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  1. Single-stage reconstruction of a traumatic tendocutaneous defect of the Achilles using free composite anterolateral thigh flap with vascularized fascia lata
    Liang Yii RS, Chai SC, Zainal HM, Basiron N
    Jt Dis Relat Surg, 2022;33(3):673-679.
    PMID: 36345197 DOI: 10.52312/jdrs.2022.843
    Combined tendocutaneous defect of Achilles tendon remains a complex reconstructive challenge whereby both the soft tissue coverage and tendon reconstruction have to be considered to achieve a good functional and aesthetic outcome. A 14-year-old boy who sustained an open right calcaneum fracture (Gustilo-Anderson IIIB) with a transected Achilles tendon and huge skin defect from motorcycle wheel spoke injury was admitted. The Achilles tendon repair site broke down following initial surgical debridement and primary repair, resulting in a sizeable combined tendocutaneous defect. Simultaneous soft tissue coverage and tendon defect reconstruction using composite sensate free anterior lateral thigh (ALT) fasciocutaneous flap with vascularized fascia lata was performed subsequently. The vascularized fascia lata was tubularized to wrap the native proximal stump of Achilles tendon and secured using the modified Krakow suturing technique. The distal end of tubularized fascia lata was, then, secured by drilling across right calcaneum bone, passing the suture transosseously and screwed. He led an uneventful postoperative recovery with satisfactory functional and aesthetic outcomes at one year of follow-up. In conclusion, the present case demonstrates the reliability of this technique and its advantages over other flap choices in reconstruction of a huge combined tendocutaneous defect.
    Matched MeSH terms: Fascia Lata/injuries; Fascia Lata/transplantation
  2. Fulltext Tornwaldt Cyst: a case report of unusual dental symptoms
    Asfizahrasby Mohd Rasoul, Norliwati Ibrahim
    International Medical Journal Malaysia, 2017;16(21):25-25.
    MyJurnal
    Tornwaldt's (Thornwaldt's) or nasopharyngeal cyst is an uncommon developmental
    benign cyst located in the midline postero-superior wall of nasopharynx. Incidence reported in
    general population is 0.06%. It occurred in the potential space due to outpouching of ectoderm into
    the pharyngobasilar fascia at the site where notochord attached to pharyngeal ectoderm. (Copied from article).
    Matched MeSH terms: Fascia
  3. Fulltext Low-grade liquid silicone injections as a penile enhancement procedure: Is bigger better?
    Sasidaran R, Zain MA, Basiron NH
    Urol Ann, 2012 Sep;4(3):181-6.
    PMID: 23248528 DOI: 10.4103/0974-7796.102672
    To report our experience with 5 cases of complications of penile enhancement procedures secondary to liquid silicone injections and our method of management of its debilitating effects. All five patients were treated with excision of penile shaft skin down to buck's fascia followed by resurfacing with split thickness skin grafting. We conclude that penile enhancement procedures with liquid silicone by non-medical personnel could result in devastating consequences. We also demonstrate that a simple method of excision of the entire penile shaft skin and resurfacing with split skin grafting showed improvement in cosmetic as well as functional outcome.
    Matched MeSH terms: Fascia
  4. Effects of Running Surface Stiffness on Three-Segment Foot Kinematics Responses with Different Shod Conditions
    Abdul Yamin NAA, Basaruddin KS, Salleh AF, Salim MS, Wan Muhamad WZA
    Appl Bionics Biomech, 2021;2021:8842591.
    PMID: 33603827 DOI: 10.1155/2021/8842591
    Objective: The aim of this study was to investigate the effects of surface stiffness on multisegment foot kinematics and temporal parameters during running.

    Methods: Eighteen male subjects ran on three different surfaces (i.e., concrete, artificial grass, and rubber) in both heeled running shoes (HS) and minimal running shoes (MS). Both these shoes had dissimilar sole profiles. The heeled shoes had a higher sole at the heel, a thick base, and arch support, whereas the minimal shoes had a flat base sole. Indeed, the studied biomechanical parameters responded differently in the different footwear during running. Subjects ran in recreational mode speed while 3D foot kinematics (i.e., joint rotation and peak medial longitudinal arch (MLA) angle) were determined using a motion capture system (Qualysis, Gothenburg, Sweden). Information on stance time and plantar fascia strain (PFS) was also collected.

    Results: Running on different surface stiffness was found to significantly affect the peak MLA angles and stance times for both HS and MS conditions. However, the results showed that the joint rotation angles were not sensitive to surface stiffness. Also, PFS showed no relationship with surface stiffness, as the results were varied as the surface stiffness was changed.

    Conclusion: The surface stiffness significantly contributed towards the effects of peak MLA angle and stance time. These findings may enhance the understanding of biomechanical responses on various running surfaces stiffness in different shoe conditions.

