Displaying publications 1 - 20 of 26 in total

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  1. Faisal, A., Ahmad, S.H., Zulmi, W.
    MyJurnal
    Tumour surgery for locally extensive malignant neoplasms of the extremity will sometimes result in extensive composite soft tissue defect. Local flaps are usually inadequate to cover these large defects. More than one tissue flap might be required to cover any exposed neurovascular structures, bone or prosthesis. We present two cases where two composite flaps were simultaneously used to cover extensive surgical defects after ablative tumour resections in the extremity. These resulted in uncomplicated wound healing and limb salvage.
    Matched MeSH terms: Limb Salvage
  2. Wan Ismail WF
    Malays J Med Sci, 2015 Jul-Aug;22(4):1-5.
    PMID: 26715902
    The management of musculoskeletal tumours has progressed tremendously over the past few decades. Limb salvage surgery has become a standard practise without compromising the oncological outcome. Patients generally will benefit with superior function and a better quality of life compared with definitive amputation. The multidisciplinary approach and advancement of surgeries are important to achieve patient survival and optimum function.
    Matched MeSH terms: Limb Salvage
  3. Singh VA, Heng CW, Yasin NF
    Indian J Orthop, 2018 2 9;52(1):65-72.
    PMID: 29416172 DOI: 10.4103/ortho.IJOrtho_188_17
    Background: Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome.

    Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS.

    Results: The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007).

    Conclusion: Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait.

