Plastic and reconstructive robotic microsurgery--a review of current practices.

INTRODUCTION: We sought to review the current state of robotics in this specialty. METHODS: A Pubmed and Medline search was performed using key search terms for a comprehensive review of the whole cross-section of plastic and reconstructive practice. RESULTS: Overall, 28 publications specific to robotic plastic and reconstructive procedures were suitable for appraisal. CONCLUSION: The current evidence suggests robotics is comparable to standard methods despite its infancy. The possible applications are wide and could translate into superior patient outcomes.

Madura foot - mind the soil.

'Madura foot' or mycetoma is a chronic granulomatous soft-tissue infection, caused by either true fungi (eumycetoma) or Gram-positive aerobic bacteria (actinomycetoma). The infection is endemic to equatorial, tropical or sub-tropical regions. However, sporadic cases have been reported in the Western world mostly in the migrant population. The disease follows a slow progression from the time of traumatic inoculation to presentation of symptoms, characterised by a triad of chronic indurated swelling, draining sinuses and discharging granules. The granules are diagnostic as they represent collections of fungal hyphae or bacterial filaments. We present a case of a 4-year eumycetoma of the left foot in a 16-year-old Somalian girl, resident in the UK for over a year. She underwent aggressive surgical debridement with a 6-month course of anti-fungal medication. We emphasise the need for suspicion of this rare dermatosis, in view of the increasing immigrant population.

Acute upper limb ischaemia following chest wall reconstruction--a word of caution.

Irradiation arteriopathy, although rare, is a recognised entity following radiotherapy for the management of advanced cancers. It is known to manifest in varied forms and can be chronic and progressive. We present a case of an acute upper limb ischaemia following deep inferior epigastric artery perforator (DIEP) free flap reconstruction for a chest wall defect in a patient who had previously undergone radiotherapy 25 years back for carcinoma of the breast. It is envisaged that the axillary artery was thrombosed secondary to radiation arteriopathy and the collaterals that had developed were probably damaged during debridement of the irradiated unhealthy tissue prior to free flap reconstruction. A cross-limb vascular graft tunnelled under the flap restored the perfusion to the limb. We propose that the possibility of radiation arteriopathy should be considered and a preoperative arteriogram should be performed prior to planning any major surgical reconstruction in patients having undergone irradiation to major vascular beds.