Displaying publications 61 - 80 of 109 in total

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  1. Yusof NM, Fadzli AS, Azman WS, Azril MA
    Med J Malaysia, 2016 04;71(2):47-52.
    PMID: 27326940 MyJurnal
    INTRODUCTION: The understanding of the skin's vascular anatomy has improved in the last decade. It has lead to technique modification such as the staged procedure in performing sural flaps and improvement in the flap survival rate. The aim of this study was to evaluate the acute vascular complications (flap necrosis or congestion) of 29 patients who underwent distal base sural flap for coverage of wound around the ankle.

    METHODS: Twenty-four males and five females with a mean age of 37.1 years old underwent sural flap surgery to cover wounds at around the ankle. There were 12 cases of open fracture, five infected fractures, four spoke injuries, four degloving injuries and four diabetic foot ulcers. Twentythree cases were done as a single stage procedure while six as a two-stage procedure. The flaps were tunnelled under the skin in three cases.

    RESULTS: Twenty one flaps healed uneventfully, seven acute vascular complications occur in a single stage group: five developed partial necrosis, one had congestion with epidermolysis, and one had complete flap necrosis. Complications were treated by dressing or skin grafting and only one required a repeat flap surgery.

    CONCLUSIONS: Acute vascular complications may be minimised when sural flap is done in stages for elderly, diabetic, smokers and/or patients with large wound around the ankle. Even if the flap appears necrotic, the underlying structure may still be covered as the fasciosubcutaneous layer of the flap may still survive.
    Matched MeSH terms: Surgical Flaps*
  2. Tang WJ, Mat Saad AZ
    Med J Malaysia, 2017 06;72(3):199-201.
    PMID: 28733572 MyJurnal
    Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.
    Matched MeSH terms: Surgical Flaps/surgery
  3. Imran Y, Zulmi W, Halim AS
    Singapore Med J, 2004 Mar;45(3):110-2.
    PMID: 15029411
    Immediate recognition of anastomotic failure is important to ensure the viability of the vascularised fibular graft. The problems associated with post-operative bone scanning and angiography for immediate detection of anastomotic failure have been described.
    Matched MeSH terms: Surgical Flaps*
  4. Dorai AA, Halim AS
    Singapore Med J, 2007 May;48(5):e141-5.
    PMID: 17453087
    Extensive full thickness anterior abdominal wall defects pose a difficult challenge to the reconstructive surgeon. The objectives of reconstruction are the support of the intra-abdominal structures in order to preserve the functional integrity and achieve an aesthetically-acceptable appearance. Autologous tissues are versatile and provide the best reconstructive option in this type of defects. The tensor fascia latae myocutaneous flap provides identical abdominal wall musculofascial cover for full thickness defects. In extensive defects, the extended tensor fascia latae flap is a versatile option with a second microvascular anastomosis at the distal end of the flap. A total anterior abdominal wall soft tissue tumour resection defect was reconstructed with the use of the double pedicle extended free tensor fascia latae myocutaneous flap in a 60-year-old man. The patient however succumbed to the disease process six months post-reconstruction. During the follow-up period, there was no evidence of hernia at the anterior abdominal wall.
    Matched MeSH terms: Surgical Flaps*
  5. Krishnan MM, Khanijow VK, Ong G, Delilkan AE
    Singapore Med J, 1991 Apr;32(2):174-6.
    PMID: 2042084
    Tracheal tears are not as uncommon as initially thought. The resultant insufficiency and hypoxia can be life-threatening. The keystone in management is early recognition and diagnosis. Immediate surgical repair is essential.
    Matched MeSH terms: Surgical Flaps*
  6. Lim P, Paver R, Peñas PF
    J. Am. Acad. Dermatol., 2010 Nov;63(5):832-5.
    PMID: 20950738 DOI: 10.1016/j.jaad.2009.12.026
    BACKGROUND: Mohs micrographic surgery (MMS) provides a combination of high cure rate and tissue conservation. Epidemiologic factors and changes in techniques may affect the way MMS is performed.
    OBJECTIVE: We sought to evaluate changes over time in the type of patients and skin cancers that are treated using MMS, and the repairs used to close the defects.
    METHODS: We conducted a retrospective study on patients treated with MMS at the Skin and Cancer Foundation Australia, Westmead, in 1997 against those treated in 2007. Patient demographics (age, sex), pathology of tumor, anatomic site of the tumor, preoperative tumor size, postoperative defect size, and repair method were analyzed.
    RESULTS: There was a 260% increase in the number of procedures (596 in 1997 vs 1587 in 2007). The 2007 cohort was a little older (62 vs 64 years), but there were no differences in sex, anatomic site, rate of basal/squamous cell carcinoma, squamous cell carcinoma histologic subtypes, or preoperative tumor size. However, there were fewer superficial basal cell carcinomas, and the postoperative defect size was smaller in 2007 (P < .0001). There was also a decrease in the use of grafts and second-intention healing to close the defects and an increase in the number of side-to-side closures (P < .0001).
    LIMITATIONS: Retrospective study at one institution is a limitation.
    CONCLUSION: Although tumor size and the percentage of tumors in each anatomic site did not change over 10 years, the size of the defect created after MMS has become smaller. This reduction in defect size may explain why more defects are now repaired by side-to-side closure and flap repairs whereas fewer defects are repaired by skin grafting.
    Matched MeSH terms: Surgical Flaps/utilization; Surgical Flaps/statistics & numerical data
  7. Khai Luen K, Wan Sulaiman WA
    J Foot Ankle Surg, 2017 8 27;56(5):1114-1120.
    PMID: 28842095 DOI: 10.1053/j.jfas.2017.04.024
