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Article: Therapeutic Mammoplasty and Dermal Flap: A Novel Hybrid Approach for Chest Wall Reconstruction.

Khalil, Haitham H / Kalkat, Maninder

Plastic and reconstructive surgery. Global open

2020 Volume 8, Issue 3, Page(s) e2593

Abstract: Breast reduction techniques in management of breast cancer have been described since 1980 mainly to resect a large tumor in large breasts. Driven by the demand for more aesthetically acceptable results without compromising oncological safety, these ... ...

Abstract	Breast reduction techniques in management of breast cancer have been described since 1980 mainly to resect a large tumor in large breasts. Driven by the demand for more aesthetically acceptable results without compromising oncological safety, these oncoplastic approaches have become more popular. In addition, the utilization of redundant lower pole dermal flap has been a widely practiced tool in the armamentarium of implant-based breast reconstruction in patients with large ptotic breasts. The authors advocate a novel hybrid technique utilizing both therapeutic mammoplasty and lower breast pole dermal flap to provide coverage for anterior chest wall defect posttumor resection in patients with large or ptotic breasts. Methods: A retrospective review was conducted on patients who underwent chest wall resection and reconstruction using therapeutic mammoplasty and dermal flap to provide soft tissue coverage in the period between 2012 and 2018. Patient's demographics, clinicopathological, radiological, operative details, postoperative morbidity, and follow-up data were recorded. Results: Nine patients with chondrosarcoma (7/9) and giant cell tumor (2/9) were managed with a mean age 44.1 years (range 28-73). Complete oncological resection was achieved in all patients followed by rigid/nonrigid skeletal reconstructions. All procedures were completed successfully with no nipple areolar complex (NAC) necrosis or prosthesis failure experienced during the follow-up period (range 12-72 months). Excellent functional and aesthetic outcomes were reported in all patients. Conclusion: The authors' results demonstrate that this technique could be safely planned for soft tissue coverage postchest wall resection with superior aesthetic and durable outcomes.
Language	English
Publishing date	2020-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000002593
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Article ; Online: Acromiothoracic Venous Supercharge for Abdominal-Based Free Flaps in Breast and Chest Wall Reconstruction.

Alsharkawy, Kareem / Youssif, Sherif / Malahias, Marco / Filobbos, George / Kalkat, Maninder / Khalil, Haitham

Annals of plastic surgery

2023 Volume 91, Issue 6, Page(s) 734–739

Abstract: Background: Supercharging the venous drainage of free abdominal flaps in breast reconstruction has been well described in the literature, with diverse options used to augment venous drainage. In this study, we present our experience in using the ... ...

Abstract	Background: Supercharging the venous drainage of free abdominal flaps in breast reconstruction has been well described in the literature, with diverse options used to augment venous drainage. In this study, we present our experience in using the acromiothoracic vein (ATV)/thoracoacromial vein (TAV) as a secondary recipient vein for the superficial inferior epigastric vein (SIEV) of free, muscle-sparing transverse rectus abdominis myocutaneous flaps in breast and chest wall reconstruction. Patients and methods: We retrospectively reviewed 523 free, muscle-sparing transverse rectus abdominis myocutaneous flaps the senior author (H.H.K.) performed between 2009 and 2022 for breast and chest wall reconstruction; 46 cases required venous super drainage. Seventeen patients had ipsilateral SIEV anastomosed into the second internal mammary vein, 5 had ipsilateral SIEV anastomosed into flap second deep inferior epigastric vein, and 24 required the use of the (ATV)/(TAV), which will be the focus of this study. Results: The study included 24 female (20 breast and 4 chest wall reconstruction) patients ranging in ages between 39 and 72 years. They had a median follow-up of 26 months. Combined muscle splitting and cutting techniques were used to expose the ATV/TAV. Increase in operative time ranged between 10 and 20 minutes (median, 12 minutes). Vein coupler sizes were 1.5 to 3 mm. The mean weight of the flap was 740 g (range, 460-1300 g). There was 1 flap failure (salvage with latissimus dorsi flap performed), whereas 23 flaps wholly survived. Conclusions: The ATV/TAV is a suitable recipient for venous supercharging free flaps used to reconstruct breast and chest wall defects.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Aged ; Free Tissue Flaps ; Retrospective Studies ; Thoracic Wall/surgery ; Plastic Surgery Procedures ; Mammaplasty/methods ; Breast Neoplasms/surgery
Language	English
Publishing date	2023-12-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000003704
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Article: An unusual case of three concomitant primary solid cancers with unique histopathological characteristics.

