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  1. Fulltext Genetics of cleft lip and palate
    ROSLINA R., ZAINUL AHMAD R., ZILFALIL BA, WAN AZMAN WS, AHMAD SUKARI H, SAIDI J.
    Buletin Persatuan Genetik Malaysia, 2011;18(1):22-25.
    MyJurnal
    Orofacial clefts are one of the most common congenital malformations among newborns. The two main types of oral clefts are cleft lip with or without cleft (CLP) and cleft palate alone (CP). Cleft is an abnormal ssure in an anatomical structure that is normally fused. Cleft lip is the congenital failure of the maxillary and medial nasal processes to fuse, forming a ssure in the lip. Cleft palate is the congenital failure of the palate to fuse properly, forming a ssure in the roof of the mouth (Mossey, 2009).clefts are one of the most common congenital malformations among newborns. The two main types of oral clefts are cleft lip with or without cleft (CLP) and cleft palate alone (CP). Cleft is an abnormal ssure in an anatomical structure that is normally fused. Cleft lip is the congenital failure of the maxillary and medial nasal processes to fuse, forming a ssure in the lip. Cleft palate is the congenital failure of the palate to fuse properly, forming a ssure in the roof of the mouth (Mossey, 2009).
  2. Solitary sebaceous nevus of Jadassohn complicated by squamous cell carcinoma and basal cell carcinoma
    Arshad AR, Azman WS, Kreetharan A
    Head Neck, 2008 Apr;30(4):544-8.
    PMID: 17972311 DOI: 10.1002/hed.20708
    BACKGROUND: Sebaceous nevus is a benign congenital epidermal nevus. Its association with basal cell carcinoma is well known.
    METHOD: This is a case report of sebaceous carcinoma complicated by both basal cell carcinoma and squamous cell carcinoma.
    RESULTS: The behavior of this tumor is very aggressive, resulting in poor prognosis.
    CONCLUSIONS: All sebaceous nevi should be excised early.
  3. Fulltext The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction
    Azman WS, Halim AS, Samad IA
    Med J Malaysia, 2005 Oct;60(4):505-7.
    PMID: 16570718
    Vaginal defects can either be congenital or acquired due to tumor or trauma. The reconstructions are aimed in producing a good physical and functional result with the least donor site morbidity. The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branch of the superficial perineal artery, the continuation of the internal pudendal artery. Although various flaps have been described for vaginal reconstruction, the pudendal thigh flap offers a very attractive alternative.
  4. The use of facial artery musculomucosal (FAMM) readvancement flap in closure of recurrent oronasal fistula
    Ariffuddin I, Arman Zaharil MS, Wan Azman WS, Ahmad Sukari H
    Med J Malaysia, 2018 04;73(2):112-113.
    PMID: 29703876 MyJurnal
    High failure rate for recurrent palatal fistulas closure pose a great challenge to plastic surgeons. Tongue and facial artery musculomucosal (FAMM) flaps are the more commonly used flaps for closure of these recurrent fistulas. We report a case of a formerly inset FAMM flap to effectively close a previously repaired oronasal fistula.
  5. Alopecia secondary to repaired occipital encephalocele - role of tissue expander in hair restoration
    Ishak A, Mat Saad AZ, Azman WS, Halim AS
    Med J Malaysia, 2018 06;73(3):172-174.
    PMID: 29962502 MyJurnal
    Partial scalp alopecia is a common problem that can lead to severe social and psychological problems. Tissue expansion, although an old concept, provides a surgical alternative to manage areas of alopecia. We describe a case of alopecia secondary to repaired occipital encephalocele that was successfully treated using tissue expansion technique.
  6. Fulltext Acute vascular complications (flap necrosis and congestion) with one stage and two stage distally based sural flap for wound coverage around the ankle
    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.
  7. Fulltext Reconstruction of severe patellar infera syndrome with free vascularised composite tensor fascia lata flap
    Sulaiman AR, Halim AS, Azman WS, Eskandar H
    Singapore Med J, 2008 Aug;49(8):e205-7.
    PMID: 18756334
