MyMedR

Shen XF, Khoo SS

Hand Clin, 2024 May;40(2):237-248.

PMID: 38553095 DOI: 10.1016/j.hcl.2023.10.004

Microsurgery is undoubtedly the pinnacle of hand surgery. Significant advancement in recent years has stretched the indications for toe-to-hand transfer in both acquired and congenital hand defects to restore function, esthetics, and motion, with minimal morbidity to the donor site. There is no one fixed microsurgical transfer technique but a surgeon's versatility and innovation in using what one could spare because each case is unique. Esthetic refinements and reducing donor site morbidities have taken a front seat in recent years. We present a few cases to put forward the senior author's preferred techniques with this objective in mind.

Fulltext A rare case of heterotopic ossification in a newborn: a case report

Khoo S, Felix L, Azura L, Manmohan S, Jeffry A

Malays Orthop J, 2012 Nov;6(3):48-50.

PMID: 25279058 MyJurnal DOI: 10.5704/MOJ.1207.006

Heterotopic ossification (HO) is the growth of bone in soft tissue, and can be broadly classified into neurogenic, genetic and traumatic causes. The pathophysiology of HO remains unknown. This disorder is extremely rare in infants and can mimic or coexist with thrombophlebitis, cellulitis or osteomyelitis. Most importantly, HO has to be differentiated from bone-forming tumours such as osteosarcoma and osteochondroma. We report a case of traumatic HO in a fiveday- old newborn following intravenous cannulation of the right wrist and left ankle, with the latter complicated with osteomyelitis. We highlight the clinical and radiological features of HO and differential diagnoses of soft tissue ossification in early childhood.

Fulltext Bedside continuous irrigation and drainage as an interim local treatment for septic arthritis of the knee in the medically unstable patient: a case report

Khoo SS, Loi KW, Tan KT, Suhaeb AR, Simmrat S

Malays Orthop J, 2015 Jul;9(2):57-59.

PMID: 28435613 MyJurnal DOI: 10.5704/MOJ.1507.003

Septic arthritis is a surgical emergency. Prompt diagnosis and immediate treatment reduce the destruction of articular cartilage and give better outcome. We describe a simple, minimally invasive closed tube irrigation system for the initial treatment of septic arthritis of the knee in a patient with complex medical problems who was unfit to undergo surgery.

Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature

Phang ZH, Khoo SS, Gunasagaran J, Tunku Ahmad TS

J Orthop Surg (Hong Kong), 2021 12 19;29(3):23094990211067302.

PMID: 34920683 DOI: 10.1177/23094990211067302

The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term "Maggot Debridement Therapy" (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.

Photobiomodulation Therapy in Carpal Tunnel Release: A Randomized Controlled Trial

Chuah JP, Khoo SS, Chung TY, Jayaletchumi G

Photobiomodul Photomed Laser Surg, 2023 Aug;41(8):402-407.

PMID: 37506348 DOI: 10.1089/photob.2023.0018

Background: Carpal tunnel release (CTR) is widely accepted as an effective treatment for carpal tunnel syndrome. However, the recovery is often delayed and incomplete. Photobiomodulation therapy (PBMT) produces a nonthermal effect on living tissues; it promotes healing, remodels and reduces inflammation of an injured nerve. The purpose of this study was to compare the outcome of CTR between patients who underwent postoperative PBMT and without PBMT. Materials and methods: We recruited 105 patients who had open CTR from January 2019 to January 2021. Fifty-six patients fulfilled the study criteria and were randomized into two groups: with PBMT (n = 28) and without PBMT (n = 28). Demographic and clinical data were obtained preoperatively. The PBMT group had ten 3-min sessions over 3 weeks using 808 nm, 50 mW PBMT to deliver 9 J per session to the CTR incision scar. Clinical outcomes were assessed at 1, 3, and 6 months postoperatively. Data analysis was performed with SPSS software. Results: There were significant improvements in the Functional Status Scale in the Boston Carpal Tunnel Questionnaire (p = 0.018) and pain (visual analogue scales) in the morning (p = 0.019) at 1 month postoperatively in the PBMT group compared with the non-PBMT group. Improvement of tip pinch strength at 3 months (p = 0.022) and 6 months (p = 0.024), lateral pinch strength at 1 month (p = 0.042) and 3 months (p = 0.05), and tripod pinch strength at 3 months (p = 0.005) was significantly better in the PBMT group. Thumb 2-point discrimination (2PD) at 3 months (p = 0.018) and 6 months (p = 0.016) and index finger 2PD at 3 months (p = 0.039) were also significantly improved in the PBMT group. There were no side effects of PBMT reported. Conclusions: Patients who underwent PBMT post-CTR had better outcomes. PBMT may be a valuable adjunct to post-CTR care.

Reliability of WhatsApp images of plain radiographs to diagnose fractures of the hand and wrist

Khoo SS, Guruseelan N, Gunasagaran J, Shamsul SA, Razak I, Ahmad TS

J Hand Surg Eur Vol, 2023 Feb 09.

PMID: 36760195 DOI: 10.1177/17531934231151202

We assessed the reliability of plain radiographs interpreted through WhatsApp messaging system in orthopaedic hand trauma consultation in a large teaching hospital. Plain radiographs of 25 hand fractures and five normal radiographs were captured from a picture archiving and communication system using iPhone XS smartphone, anonymized and sent to 53 orthopaedic residents' and consultants' personal smartphones. The participants independently assessed the images and answered questions on fracture identification and characteristics, diagnostic confidence, further imaging and surgical inclination. The study was repeated after a 1-month washout period using the picture archiving and communication system on the hospital desktop. The results showed good (0.60

Fulltext Video-assisted thoracoscopic surgery (VATS) aided full-length phrenic nerve transfer for restoration of elbow flexion

Gunasagaran J, Ab Wahab N, Khoo SS, Shamsul SA, Shivdas S, Hashim S, et al.

J Orthop Surg (Hong Kong), 2023;31(2):10225536231180330.

PMID: 37256763 DOI: 10.1177/10225536231180330

BACKGROUND: In complete brachial plexus injury, phrenic nerve (PN) is frequently used in neurotization for elbow flexion restoration. The advancement in video-assisted thoracoscopic surgery (VATS) allows full-length PN dissection intrathoracically for direct coaptation to recipient without nerve graft.

PURPOSE: We report our experience in improving the surgical technique and its outcome.

METHODS: Seven patients underwent PN dissection via VATS and full-length transfer to musculocutaneous nerve (MCN) or motor branch of biceps (MBB) from June 2015 to June 2018. Comparisons were made with similar group of patients who underwent conventional PN transfer.

RESULTS: Mean age of patients was 21.9 years. All were males involved in motorcycle accidents who sustained complete brachial plexus injury. We found the elbow flexion recovery were earlier in full-length PN transfer. However, there was no statistically significant difference in elbow flexion strength at 3 years post-surgery.

CONCLUSION: We propose full-length PN transfer for restoration of elbow flexion in patients with delayed presentation.

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