Shatila, Mohamed / Ahmad, Ijaz / Balega, Janos / Kalkat, Maninder S / Patel, Akshay J

International journal of surgery case reports

2023 Volume 113, Page(s) 109080

Abstract: Introduction and importance: Struma Ovarii is a rare type of monodermal teratoma with at least 50 % of its mass being thyroid tissue. They make up <1 % of all ovarian tumours and 3 to 5 % of all ovarian teratomas. These tumours are usually benign but ... ...

Abstract	Introduction and importance: Struma Ovarii is a rare type of monodermal teratoma with at least 50 % of its mass being thyroid tissue. They make up <1 % of all ovarian tumours and 3 to 5 % of all ovarian teratomas. These tumours are usually benign but malignant transformation is seen in <5 % of cases. Case presentation: We present the case of a 45-year-old lady with three synchronous primary cancers on a background of Struma Ovarii; primary lung adenocarcinoma, papillary thyroid carcinoma and ovarian teratoma. Over the course of 18 months, this lady underwent full pelvic clearance of malignant Struma Ovarii and lymph nodes, total thyroidectomy, and an anatomical lung resection. Clinical discussion: This case represents an incredibly rare condition of Struma Ovarii for which there is no firm management consensus. Furthermore, the uniqueness of three separate primaries has to the best of our knowledge not previously been reported in the literature. Conclusion: This reinforces the notion that in select patients, radical management with curative intent is entirely possible but requires complete multi-disciplinary and multi-modal sub-specialty collaboration.
Language	English
Publishing date	2023-11-20
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2023.109080
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Article ; Online: Paraganglioma Fed by the Circumflex Artery.

Senanayake, Eshan L / Abdelaziz, Mahmoud / Bhabra, Moninder / Kalkat, Maninder

The Annals of thoracic surgery

2021 Volume 112, Issue 6, Page(s) e407–e409

Abstract: Mediastinal paragangliomas are rare neuroendocrine tumors and usually identified incidentally. Surgical excision remains the mainstay of treatment. Because of their location, anatomical relations, and highly vascular nature, surgical excision can be ... ...

Abstract	Mediastinal paragangliomas are rare neuroendocrine tumors and usually identified incidentally. Surgical excision remains the mainstay of treatment. Because of their location, anatomical relations, and highly vascular nature, surgical excision can be challenging. We present such a case, where the blood supply arose directly from the circumflex coronary artery and cardiopulmonary bypass was used to aid complete surgical excision.
MeSH term(s)	Aged ; Cardiopulmonary Bypass ; Coronary Vessels ; Female ; Humans ; Mediastinal Neoplasms/blood supply ; Mediastinal Neoplasms/surgery ; Paraganglioma/blood supply ; Paraganglioma/surgery
Language	English
Publishing date	2021-03-13
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.03.012
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Article ; Online: Late endovascular coil migration following traumatic pulmonary artery pseudoaneurysm embolization: case report.

Budacan, Alina-Maria / Patel, Akshay J / Foss, Helen / Abiuso, Valeria / Ganeshan, Arul / Kalkat, Maninder

Journal of cardiothoracic surgery

2022 Volume 17, Issue 1, Page(s) 87

Abstract: Background: Percutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of ... ...

Abstract	Background: Percutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare. Case presentation: A 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils. Conclusions: Although percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient's symptoms and the risk fatal complications.
MeSH term(s)	Aneurysm, False/diagnostic imaging ; Aneurysm, False/etiology ; Aneurysm, False/therapy ; Embolization, Therapeutic/methods ; Hemoptysis/etiology ; Humans ; Lung ; Male ; Middle Aged ; Pulmonary Artery/abnormalities ; Pulmonary Artery/diagnostic imaging ; Pulmonary Artery/surgery
Language	English
Publishing date	2022-04-27
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-022-01841-7
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Article ; Online: Lung cancer resection in patients with underlying usual interstitial pneumonia: a meta-analysis.

Patel, Akshay Jatin / Walters, Gareth I / Watkins, Steven / Rogers, Vanessa / Fallouh, Hazem / Kalkat, Maninder / Naidu, Babu / Bishay, Ehab S

BMJ open respiratory research

2023 Volume 10, Issue 1

Abstract: Objective: Patients with lung cancer with underlying idiopathic pulmonary fibrosis and usual interstitial pneumonia (UIP) pattern on CT represent a very high-risk group in terms of postoperative UIP acute exacerbations (AEs) and in-hospital mortality. ... ...