    Post-traumatic severe patella infera and intra-articular adhesion may lead to a severe knee stiffness. We report a 29-year-old man, a muslim prayer leader, who had a previous knee injury. He presented with knee movement from ten degrees to 30 degrees, patellar infera with a length of patella to length of patellar tendon ratio of 2:5, and severe knee arthrofibrosis. He underwent incision of the patella ligament and open arthrofibrosis release, leaving a tendon gap and skin defect of 5 cm. Reconstruction was successfully done using a free vascularised composite tensor fascia lata flap. He regained full range of knee motion with normal strength quadriceps mechanism at five months after surgery, and remained in full function at 18 months follow-up.
  8. Fulltext The outcomes of salvage surgery for vascular injury in the extremities: a special consideration for delayed revascularization
    Jagdish K, Paiman M, Nawfar A, Yusof M, Zulmi W, Azman W, et al.
    Malays Orthop J, 2014 Mar;8(1):14-20.
    PMID: 25279079 MyJurnal DOI: 10.5704/MOJ.1403.012
    A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
  9. Fulltext Resection and reconstruction of malignant tumor involving sternum
    Faisham WI, Ziyadi MG, Azman WS, Halim AS, Zulmi W, Biswal BM
    Med J Malaysia, 2012 Apr;67(2):224-5.
    PMID: 22822652 MyJurnal
    We present a series of four cases of chest wall tumor, which underwent sternum resection. The methods of resection and reconstruction chest wall defect are discussed and the final outcome highlighted.
  10. Fulltext Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review
    Mat Saad AZ, Halim AS, Faisham WI, Azman WS, Zulmi W
    ScientificWorldJournal, 2012;2012:702904.
    PMID: 22629187 DOI: 10.1100/2012/702904
    Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.
  11. 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.
  12. Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect
    Halim AS, Chai SC, Wan Ismail WF, Wan Azman WS, Mat Saad AZ, Wan Z
    J Plast Reconstr Aesthet Surg, 2015 Dec;68(12):1755-62.
    PMID: 26420474 DOI: 10.1016/j.bjps.2015.08.013
    Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.
  13. Fulltext Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion
    Choo CY, Mat-Saad AM, Wan-Azman WS, Wan Z, Nor-Azman MZ, Yahaya S, et al.
    Malays Orthop J, 2018 Nov;12(3):19-23.
    PMID: 30555642 MyJurnal DOI: 10.5704/MOJ.1811.004
    Introduction: Restoration of a functional hand is the ultimate goal following a distal radius tumour resection. The early outcomes of mobile wrist reconstruction are satisfactory; however, long-term results are unpredictable due to late wrist instability and degenerative arthritis. Our aim is to compare mobile wrist reconstruction with wrist fusion (pan-carpal fusion) in our cohort of patients. Materials and Methods: A retrospective cohort study was performed for functional outcomes of all patients who underwent resection for distal radius tumour and treated with either fusion or reconstruction of the wrist in a single institution from years 2000-2013 with a minimum of three years follow-up. Results: Eleven patients were included in the study, six of whom had wrist reconstruction with proximal fibula graft and the remaining five wrist fusion, with a mean follow-up of 6.3 years. The mean Musculoskeletal Tumour Society (MSTS) score was 82.78%, ranging from 70% to 93.3%. Average grip strength compared to the normal contralateral hand was 60.0% for total wrist fusion, which was better than wrist reconstruction with 58.07%. There was no difference in the functional outcome between fusion and mobile reconstruction in our study. Osteoarthritis changes and subluxation of the wrist joint were the most common findings in the long-term follow-up for this group. Conclusion: There was no difference in the functional outcome of the long-term follow-up between the two groups.
  14. Fulltext Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries
    Hanifah J, Paiman M, Nawfar AS, Tengku-Muzaffar T, Wan-Azman WS, Faisham WI, et al.
    Malays Orthop J, 2015 Nov;9(3):61-64.
    PMID: 28611914 MyJurnal DOI: 10.5704/MOJ.1511.014
    High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.
  15. Fulltext Long-term Outcome of Total Femur Replacement
    Adzhar AL, Faisham WI, Zulmi W, Azman WS, Sahran Y, Syurahbil AH, et al.
    Malays Orthop J, 2023 Jul;17(2):21-27.
    PMID: 37583532 DOI: 10.5704/MOJ.2307.004
    INTRODUCTION: Total femur replacement is an option instead of amputation for extensive bone tumour or after revision surgery with a massive bone loss. Over a long period of time the patients may need revision surgery, and this might affect the functional outcome. We reviewed all consecutive total femur replacements done for primary and revision surgery of primary bone tumours in our centre to evaluate the long-term functional outcome and survival.

