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One Stage Microsurgical Reconstruction with Chimeric Flap for Salvaging a Complex Hand Injuries
Mohd Shahrul Suondoh,Wan Azman Wan Sulaiman,Wan Faisham Wan Ismail,Arman Zaharil Mat Saad 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.2
Hand injuries, involving extensor tendon with carpal bone loss are catastrophic events. Reconstructive surgeons typically face difficulties in minimizing the number of operations, recovery period and restoring its functions with an acceptable aesthetic outcome. However, chimeric flap, which consists of multiple composite flaps from one of the sources of main vascular system is a promising option for reconstruction. This paper presents a case of near-amputated degloving injury over the extensor tendon with carpal bone loss on left hand due to road traffic accidents. The patient had a hand reconstruction with chimeric flap consisted of free fasciocutaneous anterolateral thigh flap and vascularized osteomyocutaneous iliac bone graft with tensor fascia lata from the lateral circumflex femoral vascular system. As a result, the hand functioned well and appeared aesthetically acceptable. Thus, this surgery is an effective option in recovering and reconstructing a complex and traumatic hand injury that involved multiple composite tissue defects.
Successful ankle replantation in two cases with different presentations
Wen, Adzim Poh Yuen,Jusoh, Mohd Hanifah,Saad, Arman Zaharil Mat,Halim, Ahmad Sukari,Faisham, Nu'man Wan Ismail Wan,Azman, Wan Sulaiman Wan Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.2
We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.
Ezat, Sharifa Wan Puteh,Hod, Rozita,Mustafa, Jamsiah,Mohd Dali, Ahmad Zailani Hatta,Sulaiman, Aqmar Suraya,Azman, Azlin Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.5
Background: Introduction of the HPV vaccine is a forefront primary prevention method in reducing the incidence of carcinogenic human papillomavirus (HPV) and cervical cancer. The Malaysia government has implemented the National HPV immunisation programme since 2010, supplying HPV vaccine free to targeted 13 year olds. This study aimed to explore the level of knowledge among mothers on cervical cancer, HPV, HPV vaccine and National HPV (NHPV) immunisation programme since its' implementation. It also assessed acceptance of mothers towards HPV vaccine being administered to their daughter, son or themselves. Materials and Methods: A cross sectional study was conducted on 155 respondents using self-administered questionnaires; conducted in December 2012 at the Obstetrics and Gynaecology Clinic in a teaching hospital in Kuala Lumpur. Respondents were selected using a multistage sampling technique. Results: A response rate of 100% was obtained. Overall, 51.0% of mothers had good knowledge, with 55% having good knowledge of cervical cancer, 54.2% for both HPV and the National HPV immunisation programme and 51.0% for the HPV vaccine. Regression analyses showed that ethnicity was associated with knowledge on cervical cancer (p=0.003) while education was associated with knowledge on HPV (p=0.049). Three factors are associated with knowledge of the National HPV immunisation programme; ethnicity (p=0.017), mothers' education (p=0.0005) and number of children (p=0.020). The acceptance of HPV vaccine to be administered among daughter was the highest at 87.1%, followed by for mothers themselves at 73.5%, and the least is for sons 62.6%. Conclusions: This study found that the overall level of knowledge was moderate. Adequate information on cervical cancer, HPV, HPV vaccination and the National HPV immunisation programme should be provided to mothers in order to increase acceptance of the HPV vaccine which can reduce the disease burden in the future.
A Lucky Case of Successful Free Fibula Osteocutaneous Flap Harvest in Peronea Arteria Magna
Rosli Mohamad Aizat,Wan Sulaiman Wan Azman,Halim Ahmad Sukari 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.2
The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.
Mohd Shahrul Suondoh,Wan Azman Wan Sulaiman,Ahmad Sukari Halim,Arman Zaharil Mat Saad,Mohammad Ali Mat Zain,Normala Basiron 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.3
Purpose: Extensive studies regarding vascular anatomy and clinical applications of anterolateral thigh (ALT) flap has been conducted for many years. However, the ALT flap perforator vessels anatomy in the Malaysian population is not well-analyzed. The purpose of this study was to determine the distribution of ALT flap perforator vessels and its clinical applications in reconstructive surgery. Methods: This is a retrospective cross-sectional study conducted in two main centers of reconstructive surgery. A total of 142 cases of ALT flaps that used as an option for soft tissue reconstruction was selected. Vascular anatomy of ALT flaps was studied precisely including the origin of vessels, location of perforators, and types of perforator vessels intraoperatively during the flap harvest. Results: The distribution of ALT flap perforator vessels can be found at three specific locations on the thigh namely perforators A, B, and C. The highest number of cutaneous perforator vessels that supplied the ALT flap was musculocutaneous perforator with 72.3%, and dominantly at perforators B and C. The remaining perforator vessels were septocutaneous perforator with 27.7%, presented mainly at perforator A. A majority of cases involved the reconstruction of wound defects following tumor resection and trauma. The most area of reconstruction was the lower limb with 33.8%. Conclusion: The distribution of ALT flap perforator vessels can be predicted during flap harvest and can be applied in numerous clinical applications for wound defect coverage. The knowledge regarding vascular anatomy of ALT flap perforator vessels can aid plastic surgeons in reconstructive surgery.
A Lucky Case of Successful Free Fibula Osteocutaneous Flap Harvest in Peronea Arteria Magna
Rosli Mohamad Aizat,Wan Sulaiman Wan Azman,Halim Ahmad Sukari 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1
The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.
Saad, Arman Zaharil Mat,Chai, Koh Siang,Sulaiman, Wan Azman Wan,Johar, Siti Fatimah Noor Mat,Halim, Ahmad Sukari Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.6
Background Anterior palatal repair performed during cleft lip repair using a vomerine flap may assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especially in patients with a wide cleft. We present our early results in the hope of triggering a re-evaluation of this technique regarding its advantages for maxillary growth through further studies of patients with a wide cleft. Methods A retrospective analysis of patients with complete unilateral and bilateral cleft lip and palate was performed, including cleft and palatal measurements taken during initial surgery (lip repair together with anterior palate repair) and upon completion of palatoplasty. Results In total, 14 patients were included in this study, of whom nine (63.3%) had unilateral cleft lip and palate and five (37.5%) had bilateral cleft. All patients had a wide cleft palate. Lip and anterior palate repair was done at a median age of 3 months, while completion of palatoplasty was done at a median age of 10.5 months. Measurements taken upon completion of palatoplasty showed significant cleft width reduction in the mid-palate and intertubercle regions; however, the palatal arch distances at nearby landmarks showed non-significant marginal changes. Conclusions Anterior palate repair using a vomerine flap significantly reduced the remaining cleft width, while the palatal width remained. Further research is warranted to explore the long-term effects of this technique in wide cleft patients in terms of facial growth.
Lower eyelid fornix deepening: A new indication for the facial artery myomucosal flap
Saad, Arman Zaharil Mat,Nordin, Nur Raihana,Sulaiman, Wan Azman Wan,Jamayet, Nafij,Johar, Siti Fatimah Noor Mat,Hussein, Adil Korean Society of Plastic and Reconstructive Surge 2021 Archives of Plastic Surgery Vol.48 No.1
Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.