Abstract	Objective: Patients with lung cancer with underlying idiopathic pulmonary fibrosis and usual interstitial pneumonia (UIP) pattern on CT represent a very high-risk group in terms of postoperative UIP acute exacerbations (AEs) and in-hospital mortality. We sought to investigate the outcomes in these patients. Methods: We carried out a meta-analysis, searching four international databases from 1 January 1947 to 27 April 2022, for studies in any language reporting on the acute postoperative outcomes of patients with lung cancer undergoing surgical resection with underlying UIP (the primary outcome). Random effects meta-analyses (DerSimonian and Laird) were conducted. We analysed the difference in incidence of postoperative AE as well as the difference in long-term overall survival among subpopulations. These were stratified by the extent of surgical resection, with meta-regression testing (uniivariate and multivariate) according to the stage of disease, operative decision making and country of origin. This study was registered with PROSPERO (CRD42022319245). Results: The overall incidence of AE of UIP postoperatively from 10 studies (2202 patients) was 14.6% (random effects model, 95% CI 9.8 to 20.1, I Conclusions: With appropriate implementation of perioperative measures such as screening for high-risk cases, appropriate use of steroids, antifibrotics and employing sublobar resection in select cases, the risk of local recurrence versus in-hospital mortality from AEUIP can be balanced and long-term survival can be achieved in a super-selected group of patients. Further investigation in the form of a randomised study is warranted.
MeSH term(s)	Humans ; Retrospective Studies ; Lung ; Idiopathic Pulmonary Fibrosis/complications ; Lung Neoplasms/complications ; Lung Neoplasms/surgery ; Lung Diseases, Interstitial/epidemiology ; Lung Diseases, Interstitial/surgery ; Lung Diseases, Interstitial/complications
Language	English
Publishing date	2023-03-22
Publishing country	England
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2736454-9
ISSN	2052-4439 ; 2052-4439
ISSN (online)	2052-4439
ISSN	2052-4439
DOI	10.1136/bmjresp-2022-001529
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Article: Preoperative Long-term Therapeutic Subcutaneous Heparin Administration into Abdomen: Possible Cause for Nonobstructive Microvascular Flap Failure.

Rhobaye, Saif / Malahias, Marco N / Youssif, Sherif / Alsharkawy, Kareem / Kalkat, Maninder / Khalil, Haitham H

Plastic and reconstructive surgery. Global open

2021 Volume 9, Issue 2, Page(s) e3400

Abstract: The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus ... ...

Abstract	The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. The authors report a case of nonobstructive microvascular failure of a free muscle sparing transverse rectus abdominis muscle utilized for soft tissue coverage following resection of a chest wall breast cancer recurrence on a background of portacath-induced deep venous thrombosis of the axillary and subclavian vein whilst on chemotherapy. History of long-term therapeutic low molecular weight heparin administration in the abdomen resulted in microangiopathic densities evident on computerized tomography scan with subsequent flap failure due to possible jeopardization of the flap microvasculature and perfusion. Following exclusion of common local and systemic factors that can cause vascular compromise, a debridement and salvage re-reconstruction procedure utilizing a contralateral free latissimus dorsi flap was performed. Reconstructive surgeons should be cautious when planning to utilize free abdominal-based flaps on the background of long-term therapeutic low molecular weight heparin administration in the abdomen and may possibly explore other alternative options of using non-abdominal free flaps from the reconstructive armamentarium within this unique context.
Language	English
Publishing date	2021-02-17
Publishing country	United States
Document type	Case Reports
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000003400
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Article ; Online: VATS surgical anatomical resection of bronchopulmonary sequestration presenting as chest sepsis.

Patel, Akshay J / Mangel, Tobin / Perris, Rebecca / El-Gamal, Islam / Shatila, Mohamed / Farooq, Muhammad Omar / Kalkat, Maninder S

Journal of cardiothoracic surgery

2022 Volume 17, Issue 1, Page(s) 130

Abstract: Background: Bronchopulmonary sequestration (BPS) is a malformation of the lungs resulting in lung tissue lacking direct communication to the tracheobronchial tree. Most cases demonstrate systemic arterial blood supply from the descending thoracic aorta, ...