    Matched MeSH terms: Fascia
  5. Fulltext Non-Traumatic Snapping Tendon on the Dorsal Aspect of the Thumb: A Diagnostic Challenge
    Kesu Belani L, Abdullah S, Soh EZF, Abd Jabar F, Nasseri Z
    Cureus, 2021 Apr 11;13(4):e14417.
    PMID: 33987066 DOI: 10.7759/cureus.14417
    A snapping tendon on the dorsal aspect of the thumb is a rare condition as opposed to the common triggering on the volar aspect of the thumb. This condition is known as triggering of the extensor pollicis longus (EPL). A 21-year-old female presented with a clicking or snapping sensation that was felt on the dorsum of her thumb when it is extended. There was no history of trauma. She worked in an ice-cream parlor with repetitive scooping ice-cream motions. Her triggering immediately resolved on releasing the EPL fascia ulnar to Lister's tubercle. Upon wake-up surgery, we could immediately confirm this. We recommend dynamic ultrasound as an investigation and do not recommend MRI. The surgical method of choice is either wake-up surgery or wide-awake local anesthesia no tourniquet (WALANT) surgery.
    Matched MeSH terms: Fascia
  6. Fulltext Determinations of a safe musculofascial plication in abdominoplasty
    Al-Shaham AA
    Med J Malaysia, 2007 Dec;62(5):380-2.
    PMID: 18705470 MyJurnal
    This study was conducted to determine a safe vertical musculo-fascial plication distance in abdominoplasty operation in order to avoid the risk of developing respiratory distress during the post operative period. Abdominoplasty is a surgical procedure that removes excess abdominal skin and fat (panneculectomy), and tightens lax anterior abdominal wall muscle; in which musculo-fascial plication is a major component of abdominoplasty in patient with significant divaricating of the recti muscles. Respiratory decompensation may occur as a result of undue plication which reduces the intra abdominal volume with diaphragmatic excursion leading to abdominal compartmental syndrome. Fifty six patients for abdominoplasty were selected prospectively, during the period from June 1998 to February 2004, male to female ratio 1:13, mean age 39.5, mean weight 95.2 kilogram. To determine a safe plication distance (PD). The difference between two pre-operative measurements of the abdominal circumference was measured, before (BB) and after (AB) application of abdominal binder. The safe plication distance (PD) in centimeters = (BB) - (AB). The mean plication distance is 13.5cm. The changes in the pulmonary functions test before and after surgery were clinically insignificant. Pre-operative determination of safe plication distance is simple and convenient method which reduces the risk of developing respiratory distress in patients undergoing abdominoplasty in the post-operative period.
    Matched MeSH terms: Fascia/surgery
  7. Fulltext Underlay myringoplasty: comparison of human amniotic membrane to temporalis fascia graft
    Harvinder S, Hassan S, Sidek DS, Hamzah M, Samsudin AR, Philip R
    Med J Malaysia, 2005 Dec;60(5):585-9.
    PMID: 16515109
    Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.
    Matched MeSH terms: Fascia/transplantation
  8. Biomaterials for repair of orbital floor blowout fractures: a systematic review
    Gunarajah DR, Samman N
    J Oral Maxillofac Surg, 2013 Mar;71(3):550-70.
    PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029
    To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults.
    Matched MeSH terms: Fascia/transplantation
  9. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics
    Merican AM, Amis AA
    J Biomech, 2009 Jul 22;42(10):1539-1546.
    PMID: 19481211 DOI: 10.1016/j.jbiomech.2009.03.041
    The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175 N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100 degrees to 0 degrees flexion. This was repeated after the following ITB loads: 30, 60 and 90 N. There was no change with 30 N load for patellar translation. On average, at 60 and 90 N, the patella translated laterally by 0.8 and 1.4mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7 degrees, 1.2 degrees and 1.5 degrees for 30, 60 and 90 N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60 degrees and 75 degrees flexion. The increase was 5.2 degrees, 9.5 degrees and 13 degrees in this range for 30, 60 and 90 N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known.
    Matched MeSH terms: Fascia/physiology
  10. Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child
    Ali F, Halim AS, Najihah SZ, Ibrahim M, Abdullah J
    J Craniomaxillofac Surg, 2005 Oct;33(5):326-30.
    PMID: 16125400
    A vascularized outer-table calvarial bone graft was used for repairing a Posnick type 2 traumatic orbito-frontal bone defect supported by the use of a calcium-based putty (Allomatrix) in a 7-year-old girl. Gaps between the donor and recipient sites were filled with Allomatrix containing demineralized bone matrix particles. Four years later there was a good cosmetic result using an artificial left eye.
    Matched MeSH terms: Fascia/blood supply; Fascia/transplantation*
  11. Fulltext Reconstruction of lower leg defects using a medial island fasciocutaneous flap
    Naresh B, Parameswaran S
    Med J Malaysia, 1998 Sep;53 Suppl A:77-82.
