Displaying publications 21 - 40 of 95 in total

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  1. Fulltext Staged Surgery for Severe Soft Tissue and Bone Loss of the Knee
    Chan, C.K., Goh, J.H., Ng, W.M., Kwan, M.K., Merican, A.M., Soong, K.L.
    Malays Orthop J, 2010;4(2):40-43.
    MyJurnal
    A 20- year-old female student was involved in a motor vehicle accident. She sustained a severe friction injury to the left knee that resulted in considerable soft tissue and bone loss. There was also damage to the knee extensor mechanism, tibialis anterior muscle, femoral trochlea, the anterior half of the tibial plateau extending distally to the proximal tibia and skin. However, there was no crushing of the limb or resultant neurovascular deficit but cancellous bone and the remainder of the joint were exposed. Repeated surgical debridement was performed and was followed by covering of the soft tissue using a latissimus dorsi free flap and skin grafts. The bony defect was reconstituted with antibiotic bone cement to prevent flap adherence and shrinkage, enhance stability and prevent fracture. The cement was later removed at the time of arthrodesis at which time an ipsilateral double barrel vascularised fibular graft supplemented with autogenously cancellous bone and a ring fixator was used. Computer tomography confirmed union at three months post procedure. The fixator was then removed and a tibialis posterior transfer was performed.
    Matched MeSH terms: Debridement
  2. Fulltext Scanning electron microscopic evaluation of the successful sterilization of Lucilia cuprina (Wiedemann) utilized in maggot debridement therapy (mdt)
    Yeong YS, Nazni WA, Santana RL, Mohd Noor I, Lee HL, Mohd Sofian A
    Trop Biomed, 2011 Aug;28(2):325-32.
    PMID: 22041752
    In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots produced after sterilization process before delivering onto patient wounds. Sterility of sterile maggots is crucial in ensuring the safe usage of MDT and patient's health. Eggs of L. cuprina collected from a laboratory colony were divided into treated group (sterilized) and control group (non-sterilized). Treated group underwent sterilization while eggs from control group were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the main disinfectants used in this sterilization process. Scanning electron microscope (SEM) was used to examine and ascertain the sterility of sterile maggots. SEM results showed that all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots used in Malaysia MDT was proven successful and MDT is safe to be used as wound management tools.
    Matched MeSH terms: Debridement/methods
  3. Fulltext Sub acromial debridement surgery with acromioplasty for chronic shoulder pain - biomechanical challenges in physical rehabilitation
    Leonar, J.H., Siti Salmiah, M.D., Das, S., Ayiesah, H.R.
    Journal of Surgical Academia, 2011;1(1):76-80.
    MyJurnal
    Arthroscopic sub acromial debridement surgery with acromioplasty is one of the shoulder surgeries performed to treat chronic shoulder pain. This surgical procedure is usually indicated in sub acromial impingement syndrome of shoulder, degenerative rotator cuff tears, severe functional limitation of shoulder joint and often surgery was performed in cases where all the conservative management had failed in the treatment of chronic shoulder pain. Even though the patient would be referred for early rehabilitation, post operative management of this surgical condition is highly challenging. Movement of the shoulder joint is often related with scapulo-thoracic joint, acromio-clavicular joint and sternoclavicular joint and the shoulder movements are governed by various different muscular forces from these joints. Failure to understand this biomechanical complexity of shoulder joint during post operative rehabilitation results in failure of the surgical outcome and might cause severe functional limitation with recurrent shoulder pain. Often in clinical practice, greater emphasis is given to achieve and regain movements in shoulder joint at the expense of the joint stability. However, inadequate scapular stability might further predispose the shoulder joint to excessive loading and results in repetitive injuries leading to chronic shoulder pain. This might affect the surgical and clinical outcome of the acromioplasty and result in surgical failure. Hence, surgeons and clinicians need to understand the biomechanical contributions in the post operative rehabilitation of the shoulder joint. The present case report emphasises the biomechanical model of post operative rehabilitation of a patient who had arthroscopic sub acromial debridement with acromioplasty.
    Matched MeSH terms: Debridement
  4. Fulltext Wound bed preparation from a clinical perspective
    Halim AS, Khoo TL, Saad AZ
    Indian J Plast Surg, 2012 May;45(2):193-202.
    PMID: 23162216 DOI: 10.4103/0970-0358.101277
    Wound bed preparation has been performed for over two decades, and the concept is well accepted. The 'TIME' acronym, consisting of tissue debridement, infection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.
    Matched MeSH terms: Debridement
  5. Fulltext Management of osteonecrosis of the hip complicated with fracture: a case report
    Chua Y, Wazir N, Chiu C, Kareem B
    Malays Orthop J, 2012 Jun;6(SupplA):43-5.
    PMID: 25279075 MyJurnal DOI: 10.5704/MOJ.1211.011
    A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).
    Matched MeSH terms: Debridement
  6. Fournier's Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss
    Singam P, Wei KT, Ruffey A, Lee J, Chou TG
    Malays J Med Sci, 2012 Jul;19(3):81-4.
    PMID: 23610554