    Sensate, durable heel pad reconstruction is challenging. The present study assessed the functional outcomes after heel pad reconstruction using various flap techniques at our institution. From June 2011 to June 2016 (5-year period), 7 consecutive patients underwent heel pad reconstruction for various etiologies, with 3 microvascular free flaps (42.9%; 2 musculocutaneous flaps [66.7%] and 1 contralateral medial plantar flap [33.3%]) and 4 local pedicle flaps (57.1%; 3 instep medial plantar artery flaps [75.0%] and 1 distally based reverse sural flap [25.0%]). The patient records and demographic data were reviewed, and surgically related information was obtained and analyzed. The subjective components of the American Orthopaedic Foot and Ankle Society hindfoot clinical ratings scale were used to evaluate the pain and functional outcomes. Sensation was assessed using Semmes-Weinstein monofilaments, and ulcer recurrence was recorded. The mean age of the patients was 41.7 (range 11 to 70) years, the mean defect size was 59 (range 12 to 270) cm2, and the mean follow-up duration was 22 (range 15 to 43) months. Complete flap survival was achieved without significant complications in all 7 patients. Patients treated with the sensate medial plantar artery flap recorded the highest mean American Orthopaedic Foot and Ankle Society score of 57.3 (maximum score of 60) and experienced a return of deep sensation at 6 (range 6 to 24) months and protective sensation at 1 year. This was followed by the reverse sural flap and the musculocutaneous flap. No recurrent heel ulceration was observed in our series of patients. In conclusion, the sensate medial plantar flap is a satisfactory method for coverage of small- to moderate-size heel defects.
    Matched MeSH terms: Surgical Flaps/blood supply; Surgical Flaps/transplantation*
  8. Rana R, Ramachandra SS, Lahori M, Singhal R, Jithendra KD
    Contemp Clin Dent, 2013 Oct;4(4):556-8.
    PMID: 24403810 DOI: 10.4103/0976-237X.123090
    Ideal alveolar ridge width and height allows placement of a natural appearing pontic, which provides maintenance of a plaque-free environment. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. Localized alveolar ridge defect refers to a volumetric deficit of the limited extent of bone and soft-tissue within the alveolar process. These ridge defects can be corrected by hard tissue and/or soft-tissue augmentation. A 30-year-old male patient was referred to the Department of Periodontology for correction of Seibert's Class III ridge defect in the lower anterior region. Granulation tissue/connective tissue present at the base of the defect was removed after elevation of full thickness flap. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap and bone graft was placed into the defect. If a soft-tissue graft material could be used to replace the palatal grafts, then all the possible complications associated with donor site would be eliminated and above all periodontal plastic surgery and ridge augmentation would be better accepted by patients.
    Matched MeSH terms: Surgical Flaps
  9. Lee LM, Razi A
    Asian J Surg, 2004 Oct;27(4):336-8.
    PMID: 15564191
    This report of a patient with a persistent tracheo-oesophageal (TE) fistula after removal of a speech valve describes a modification of the technique described by Rosen et al for closing TE. Under local anaesthesia, an incision was made above the stoma edge from 9 o'clock to 3 o'clock. The trachea was separated from the oesophagus to beyond the fistula, and the fistula tract was excised. The oesophageal opening was closed in layers and a local flap rotated from the adjacent sternocleidomastoid muscle and sutured over the oesophageal closure. The trachea was then closed separately.
    Matched MeSH terms: Surgical Flaps
  10. Krishnan MMS, Janakarajah N
    Med J Malaysia, 1983 Mar;38(1):43-6.
    PMID: 6633335
    Carcinoma of the buccal mucosa is the commonest intra-oral malignancy seen in Malaysia. The purpose of this paper is to present 12 patients with carcinoma of the buccal mucosa who were seen by the authors between January 1981 to September 1981. The principal problems are those of late presentation and treatment, these aspects are illustrated, with a view of early return to normal life.
    Matched MeSH terms: Surgical Flaps
  11. Chuah SK, Bajuri MY, Mohd Nor F
    Cureus, 2019 Jun 28;11(6):e5023.
    PMID: 31501722 DOI: 10.7759/cureus.5023
    Chronic osteomyelitis treatment is always a challenge to orthopaedic surgeons which requires great dedication and perseverance. We report a successful limb salvage case of a 46-year-old man who suffered from a left tibia chronic osteomyelitis with soft tissue defect. The treatment approach was a thorough wound debridement of devitalized tissues and necrotized bone, commencement of culture-directed antibiotics, reconstruction with vascularized osteomyocutaneous fibula flap, and skeletal stabilization with internal fixation. As compared to below knee amputation, the result we obtained in this case is more promising with regard to mobility and function.
    Matched MeSH terms: Surgical Flaps
  12. Langat AS, Wan Sulaiman WA, Mat Johar SFN
    Cureus, 2021 Mar 19;13(3):e13987.
    PMID: 33884238 DOI: 10.7759/cureus.13987
    The heel of the foot is covered by highly specialized thick, glabrous skin containing fibroadipose tissue with numerous fibrous septae traversing the subcutaneous tissue, which acts as a shock-absorbent and prevents shearing of the skin. The loss of heel pad would cause interruption of the propelling function of the foot during walking. Therefore, heel pad reconstruction is an important procedure for wound closure in the acute phase and also functional reconstruction in delayed cases. We report a case of heel pad deformity in a patient who presented to us with left heel pain and inability to fully bear weight, which has caused her walking difficulty, following a road traffic accident. She sustained a degloving injury of the left foot and an open fracture of left calcaneum with ruptured Tendon Achilles in which the wound was initially addressed with failed reverse sural flap and the wound was allowed to heal by secondary intention. Delayed heel reconstruction was carried out with a propeller medial plantar flap and split skin graft. Postoperatively, the patient had improved functional and esthetic outcome.
    Matched MeSH terms: Surgical Flaps
  13. Alhawri K, Alakhfash A, Alqwaee A, HassabElnabi M, Ahmed F, Alhawri M, et al.
    J Card Surg, 2021 Aug;36(8):2890-2900.
    PMID: 34047395 DOI: 10.1111/jocs.15618
    BACKGROUND: Anomalous origin of one pulmonary artery from the aorta is a rare congenital anomaly affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. Early surgical treatment has been proven safe with excellent results. The surgical approach and technique is challenging and should be decided ahead before the patient to surgery. Different techniques were described including direct reimplantation, conduit interposition, aortic ring flap.

