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A review of free flap failures in the University Hospital, Kuala Lumpur

Ahmad TS, Musa G, Lee JK

Ann Acad Med Singap, 1997 Nov;26(6):840-3.
PMID: 9522989

Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient's age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flaps, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration. The infection rate was 16.4% and this had a strong correlation with the free flap failure in our study population. Postoperative anaemia could adversely affect the tissue oxygenation of the free flap and delay the re-exploration due to the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed. The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary both for the preoperative planning of free flap surgery as well as salvaging a failure.
Fulltext Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study

Kohno A, Nik Farid ND, Musa G, Abdul Aziz N, Nakayama T, Dahlui M

BMJ Open, 2016;6(3):e010668.
PMID: 27006344 DOI: 10.1136/bmjopen-2015-010668

While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia.
Fulltext Issues in healthcare services in Malaysia as experienced by Japanese retirees

Kohno A, Musa G, Nik Farid ND, Abdul Aziz N, Nakayama T, Dahlui M

BMC Health Serv Res, 2016 May 05;16:167.
PMID: 27151089 DOI: 10.1186/s12913-016-1417-3

BACKGROUND: Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country.
METHODS AND RESULTS: From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'.
DISCUSSION: We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia.
CONCLUSION: Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

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