    PMID: 10968186
    It is usually a major task providing soft tissue cover to significant defects of the lower leg. A wide variety of flaps and techniques are available, each with its advantages and limitations. Previously described anatomic study of the septocutaneous vessels of the leg have indicated a consistent lower most perforator at 9-12 cm from the tip of the medial malleolus. An island fasciocutaneous flap based on this perforator vessels can be raised subfascially. After the vessels have been dissected clean down to the posterior tibial artery, it can be rotated up to 180 degrees degrees. Successful soft tissue reconstruction was achieved in 18 patients. Most of the tissue loss was due to trauma and were around the ankle and the heel. There were 7 minor complications which resolved completely after 2 months. Its simplicity of design and elevation plus its extensive arc of rotation makes it a reliable and versatile flap in the reconstruction of lower leg defects.
    Matched MeSH terms: Fascia
  12. Fulltext Necrotising Fasciitis of the Lower Limb caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus
    Chan, C.K., Merican, A.M., Nawar, A.M., Hanifah, Y.A., Thong, K.L.
    Malays Orthop J, 2010;4(3):36-38.
    MyJurnal
    Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CA-MRSA trend.
    Matched MeSH terms: Fascia
  13. Fulltext Necrotizing fasciitis of the upper back presenting with left shoulder pain
    Mohamad Isa MZ, Mohamed-Yassin MS, Abdul Kadir RF
    Clin Pract, 2020 Mar 31;10(1):1218.
    PMID: 32373307 DOI: 10.4081/cp.2020.1218
    Necrotizing fasciitis is a severe and progressive infection of deep soft tissues which results in destruction of the fascia and overlying subcutaneous fat. We report a case of a 45-year-old diabetic gentleman who initially presented with left shoulder pain, which was treated symptomatically. Upon representation, he had fever and the pain extended to his left upper back. There was a warm, firm and mildly tender purplish swelling on his mid to the left upper back. Blood tests revealed significantly elevated white cell counts and C-reactive protein. A CT thorax showed extensive soft tissue gas within the deep and superficial fascial layers of his left upper back. Necrotizing fasciitis was confirmed intraoperatively. The diagnosis of this condition is often difficult as early symptoms can be mild and nonspecific. A high Laboratory Risk Indicator for NECrotizing fasciitis (LRINEC) score may be helpful to rule in this diagnosis and guide further management.
    Matched MeSH terms: Fascia
  14. Fulltext Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in Malaysian Patients with Necrotising Fasciitis
    Syed A, Alvin T, Fazrina A, Abdul R
    Malays Orthop J, 2017 Jul;11(2):36-39.
    PMID: 29021877 MyJurnal DOI: 10.5704/MOJ.1707.005
    Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.
    Matched MeSH terms: Fascia
  15. Fulltext Necrotizing fasciitis of the head and neck: surgical outcomes in three cases
    Shaariyah MM, Marina MB, Mohd Razif MY, Mazita A, Primuharsa Putra SH
    Malays J Med Sci, 2010 Apr;17(2):51-5.
    PMID: 22135538 MyJurnal
    Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.
    Matched MeSH terms: Fascia
  16. Fulltext Endoscopic transnasal approach to anterior and middle cranial base lesions
    Tan SH, Brand Y, Prepageran N, Waran V
    Neurol India, 2015 Sep-Oct;63(5):673-80.
    PMID: 26448224 DOI: 10.4103/0028-3886.166539
    We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative.
    Matched MeSH terms: Fascia Lata
  17. Fulltext Abdominal flap: a reconstructive option for hand defect in rural setting
    Sinnasamy, Shankari, B Mohd Shakir, Vijayashingam, Naveen, Mustaqim Afifi @ Apipi, Prakash, Doddaballapur Ramaiah
    Borneo Journal of Medical Sciences, 2018;12(3):63-67.
    MyJurnal
    Reconstruction of hand injury is the challenge for the surgeon especially in rural settings. This case report is about a 10-year-old boy, who sustained large degloving wound of dorsum of right hand with extensor tendon injury following a road traffic accident. We performed a staged abdominal flap with tensor fascia lata graft for tendon reconstruction as microsurgery facilities was not available. Post-operatively he was subjected to physiotherapy and he has a functional right hand. This case report aimed to highlight abdominal flap as reconstructive option as compared to skin grafting which is reproducible with limited resources. Besides that, overall exposure to all surgical options is of paramount importance in the training of trainees to equip them with skills to serve in rural setting.
    Matched MeSH terms: Fascia Lata
  18. 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: Fascia
  19. Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience
    Gendeh BS, Mazita A, Selladurai BM, Jegan T, Jeevanan J, Misiran K
    J Laryngol Otol, 2005 Nov;119(11):866-74.
    PMID: 16354338
    The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.
    Matched MeSH terms: Fascia Lata/transplantation
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