Introduction: Robotic-assisted surgery is gaining popularity because of reported improvement in aesthetic outcomes while reducing the occurrence of complications compared with conventional surgical methods. Deep inferior epigastric perforator (DIEP) flap harvesting has a long track record as a viable procedure for autologous reconstruction of the breast. In this literature review, we describe the feasibility of using the robotic platform in DIEP flap harvest. Methods: The Preferred Reporting Items for Systemic Reviews and Meta-Analysis methodology was to guide the literature review. PubMed and Scopus databases were searched from inception to June 6, 2022. The Medical Subject Heading terms and keywords used to conduct this search are as described: "Robotic AND deep inferior epigastric perforator AND Breast reconstruction." Results: Seven publications, detailing a total of 56 robotic-assisted DIEP flap harvest procedures, were selected for review. Four publications used the transabdominal preperitoneal approach, whereas 2 exclusively used a totally extraperitoneal approach, and 1 compared the 2 approaches. The measured outcomes included technical feasibility of flap harvest in cadavers, viable flap harvest in live patients, harvest time and pedicle dissection time, pedicle length, fascial incision length, donor site pain, need for postoperative narcotic, donor site morbidity, and hernia formation. Overall, the reviewed articles demonstrated successful DIEP flap harvesting without the need for conversion to the conventional open procedure. Postoperative complications were minimal. Robotic DIEP flap harvest was shown to be safe and there were no reports of donor-site morbidity in the studies reviewed. The main advantages of the robotic approach include decreased postoperative pain and length of hospital stay, along with improved aesthetic outcomes. The main disadvantages are increased operative time and cost. Conclusions: Although at its current iteration, the robotic-assisted DIEP flap is feasible, it may not be practical in all settings. Furthermore, the true benefit of the robotic platform is yet to be determined, as more long-term studies are necessary.

According to the International Society of Aesthetic Plastic Surgery, surgical and nonsurgical aesthetic procedures increased in 2019 by 7.1% and 7.6%, respectively, compared with 2018. 1 Cosmetic medical tourism saw a concurrent increase during this time. Countries receiving the highest percentage of foreign patients were Thailand (33.2%), Mexico (22.5%), and Turkey (19.2%). 1 Many patients travel abroad due to reduced cost, cultural similarity between patient and providers, easy accessibility, and availability of procedures not performed in home country. 2,3 However, foreign regulations and safety standards for facilities, drugs, medical products, and devices may vary, and in some circumstances, be more lax than in the United States, increasing risk of postsurgical complications. 2 Additionally, patients who travel for procedures often lack follow-up with their surgeons, delaying timely detection of complications. 3 Common complications following cosmetic surgery performed abroad include wound infection, poor wound healing, wound dehiscence, and thromboembolic events. [2][3][4] Patients are also at risk of postsurgical infection associated with foreign pathogens. 2,4 This case highlights a patient presenting with serious surgical and medical complications post-lipoabdominoplasty performed in Latin America, emphasizing burdens on home healthcare system and importance of patient education. CASE REPORTA 48-year-old woman with no reported medical history underwent elective ventral hernia repair, liposuction, and abdominoplasty in Latin America. The patient reportedly had anaphylactic shock after receiving diclofenac postoperatively, and was transported via air to our hospital in San Antonio, Texas. On hospital day 2, the patient underwent emergent exploratory surgery due to tender abdomen, hemorrhagic bullae (Fig. 1), and ecchymosis (Fig. 2) found on examination, suggesting infection. In the OR, necrotizing soft tissue infection (NSTI) of the abdominal wall was observed; necrotic sections of abdominal wall were debrided with two areas of fascial debridement in right and left upper quadrants. Bowel perforation at the hepatic flexure was incidentally

Basal Cell Carcinoma (BCC) is the most common malignancy that can cause local tissue destruction. While treatment options for BCC vary depending on the degree of malignant progression, surgical intervention is generally required when there is significant tissue involvement. We present a case of a 40-year-old woman with extensive BCCs requiring a multidisciplinary surgical approach for treatment. Our case highlights the importance of utilizing a multidisciplinary team as well as different surgical management options for late stage BCCs.

BackgroundRisk stratification for complex procedures such as microsurgical reconstruction of the lower extremities is an important part of preoperative planning and counseling. The aim of this study was to determine the effectiveness of the modified five‐item frailty index (5‐mFI) score, a validated tool for assessing risk in surgical patients, in predicting postoperative complications after lower extremity (LE) free flap reconstruction.MethodsA retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database was conducted from 2010 to 2020 on patients who underwent LE free‐flap reconstruction. 5‐mFI scores were calculated and patients were categorized as 5‐mFI ≥2 or <2.The primary endpoint was the presence of 30‐day overall complications. The secondary endpoints included 30‐day readmission, need for reoperation, and need to discharge to a care facility. Comparisons were made using one‐way analysis of variances, Pearson's chi‐squared test, or Fisher's extract test. Multivariable logistic regression models were performed for sex, age, BMI, smoker status, operative time, and ASA classification.ResultsTotal of 294 (61.6% males) patients were identified. Univariate analysis showed 5‐mFI ≥2 had higher rates of overall complications (p = .043) and hematologic complications (p = .033). In this population, there were also higher rates of reoperation (p = .003) and discharge to care facility (p < .001). Multivariable regression models further substantiated that 5‐mFI ≥2 was independently associated with increased overall complications [2.46, CI: 1.10–5.59, p = .031], hematologic complications [2.55, 1.02–6.35, p = .046], reoperation [4.55, 1.54–13.3, p = .006], and discharge to facility [2.86, 1.27–6.45, p = .011].ConclusionsThere is a strong association of 5‐mFI ≥2 with adverse post‐operative outcomes in male patients undergoing LE free‐flap reconstruction. This can be a valuable adjunct in the counsel of patients for whom lower extremity salvage is feasible.

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