    MATERIALS AND METHODS: All patients who had total femur resection and reconstruction with modular endoprosthesis replacement in our centre from June 1997 to May 2022 were reviewed. The respondents were surveyed through WhatsApp using google form which was translated into Bahasa Malaysia based on the Musculoskeletal Tumour Society Scoring System (MSTS). The data were presented as descriptive data on the final survival of the limb and prosthesis.

    RESULTS: Ten patients underwent total femur replacement. There were eight osteosarcoma, one giant cell tumour and one chondromyxoid fibroma. Three patients with osteosarcoma succumbed to pulmonary metastases; all had good early post-operative functional outcomes without local recurrence. Seven patients were available for long term evaluation of function with a mean follow-up of 17.6 years (ranged 10-25 years). Four patients with total femur replacement had good functional outcomes (60-80%) without revision with 10-25 years follow-up. Three patients experienced acetabulum erosion and chronic pain that required early hip replacements. Two of them were complicated with superior erosions and bone loss and subsequently were managed with massive reconstruction using cemented acetabulum cage reconstruction. The other has diabetes mellitus with chronic infection following revision of distal femur endoprosthesis to total femur replacement and subsequently underwent limited hemipelvectomy after 14 years.

    CONCLUSION: Total femur replacement offers a good long term functional outcome and prosthesis survival and is a favourable option for limb salvage surgery.

  16. Epidemiology of surgically treated patient in road traffic accident with lower extremity vascular injury from a single centre in Kelantan
    Koh SC, Wan Faisham Nu'man WI, Siti Fatimah NMJ, Wan Azman WS, Mohammad P, Arman Zaharil MS
    Med J Malaysia, 2020 05;75(3):292-294.
    PMID: 32467547
    INTRODUCTION: Lower extremity vascular injury can result in either temporary or permanent disability.

    METHODS: This is a clinical audit involving all patients admitted to our institution from January 2008 to June 2018 of those who had undergone revascularization surgery for lower limb trauma.

    RESULTS: Fifty-nine patients were in this study with a mean age of 28.1 years. Most of the patients were motorcyclist involved in road traffic accidents with cars (n=30, 50.8%). The popliteal artery was most commonly seen injury (n=41, 69.5%). The mean duration of ischaemia was 14.1 hours. The limb salvage rate was 89.8%.

    CONCLUSION: Lower extremity vascular injury caused by RTA treated in our institution predominantly involved young patients aged between 18-30 years associated with long bone fractures causing contusion and thrombosis of the popliteal artery.

  17. Fulltext Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies
    Tunku-Naziha TZ, Wan-Yuhana W, Hadizie D, Muhammad-Paiman, Abdul-Nawfar S, Wan-Azman WS, et al.
    Malays Orthop J, 2017 Mar;11(1):12-17.
    PMID: 28435568 MyJurnal DOI: 10.5704/MOJ.1703.005
    The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.
  18. Prognostic factors and survival rate of osteosarcoma: A single-institution study
    Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, et al.
    Asia Pac J Clin Oncol, 2017 Apr;13(2):e104-e110.
    PMID: 25870979 DOI: 10.1111/ajco.12346
    AIM: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center.

    METHODS: This was a retrospective cohort study of all patients treated between January 2005 and December 2010.

    RESULTS: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis.

    CONCLUSION: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.

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