Robotic harvest of the free gracilis muscle flap.

The conventional approach to harvest of the gracilis muscle flap necessitates a medial thigh incision that is often related to several donor site complications. In this report we describe the robotic harvest of the free gracilis muscle flap in order to reduce the morbidity associated with the open incision. Through three ports, the robotic system (Da Vinci Xi, Intuitive Surgical) enables precise dissection of the gracilis muscle, the vascular pedicle, and the obturator nerve; thus, enhancing surgical control, optimizing visualization through magnification, aiding in detailed vascular pedicle dissection and minimizing human error. We believe that the technique of totally robotic harvest of the free gracilis muscle flap, herein introduced, is a feasible and effective approach, and confers specific advantages over traditional harvest technique.

Evaluation of histopathological margin and other recurrence parameters in basal cell carcinoma: A retrospective analysis of 8821 lesions.

Basal cell carcinoma (BCC) is the most common skin cancer. Removing the lesion with wide surgical margins and obtaining a microscopically intact margin is considered sufficient in the treatment of BCC. However, it may not always be possible to provide wide and intact margins in cosmetically and functionally important areas. Although recurrence rates after BCC excision vary among studies, the recurrence rate at 5 years is considered to be 2%. BCC subtype, perineural invasion, and close margin are important factors in recurrence. The aims of this study are to investigate the other factors associated with recurrence in BCC treatment and reveal the value of the "histopathological surgical margin" which can help in making the decision for re-excision. A statistically significant correlation is observed between the increase in tumour size and recurrence(p<0.05). The recurrence rate after excision with a histopathologic margin of 1 mm or less is 19%. This rate is found to be 8% in patients with a histopathological margin greater than 1 mm and 3 mm or less. Reticular dermis and deeper tissue invasion statistically increase the recurrence rate. Multiple excision and the presence of residual tumour in the re-excision sample also increase the recurrence rate. In conclusion, recurrence in BCC patients is affected by more than one parameter. We highly recommend re-excision in patients with a histopathological margin of 1 mm or less. In tumours with histopathological margins between 1 mm and 3 mm, the decision for re-excision or "wait-and-see" approach should be made according to the characteristics of the tumours and patients.