    Fournier's gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles' fascia around the external genitalia. It can extend cephalad to involve the Scarpa's fascia and Camper's fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier's gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement.
    Matched MeSH terms: Debridement
  7. Fulltext Outcomes of infected grade IIIB open tibial fractures
    Yusof NM, Halim AS
    Singapore Med J, 2012 Sep;53(9):591-4.
    PMID: 23023900
    Infection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.
    Matched MeSH terms: Debridement/methods*
  8. Fulltext Open total talus dislocation: a case report
    Tan E, Chua H, Ooi C, Zulkiflee O
    Malays Orthop J, 2012 Nov;6(3):60-2.
    PMID: 25279062 MyJurnal DOI: 10.5704/MOJ.1207.009
    Total talus dislocation is a rare injury and is commonly accompanied by associated fractures. Common worrisome sequelae are infection, avascular necrosis and post-traumatic arthritis. We report here on a patient who sustained an open total talus dislocation with an ipsilateral medial malleolus fracture. Following early debridement, reduction and a combination of internal and external fixations, early recovery was good with no evidence of avascular necrosis.
    Matched MeSH terms: Debridement
  9. Fulltext Chronic osteomyelitis secondary to human bite: a case report
    Tan W, Wazir N, Chiu C, Ko M
    Malays Orthop J, 2012 Nov;6(3):40-1.
    PMID: 25279055 MyJurnal DOI: 10.5704/MOJ.1207.003
    We report a case of a human bite that was initially inadequately treated and progressed to chronic osteomyelitis, finally resulting in digital amputation. Human bites are seemingly innocuous, but if neglected, may lead to subsequent infection and morbidity. Persistence of symptoms should alert the practitioner to the possibility of infection extending to the soft tissue or bone. Bacteriological studies commonly yield mixed aerobic and anaerobic flora. Early debridement and antibiotic treatment may prevent development of severe soft tissue or bone infection.
    Matched MeSH terms: Debridement
  10. Fulltext Traumatic hemipelvectomy with free gluteus maximus fillet flap covers: a case report
    Faisham W, Azman W, Muzaffar T, Muslim D, Azhar A, Yahya M
    Malays Orthop J, 2012 Nov;6(3):37-9.
    PMID: 25279054 MyJurnal DOI: 10.5704/MOJ.1207.002
    Traumatic hemipelvectomy is an uncommon and life threatening injury. We report a case of a 16-year-old boy involved in a traffic accident who presented with an almost circumferential pelvic wound with wide diastasis of the right sacroiliac joint and symphysis pubis. The injury was associated with complete avulsion of external and internal iliac vessels as well as the femoral and sciatic nerves. He also had ipsilateral open comminuted fractures of the femur and tibia. Emergency debridement and completion of amputation with preservation of the posterior gluteal flap and primary anastomosis of the inferior gluteal vessels to the internal iliac artery stump were performed. A free fillet flap was used to close the massive exposed area.
    Matched MeSH terms: Debridement
  11. Fulltext An unusual case of chronic suppurative osteomyelitis of the mandible
    Kamran Ali, Ashfaq Akram, Muhammad Usman Akhtar
    Archives of Orofacial Sciences, 2012;7(1):1-5.
    MyJurnal
    Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.
    Matched MeSH terms: Debridement
  12. Fulltext Stage protocol in the management of infection following plating of the Tibia
    Nazri, M.Y.
    International Medical Journal Malaysia, 2012;11(1):41-46.
    MyJurnal
    Introduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union
    time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results.
    Matched MeSH terms: Debridement
  13. Fulltext The antibacterial activity of sodium hypochlorite and chlorhexidine against Enterococcus faecalis: A review on agar diffusion and direct contact methods
    Luddin N, Ahmed HM
    J Conserv Dent, 2013 Jan;16(1):9-16.
    PMID: 23349569 DOI: 10.4103/0972-0707.105291
    Complete debridement and disinfection of the root canal system are fundamental requirements for successful endodontic treatment. Despite the morphological challenges of the internal root anatomy, root canal irrigants play an important role in the optimization of the root canal preparation, which is essentially a chemo-mechanical procedure. Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions in retreatment cases. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using different experimental models against this microorganism. However, many controversies with regard to the ideal irrigant and concentration do in fact exist. Hence, this review aims to discuss the antibacterial activity of these two main root canal irrigants against Enterococcus faecalis using the agar diffusion and direct contact methods and the possible modulating factors responsible for inconsistent findings among different studies. In addition, the disinfection potential of both chemical agents on gutta percha and Resilon cones are also discussed. The source of this review was conducted through an electronic literature search using PubMed database from December 1997 until December 2011, which analyze the related laboratory investigations of both irrigants, published in major endodontic journals.
    Matched MeSH terms: Debridement
  14. Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients
    Bastion ML, Ling KP
    Med J Malaysia, 2013 Jun;68(3):208-16.
    PMID: 23749008 MyJurnal
    PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
    METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
    RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
    CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.
    Matched MeSH terms: Debridement*
  15. Fulltext Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole
    Fadzillah MT, Ishak SR, Ibrahim M
    Case Rep Ophthalmol Med, 2013;2013:413953.
    PMID: 23509650 DOI: 10.1155/2013/413953
    Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.
    Matched MeSH terms: Debridement
  16. Fulltext Negative Pressure Wound Therapy in Infected Wound following Posterior Spinal Instrumentation using Simple Self-assembled System: A Case Report
    Chang C, Chan H, Lim S, Khoo E, Zulkiflee O
    Malays Orthop J, 2014 Jul;8(2):49-51.
    PMID: 25279094 MyJurnal DOI: 10.5704/MOJ.1407.004
    Postoperative wound infection in an instrumented spine patient is often disastrous. Management includes implant removal leading to spine instability. Negative pressure wound therapy (NPWT) applied to the spine surgical wound is one of the wound care technique with successful results. We report a case of a man who sustained Chance fracture of Lumbar 1 (L1) vertebra treated with long segment posterior instrumentation, who unfortunately developed Extended-spectrum beta-lactamase (ESBL) positive E. coli infection one month after the operation. After careful debridement of the wound, the implant became exposed. Three cycles of NPWT were applied and the wound healed with granulation tissue completely covering the implant, and thus negating the need to remove the implant. In conclusion, the NPWT is a good alternative in postoperative wound management especially in an instrumented spine patient.
    Matched MeSH terms: Debridement
  17. Fulltext Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia
    Bodilsen J, Langgaard H, Nielsen HL
    BMJ Case Rep, 2015 Jan 16;2015.
    PMID: 25596295 DOI: 10.1136/bcr-2014-207340
    A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.
    Matched MeSH terms: Debridement
  18. Fulltext Painful Lytic Lesions of the Foot: A Case Report
    Vaishya R, Vijay V, Ghogare P, Vaish A
    Malays Orthop J, 2015 Mar;9(1):35-37.
    PMID: 28435595 DOI: 10.5704/MOJ.1503.005
    The presence of lytic lesions in the bones of foot raises a number of diagnostic possibilities ranging from infection, inflammatory pathology to neoplastic conditions. Although the radiological picture is not pathognomonic of any pathology, clinical history and histopathological examination can help to clinch the diagnosis. We present a case of multiple lytic lesions of the foot and discuss possible differential diagnoses. The patient was diagnosed as a case of madura foot and the lesions responded to surgical debridement and anti-fungal treatment with a good functional outcome. Madura foot is an uncommon, chronic granulomatous fungal or bacterial infection with a predilection in people who walk barefoot. Although known for a specific geographical distribution, madura foot should be kept as a possible diagnosis in patients presenting with lytic lesions of the foot due to population emigration across the world.
    Matched MeSH terms: Debridement
  19. External Inflammatory Root Resorption in Mandibular First Molar: A Case Report
    Nayak MT, Nayak A
    Malays J Med Sci, 2015 Nov;22(6):63-66.
    PMID: 28223888
    External root resorption (ERR) is an irreversible loss of external tooth structure. Its etiology is multifactorial, but in many aspects remain unclear. Periapical inflammation sustained by infection can cause apical root resorption in permanent teeth. The infection may be asymptomatic for many years, although it is rarely misdiagnosed. Treatment of such lesions should include use of intracanal medicaments for complete debridement of the microbes. Here, we present a case of 21-year-old male patient who presented with external inflammatory root resorption.
    Matched MeSH terms: Debridement
  20. Combined endoscopic transnasal and transoral approach for extensive upper cervical osteoradionecrosis
    Tan SH, Ganesan D, Rusydi WZ, Chandran H, Prepageran N, Waran V
    Eur Spine J, 2015 Dec;24(12):2776-80.
    PMID: 26210311 DOI: 10.1007/s00586-015-4153-1
    PURPOSE: Osteoradionecrosis (ORN) is a rare yet well-recognized complication following radiotherapy to the head and neck. We illustrate the only case of a spontaneous extrusion of the sequestered C1 arch through the oral cavity and discuss our experience with a combined endoscopic transnasal and transoral approach for cervical ORN.

    METHODS: A 56-year-old female presented with a 3-month history of blood-stained nasal discharge. She had been treated with radiotherapy for nasopharyngeal carcinoma 25 years earlier. Flexible nasal endoscopy demonstrated an exposed bone with an edematous posterior nasopharyngeal mass. Computed tomography showed a pre-vertebral mass with destruction of C1 and C2. She underwent occipito-cervical fusion followed by a combined transnasal and transoral endoscopic debridement of non-viable bone in the same perioperative setting. Healing of the raw mucosa was by secondary intention and reconstruction was not performed.

    RESULTS: Histopathological examination reported ulcerated inflamed granulation tissue with no evidence of malignancy. During follow-up, she remained neurologically intact with no recurrence.

    CONCLUSION: Using both nasal and oral spaces allows placement of the endoscope in the nasal cavity and surgical instruments in the oral cavity without splitting the palate. Hence, the endoscopic transnasal and transoral approach has vast potential to be effective in carefully selected cases of cervical ORN.

    Matched MeSH terms: Debridement/methods
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