    AIM: We present a neonate with anomalous origin of the right pulmonary artery from the aorta and discuss the surgical technique and complications in the literature.

    Matched MeSH terms: Surgical Flaps
  14. Low PH, Abdullah JY, Abdullah AM, Yahya S, Idris Z, Mohamad D
    J Craniofac Surg, 2019 Jun 28.
    PMID: 31261343 DOI: 10.1097/SCS.0000000000005713
    PURPOSE: Decompressive craniectomy is a life-saving procedure in the setting of malignant brain swelling. Patients who survive require cranioplasty for anatomical reconstruction and cerebral protection. Autologous cranioplasty remains the commonest practice nowadays, but partial bone flap defects are frequently encountered. The authors, therefore, seek to develop a new technique of reconstruction for cranioplasty candidate with partial bone flap defect utilizing computer-assisted 3D modeling and printing.

    METHODS: A prospective study was conducted to evaluate the outcome of a new reconstruction technique that produces patient-specific hybrid polymethyl methacrylate-autologous cranial implant. Computer-assisted 3D modeling and printing was utilized to produce patient-specific molds, which allowed real-time reconstruction of bone flap with partial defect intra-operatively.

    RESULTS: Outcome assessment for 11 patients at 6 weeks and 3 months post-operatively revealed satisfactory implant alignment with favorable cosmesis. The mean visual analog scale for cosmesis was 91. Mean implant size was 50cm, and the mean duration of intra-operative reconstruction was 30 minutes. All of them revealed improvement in quality of life following surgery as measured by the SF-36 score. Cost analysis revealed that this technique is more cost-effective compared to customized cranial prosthesis.

    CONCLUSION: This new technique and approach produce hybrid autologous-alloplastic bone flap that resulted in satisfactory implant alignment and favorable cosmetic outcome with relatively low costs.

    Matched MeSH terms: Surgical Flaps
  15. Salauddin SA, Ghazali H
    Malays J Med Sci, 2019 Nov;26(6):137-142.
    PMID: 31908595 MyJurnal DOI: 10.21315/mjms2019.26.6.14
    Background: Penile augmentation using injection of a foreign body into penile skin was mainly performed by non-medical personnel. Majority of these patients end up with complication of an abnormal mass formation known as penile paraffinoma.

