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Arman Zaharil Mat Saad,Koh Siang Chai,Wan Azman Wan Sulaiman,Siti Fatimah Noor Mat Johar,Ahmad Sukari Halim 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.6
Background Anterior palatal repair performed during cleft lip repair using a vomerine flapmay assist in recruiting additional soft tissue for subsequent completion of palatoplasty, especiallyin patients with a wide cleft. We present our early results in the hope of triggering are-evaluation of this technique regarding its advantages for maxillary growth through furtherstudies of patients with a wide cleft. Methods A retrospective analysis of patients with complete unilateral and bilateral cleft lipand 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 unilateralcleft 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 ofpalatoplasty was done at a median age of 10.5 months. Measurements taken upon completionof palatoplasty showed significant cleft width reduction in the mid-palate and intertubercleregions; however, the palatal arch distances at nearby landmarks showed non-significantmarginal changes. Conclusions Anterior palate repair using a vomerine flap significantly reduced the remainingcleft width, while the palatal width remained. Further research is warranted to explore thelong-term effects of this technique in wide cleft patients in terms of facial growth.
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.
Koh Siang Chai,Farah Hany Omar,Arman Zaharil Mat Saad,Wan Azman Wan Sulaiman,Ahmad Sukari Halim 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.5
Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.
Chai, Koh Siang,Omar, Farah Hany,Saad, Arman Zaharil Mat,Sulaiman, Wan Azman Wan,Halim, Ahmad Sukari Korean Society of Plastic and Reconstructive Surge 2019 Archives of Plastic Surgery Vol.46 No.5
Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.
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.
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.
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.