Abstract	Background: Bronchopulmonary sequestration (BPS) is a malformation of the lungs resulting in lung tissue lacking direct communication to the tracheobronchial tree. Most cases demonstrate systemic arterial blood supply from the descending thoracic aorta, the abdominal aorta, celiac axis or splenic artery and venous drainage via the pulmonary veins with occasional drainage into azygos vein. BPS is considered a childhood disease and accounts for 0.15-6.40% of congenital pulmonary malformations. BPS is divided into intralobar sequestrations (ILS) and extralobar sequestrations (ELS) with ILS accounting for 75% of all cases. Methods: Here we present our 11-year experience of dealing with BPS; all cases presented with recurrent chest sepsis in young-late adulthood regardless of the type of pathological sequestration. The surgical technique employed was a minimally invasive video-assisted thoracoscopic anterior approach (VATS). Results: Between May 2010 and September 2021, we have operated on nine adult patients with bronchopulmonary sequestration who presented late with symptoms of recurrent chest sepsis. Most patients in the cohort had lower lobe pathology, with a roughly even split between right and left sided pathology. Moreover, the majority were life-long never smokers and an equal preponderance in males and females. The majority were extralobar sequestrations (56%) with pathological features in keeping with extensive bronchopneumonia and bronchiectasis. There were no major intra-operative or indeed post-operative complications. Median length of stay was 3 days. Conclusions: Dissection and division of the systemic feeding vessel was readily achievable through a successful anterior VATS approach, regardless of the type of sequestration and without the use of pre-operative coiling of embolization techniques. This approach gave excellent access to the hilar structures yet in this pathology, judicious and perhaps a lower threshold for open approach should be considered.
MeSH term(s)	Adult ; Bronchopulmonary Sequestration/complications ; Bronchopulmonary Sequestration/diagnosis ; Bronchopulmonary Sequestration/surgery ; Child ; Diagnostic Imaging ; Female ; Humans ; Male ; Sepsis/complications ; Sepsis/diagnosis ; Sepsis/surgery ; Thoracic Surgery, Video-Assisted ; Thorax/pathology
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-022-01887-7
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Article: Chest wall resection and reconstruction for recurrent breast cancer - A multidisciplinary approach.

Menon, Ashvini / Khalil, Haitham / Naidu, Babu / Bishay, Ehab / Steyn, Richard / Kalkat, Maninder S

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2020 Volume 18, Issue 4, Page(s) 208–213

Abstract: Background: Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected ... ...

Abstract	Background: Despite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered. Methods: Between 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22-77 years). Results: The median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1-24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66-97) and 61% (95% CI 31-81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45-86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7-65.7) and 24.5 months (95% CI 7.3-41.7) for patients with distant metastatic recurrence. Conclusion: A multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival.
MeSH term(s)	Adult ; Aged ; Breast Neoplasms/mortality ; Breast Neoplasms/surgery ; Carcinoma/mortality ; Carcinoma/surgery ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Thoracic Wall/surgery ; Treatment Outcome
Language	English
Publishing date	2020-01-06
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2019.10.001
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Article ; Online: Staging computerized tomography before delayed breast reconstruction could alter the management plan.

Iqbal, Javeria / Malahias, Marco N / Alsharkawy, Kareem / Youssef, Sherif / Trigkatzis, Platon / Shimal, Amar / Pradhan, Poonam / Kalkat, Maninder / Khalil, Haitham H

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2021 Volume 74, Issue 12, Page(s) 3289–3299

Abstract: Background: Delayed breast reconstruction (DBR) comprises a significant proportion of breast reconstruction practice post completion of breast cancer treatment. The tumour's biology, staging, time constraints, ongoing treatment, and patient and surgeon' ... ...

Abstract	Background: Delayed breast reconstruction (DBR) comprises a significant proportion of breast reconstruction practice post completion of breast cancer treatment. The tumour's biology, staging, time constraints, ongoing treatment, and patient and surgeon's preference influence the decision to pursue DBR. There are no guidelines for assessing the oncological status before DBR in otherwise asymptomatic patients, particularly in those with a higher risk of recurrence. The purpose of this study was to identify the cohort of patients who could potentially benefit from staging CT scan before DBR regardless of the reconstructive modality and its impact on the overall management. Material and methods: A retrospective review on 207 consecutive patients, who underwent staging CT scan before DBR in the period between 2009 and 2019 was performed. The CT scan findings were correlated with the breast prognostication scoring model (Nottingham Prognostic Index [NPI]) as an indicator factor for staging reasons. Results: Incidental findings were reported in 34% (71/207) of the reviewed CT scans (incidentaloma group). There was no statistical significance in the NPI scores between non incidentaloma and incidentaloma groups. However, 5.7% (12/207) had their DBR procedure cancelled or the surgical plan altered. Conclusion: The patients with moderate to poor prognosis (NPI score 3.4 and above) could benefit from CT staging scan before DBR. This scan could detect adverse prognostic features precluding major surgery, which saves patients from unnecessary surgical risks and discomfort, and direct them towards the relevant management pathway.
MeSH term(s)	Adult ; Aged ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Female ; Humans ; Mammaplasty ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2021-06-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2021.05.004
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