    Methods: We described three different surgical techniques for correction of penile paraffinoma based on our single-centre experience. Informed consents were obtained from patients whose photographs were taken during the operation step.

    Results: In general, three patients had simple excision biopsy with primary suturing, four patients underwent single stage excision of circumferential granuloma with bilateral scrotal skin flap reconstruction and one patient experienced dual stage procedure. Three of them were injected with paraffin, one with silicone and the remaining four were unable to identify the substance used. All patients successfully underwent the surgical procedure and four of them had minor post-operative surgical site infection and wound gapping.

    Conclusion: All patients recovered well and the mean International Index of Erectile Function (IIEF-5) score obtained was 24.25. In our experience, excision biopsy was adequate for focal mass and reconstructive surgery using bilateral scrotal flap was suitable for circumferential mass.

    Matched MeSH terms: Surgical Flaps
  16. Singh M, Sharma A, Duthie G, Balasingh D, Kandasamy P
    Asian J Surg, 2005 Jul;28(3):189-91.
    PMID: 16024313
    Treatment of anal fissures has changed dramatically in the past decade. This is primarily due to a better understanding of its pathophysiology and the implications of the various available options. Only a few anal fissures fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60-70% of the flap donor sites break down with complications. We propose using a rotation flap to overcome this problem.
    Matched MeSH terms: Surgical Flaps*
  17. Chou HD, Chong YJ, Teh WM, Chen KJ, Liu L, Chen YP, et al.
    Am J Ophthalmol, 2021 03;223:296-305.
    PMID: 32950511 DOI: 10.1016/j.ajo.2020.09.023
    PURPOSE: To compare the outcomes between using a nasal and a temporal inverted internal limiting membrane (ILM) flap both assisted by a novel technique in repairing a full-thickness macular hole (FTMH).

    DESIGN: Retrospective interventional case series.

    METHODS: Thirty-nine eyes from 39 patients with a FTMH <600 μm were included from a single institution. All patients underwent vitrectomy using a semicircular single-layered ILM inverted flap assisted by a sub-perfluorocarbon liquid injection of ophthalmic viscoelastic device (OVD) technique. Best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography were used to compare outcomes between nasal (n = 19) and temporal (n = 20) groups.

    RESULTS: At 6 months postoperatively, all FTMHs closed and BCVA were significantly improved. Overall, 36 eyes (92%) achieved U-shaped closure, and ellipsoid zone restoration was noted in 24 eyes (62%). An ILM flap was present in 29 eyes (74%) and 86% remained single-layered. There were significantly more deep inner retinal dimples in the temporal group (35%) compared with 5% in the nasal group (P = .04), but these were unrelated to BCVA. Significant retinal thinning in the temporal outer sub-field was noted in the temporal group and was negatively correlated with BCVA (rho [ρ]: - .53; P = .03). No significant postoperative retinal displacement was noted in either group.

    CONCLUSIONS: The technique of using sub-perfluorocarbon liquid injection of OVD secured single-layered flaps intraoperatively and postoperatively. Both the nasal and temporal inverted ILM flaps repaired FTMH and improved visual acuity. However, both temporal macular thinning and deep inner retinal dimples were significantly greater in the temporal group.

    Matched MeSH terms: Surgical Flaps*
  18. Manuel AM, Kalimuthu S, Pathmanathan SS, Narayanan P, Zainal Abidin Z, Azmi K, et al.
    Asian J Surg, 2017 Apr;40(2):158-162.
    PMID: 24210537 DOI: 10.1016/j.asjsur.2013.09.011
    Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.
    Matched MeSH terms: Surgical Flaps/blood supply; Surgical Flaps/transplantation
  19. Halim AS, Alwi AA
    Ann Plast Surg, 2014 Aug;73(2):170-3.
    PMID: 23528630 DOI: 10.1097/SAP.0b013e318270704b
    The use of internal mammary perforators (IMPs) as recipient vessels in autologous free flap breast reconstruction has many additional benefits compared with the internal mammary or thoracodorsal vessels. Our goals were to analyze the characteristics of these vessels and to evaluate the reliability of using them in an Asian population.
    Matched MeSH terms: Surgical Flaps/blood supply*; Surgical Flaps/transplantation
  20. Al-Juboori MJ, AbdulRahaman SB, Hassan A
    Implant Dent, 2013 Aug;22(4):351-5.
    PMID: 23811720 DOI: 10.1097/ID.0b013e318296583d
    To detect the correlation between crestal bone resorption and implant stability during healing period using resonance frequency analysis (RFA).
    Matched MeSH terms: Surgical Flaps/surgery
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