    Matched MeSH terms: Limb Salvage
  4. Muhammad Hafiz, A.S., Mohd Yazid, B., Norliyana, M., Rasyidah, R.
    Medicine & Health, 2018;13(1):286-290.
    MyJurnal
    Osteomyelitis refers to an infection of the bone characterized by progressive inflammatory destruction caused by infecting microorganism. Open fracture carries the risk of developing osteomyelitis from 3 to 50% with a high amputation rate. Salvage of the limb is always a challenge and needs perseverance. We report the case of a 44-year-old male with chronic osteomyelitis with successful multiple limb salvage surgeries. The curative approach to chronic osteomyelitis has the following goals including arrest of infection, pain reduction and salvage of limb and function. With regard to survival and function, the result obtained in this case is more promising compared to above knee amputation.
    Matched MeSH terms: Limb Salvage
  5. Saadon I, Amit B, Zolquarnian A, Muhamad F
    Malays Orthop J, 2017 Jul;11(2):64-67.
    PMID: 29021882 MyJurnal DOI: 10.5704/MOJ.1707.010
    Musculoskeletal tumours of the lower limbs especially malignant tumours are not common. The fibula is the site of primary bone tumours as reported in 2.4% of lower limb tumours with the proximal third being more frequently involved than the distal segment. Osteosarcoma is the most common primary malignant bone tumour of nonhaematopoietic origin, with distal fibular involvement in 0.47% of patients. The advances in imaging techniques and neo-adjuvant chemotherapy have now made it possible to accurately define the extent of tumour and plan limb salvage with tumour resection. The purpose of this case report is to highlight the successful outcome of limb salvage procedure with a five year follow up in an 11-year old boy with distal fibular osteosarcoma. Limb salvage surgery with distal fibulectomy and retention of the foot are a good alternative to radical amputation.
    Matched MeSH terms: Limb Salvage
  6. Shamsuddin AA, Mujait K
    Med J Malaysia, 2005 Jul;60 Suppl C:108-10.
    PMID: 16381294
    The choice between limb salvage and primary amputation in a severely injured limb is at time difficult. A case of severe Gustilo type-IIIB open fracture of the tibia with massive soft tissue loss is presented to highlight the immediate and definitive treatment undertaken to preserve the limb.
    Matched MeSH terms: Limb Salvage*
  7. Merican AM, Kwan MK, Cheok CY, Wong ELW, Sara TA
    Med J Malaysia, 2005 Jun;60(2):218-21.
    PMID: 16114164
    Near total amputation of the upper limb if unsalvageable would cause severe disability. However, delayed revascularisation can be life threatening. We report two cases of revascularisation of the upper limb following near total amputation that was successful and functional after a warm ischaemic time of ten hours. The first was a traction avulsion injury of the arm leaving major nerves contused but in continuity. The second was a sharp injury through the mid-forearm attached by only a bridge of skin. Attempting revascularisation of a proximal injury beyond 6 hours, in selected cases is worthwhile.
    Matched MeSH terms: Limb Salvage*
  8. Yasin NF, Ajit Singh V, Saad M, Omar E
    BMC Cancer, 2015;15:289.
    PMID: 25884718 DOI: 10.1186/s12885-015-1234-9
    Limb salvage surgery is a treatment of choice for sarcomas of the extremities. One of the options in skeletal reconstruction after tumour resection is by using a recycled bone autograft. The present accepted methods of recycling bone autografts include autoclaving, pasteurization and irradiation. At the moment there is lack of studies that compare the effectiveness of various sterilization methods used for recycling bone autografts and their effects in terms of bone incorporation. This study was performed to determine the effects of different methods of sterilization on bone autografts in rabbit by radiological, biomechanical and histopathological evaluations.
    Matched MeSH terms: Limb Salvage*
  9. Faisham WI, Zulmi W, Aidura M, Yazid MD, Sallehuddin AY, Azman MZN, et al.
    Med J Malaysia, 2001 Jun;56(2):248-51.
    PMID: 11771089
    Malignant pelvic tumours often present late, hence a high index of suspicion should be maintain in order to arrive at the diagnosis. This is particularly true for those who have unusual symptoms. A proper planning and staging strategies is required to save the limb, and the limb salvage surgery is at present the surgery of choice to achieve local control and restoring optimum functions of the lower limbs as being illustrated by our three cases.
    Matched MeSH terms: Limb Salvage*
  10. Ariff M, Zulmi W, Faisham W, Nor Azman M, Nawaz A
    Malays Orthop J, 2013 Mar;7(1):56-62.
    PMID: 25722809 MyJurnal DOI: 10.5704/MOJ.1303.018
    We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment.
    Matched MeSH terms: Limb Salvage
  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: Limb Salvage
  12. Kow, Ren Yi, Aziah Abdul Aziz, Muhammad Firdaus Abas, Low, Chooi Leng, Akmal Azim Ahmad Alwi
    MyJurnal
    The human foot serves as an important part to support
    the body weight and accounts for the majority of our
    movements. A mangled limb involves injury to at least
    three out of four systems, namely the soft tissues, nerves,
    blood supply and bone. While amputation is indicated in
    some cases of mangled limb, with proper planning, limb
    salvaging surgical management is also a viable option.
    Special consideration to the skeletal stabilization, control
    of infection, vascular status and soft tissue coverage is
    paramount to the success of limb salvaging surgery. We
    present a case of mangled limb which was successfully
    treated with limb salvaging surgical management. Initial
    debridement, Kirschner wires insertion and cross ankle
    external fixation were used for skeletal stabilization. An
    antibiotic spacer was inserted for local antibiotic and to
    maintain the length left due to the loss of medial and
    intermediate cuneiform bones. The anterior tibialis
    artery and its venae comitantes were utilized for free
    vascularized fibular graft to provide bony reconstruction
    as well as soft tissue coverage for the mangled foot.
    Matched MeSH terms: Limb Salvage
  13. Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Lim BC
    Malays Orthop J, 2019 Nov;13(3):45-52.
    PMID: 31890110 DOI: 10.5704/MOJ.1911.008
    Introduction: Diabetic foot infection, a complication which can lead to lower limb amputation, is a major source of morbidity and mortality in Malaysia. The objective of this study was to determine the predictive factors of major lower limb amputation among patients with diabetes mellitus in a cluster of three district hospitals in Pahang, Malaysia. Materials and Methods: This cross-sectional study involved 170 patients who had undergone surgical interventions for diabetic foot infections at three district hospitals from 1st of September 2014 to 31st December 2015. The predictors for major amputation of lower limb were determined using simple logistic regression (LR) and forward LR multiple logistic regression. Results: A total of 21 patients had undergone major amputations of lower limb (15 transtibial and 6 transfemoral). The following factors were associated with major amputation of lower limb; longer duration of disease, age ≥ 60 years, patients from Bentong Hospital, presence of hypertension, presence of fever, history of multiple limb-salvaging surgeries, monomicrobial culture, necrotising fasciitis, anemia and leukocytosis. Upon forward LR multiple logistic regression, only duration of disease, history of more than three previous limb-salvaging surgeries and total white blood cell count ≥15X109/L were found to be significant as predictive factors of major amputation of lower limb. Conclusion: Among the factors analysed in this study, a longer duration of disease, raised total white blood cell count and history of more than three limb-salvaging surgeries were identified as predictors for major amputation of lower limb in diabetic foot infections using stepwise logistic regression analysis.
    Matched MeSH terms: Limb Salvage
  14. Rosli MA, Wan Ismail WF, Wan Sulaiman WA, Mat Zin NA, Abdul Halim S, Mat Johar F, et al.
    Foot Ankle Int, 2021 Dec;42(12):1570-1578.
    PMID: 34286617 DOI: 10.1177/10711007211025280
    BACKGROUND: Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors.

    METHODS: We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case.

    RESULTS: The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either.

    CONCLUSION: Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes.

    LEVEL OF EVIDENCE: Level IV, case series.

    Matched MeSH terms: Limb Salvage
  15. Aimanan K, Loi L, Pian PM, Pillay KVK, Hussein H
    Ann Vasc Surg, 2024 May;102:216-222.
    PMID: 37924866 DOI: 10.1016/j.avsg.2023.09.097
    BACKGROUND: The primary aim of this study was to assess the role of internal iliac patency in predicting outcomes of above-knee amputation (AKA) stump healing. The secondary objectives were to assess the accuracy of Wound, Ischemia, and Foot Infection (WIfI) classification system in predicting AKA stump healing and its association with delayed mortality.

