth. Customization of the original model and of the maneuvers is the main limitation of the software, because of the currently existing technology in 2014.

Relatively small soft-tissue defects of the lower leg following tumor excision are usually treated, especially in older patients, by split-thickness skin grafting. On specific sites where periosteum or paratenon is exposed, as well as when a skin graft is best avoided for cosmetic reasons, an excellent alternative option is the use of posterior tibial artery perforator flaps.Such flaps are designed and elevated "on demand," ie, according to the defect location and on whichever perforator is best found suited to supply the flap and allow adequate transposition.However, operative time is longer, and the surgeon needs to be judicious in dissection, as well as versatile in choosing the best flap design after identifying a suitable perforator.Between 2003 and 2008, 24 patients underwent this procedure, with uniformly successful result except for 2 partial flap necrosis.The advantages of posterior tibial artery perforator flaps are a quick and usually safe procedure, which provides good contour with excellent color, texture, and thickness match, with long-term stability of the reconstruction at the expense of minimal donor-site morbidity.