Ahmed Farahat

Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix

BackgroundThoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction.MethodsThis study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix.ResultsOverall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as “excellent” or “good.”ConclusionThoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix.

Batwing versus Wise pattern mammoplasty for upper pole breast tumours: a detailed comparison of cosmetic outcome

BackgroundThe aim of this study is to compare the results of batwing mammoplasty and Wise pattern mammoplasty in the surgical management of upper pole breast tumours.MethodsThis is a retrospective observational study including 126 breast cancer patients who presented between 2009 and 2015 to the National Cancer Institute of Cairo University in Egypt. All patients were candidates for breast conservation, with upper pole tumours, which was defined as tumours between 3 and 9 o’clock. Patients were categorized into two groups. Group A (64) included patients who underwent inferiorly based therapeutic mammoplasty, while group B (62) was designated for patients who had batwing mammoplasty. The results of both groups were compared and analyzed.ResultsWise pattern mammoplasty group had statistically significant higher complication rate. The overall aesthetic result of Wise pattern technique was superior to batwing mammoplasty. However, batwing mammoplasty showed a statistically significant higher rate of patient satisfaction.ConclusionsBoth techniques are valid options for upper pole breast tumours. Wise pattern therapeutic mammoplasty remains aesthetically superior; however, batwing mammoplasty is an easy, simple technique with acceptable results to patients.

Invasive duct carcinoma of the forearm: a rare case of distant, isolated ‘carcinoma en cuirasse’

Cutaneous metastasis (carcinoma en cuirasse) is a condition that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. Contralateral distant cutaneous breast cancer has never been reported before and hence, the nature and management of such rare cases remains challenging. We aim to present a case of left-sided ‘distant’ cutaneous metastatic invasive duct carcinoma affecting the distal upper extremity (contralateral side) two and half years (disease-free) following treatment for right breast cancer (right mastectomy + chemoradiation). A complete metastatic work-up excluded the presence of any underlying disease. Clinical examination revealed a fungating, irregular ulcer that bled easily on touch involving the left forearm. The ulcer was excised totally and the raw area reconstructed using a split thickness graft. The patient had uneventful postoperative course and now remains disease-free for almost 1 year with no evidence of local recurrence.

The role of thoracodorsal artery perforator flap in oncoplastic breast surgery

BACKGROUND AND AIMnThoracodorsal artery perforator flap (TDAP) is one of the relatively new techniques in breast reconstruction. In this study, we try to evaluate the outcome of this flap in oncoplastic procedures.nnnMETHODSnThis study included 40 patients of stage II breast cancer who underwent partial mastectomy with skin excision at the National Cancer Institute of Cairo University between 2011 and 2014. The resultant defects were immediately reconstructed using the thoracodorsal artery perforator flap. Operative time and complication rates were recorded. The cosmetic outcome was assessed through a questionnaire.nnnRESULTSnThe mean operative time was 227min. The total complication rate was 20% with flap congestion being the most common complication. The cosmetic outcome was acceptable with 80% of patients rating their outcome as either good or excellent. The subjectively assessed functional outcome showed a mean time of 10days postoperative for patients to regain their full range of shoulder movements.nnnCONCLUSIONnThoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.

Echinococcal cyst of the pancreas with Cystopancreatic duct fistula successfully treated by partial cystectomy and Cystogastrostomy

The primary pancreatic hydatid (echinococcal) cyst is extremely rare with a reported incidence of <1%. Owing to its rareness and a considerable overlap of imaging features, a preoperative diagnosis is usually difficult. The dilemma in confirming this benign diagnosis has often questioned the extent of radical pancreatic resection. The involvement of pancreatic duct (cystopancreatic duct fistula) further complicates the management of such cystic lesions. In this report, we present a case of isolated hydatid cyst of the pancreatic body and tail communicating with the pancreatic duct. Cystogastrostomy preceded by partial cystectomy in the same setting has never been reported to date. The patient had an uneventful postoperative course and follow-up showed no evidence of cyst recurrence or dissemination. We consider this a safe surgical option in longstanding large cysts, especially if a cystopancreatic fistula is detected beforehand. The success of such a procedure however may rely on the size and thickness of the cyst wall to support this anastomosis.

Gallbladder Stone Migrating in the Liver and Mimicking Gallbladder Cancer (GBCA)

We report a case of gallbladder stone that eroded the posterior wall of the gallbladder and migrated into the liver parenchyma giving a similar picture to Gallbladder Cancer (GBCA) on imaging. Such a clinical scenario is uncommon in the presence of raised serum tumor markers (CA 19.9) and significant weight loss. It is to the authors’ knowledge that a similar case has hardly been reported in the literature.