    METHODS: This is a retrospective study performed in a vascular surgery unit in a tertiary hospital on patients who underwent AKAs over 1 year, from July 2021 until June 2022. Patient demographic data, WIfI scoring, outcome of AKAs, and patency of profunda femoris and internal iliac artery (IIA) were collected. To minimize confounding, a single vascular surgeon performed all computed tomography imaging reviews and arterial measurements. Approval for this study was obtained from the National Research Registry, NMRR ID-23-01865-KQ4 (investigator initiated research).

    RESULTS: Ninety patients underwent AKA over 1 year, from July 2021 until June 2022. Occluded IIA in the presence of patent profunda femoris did not affect the wound healing of the AKA stump. There was significant association between WIfI scoring and mortality. Patients with a WIfI scoring of 3 to 4 were observed to have a higher mortality rate compared with patients with normal healing: 47 (72.0%) vs. 4 (80.0%); P = 0.021.

    CONCLUSIONS: In this study, the IIA patency shows no statistically significant effect on AKA stump healing; however, the small number of patients is a drawback of the study. This study also demonstrates that the WIfI score can be a prognostic factor for mortality in patients undergoing AKA.

    Matched MeSH terms: Limb Salvage
  16. Pan KL, Chan WH, Ong GB, Premsenthil S, Zulkarnaen M, Norlida D, et al.
    World J Surg Oncol, 2012;10:105.
    PMID: 22681750 DOI: 10.1186/1477-7819-10-105
    Tumor prostheses currently give the best short- and medium-term results for limb-salvage reconstruction procedures in the treatment of bone tumors. However, in developing countries, the cost of a tumor prosthesis is beyond the reach of much of the population. We report the use of autoclaved tumor-bearing bone in 10 patients, as an affordable alternative to the use of prostheses.
    Matched MeSH terms: Limb Salvage*
  17. Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS
    Med J Malaysia, 2004 Dec;59 Suppl F:24-34.
    PMID: 15941157
    We reviewed the surgical and oncological management 23 consecutive patients with osteosarcoma of the long bones to determine the outcome of limb salvage technique performed in our centre. All patients received neoadjuvant chemotherapy. There were 15 males and 8 females with a mean age at diagnosis of 19 years (9 to 36). The median follow-up was 30 months (10 to 60). Fifteen had lesion around the knee joint followed by three in the proximal humerus, two in distal humerus, two in the pelvis, and one in the distal tibia. Six patients presented with lung metastases at diagnosis. We performed limb salvage surgery to control local disease in 16 patients and amputation in 7. The resection margins of the primary lesion were adequate and free of tumour cells in all patients. Local recurrence developed in 1 patient of limb salvage group. The overall median survival was 22 months and actuarial survival was 52% at 3 years. Eleven patients died of pulmonary metastases within 2 years of follow-up. Median survival of the limb salvage surgery group was 30 months compared to 6 months in the amputation group. As per our experience, limb salvage technique is a feasible option in extremity osteosarcoma without compromising survival.
    Matched MeSH terms: Limb Salvage*
  18. Yusoff FM, Kajikawa M, Takaeko Y, Kishimoto S, Hashimoto H, Maruhashi T, et al.
    Sci Rep, 2020 11 16;10(1):19891.
    PMID: 33199760 DOI: 10.1038/s41598-020-76886-6
    Cell therapy using intramuscular injections of autologous bone-marrow mononuclear cells (BM-MNCs) improves clinical symptoms and can prevent limb amputation in atherosclerotic peripheral arterial disease (PAD) patients with critical limb ischemia (CLI). The purpose of this study was to evaluate the effects of the number of implanted BM-MNCs on clinical outcomes in atherosclerotic PAD patients with CLI who underwent cell therapy. This study was a retrospective observational study with median follow-up period of 13.5 years (range, 6.8-15.5 years) from BM-MNC implantation procedure. The mean number of implanted cells was 1.2 ± 0.7 × 109 per limb. There was no significant difference in number of BM-MNCs implanted between the no major amputation group and major amputation group (1.1 ± 0.7 × 109 vs. 1.5 ± 0.8 × 109 per limb, P = 0.138). There was also no significant difference in number of BM-MNCs implanted between the no death group and death group (1.5 ± 0.9 × 109 vs. 1.8 ± 0.8 × 109 per patient, P = 0.404). Differences in the number of BM-MNCs (mean number, 1.2 ± 0.7 × 109 per limb) for cell therapy did not alter the major amputation-free survival rate or mortality rate in atherosclerotic PAD patients with CLI. A large number of BM-MNCs will not improve limb salvage outcome or mortality.
    Matched MeSH terms: Limb Salvage*
  19. Imran Y, Zulmi W, Halim AS
    Singapore Med J, 2003 Jun;44(6):286-7.
    PMID: 14560858
    Thirteen patients had skeletal reconstruction using vascularised fibula graft following resection of the diseased bone. Eleven patients had reconstruction of the lower limbs and two patients of the upper limbs. Clinical and radiographical evidence union were achieved with the average time of 32 weeks (earliest eight weeks). Six out of 11 patients (54%) in lower limb reconstruction started weight bearing at the average of 27 weeks. Bony union in this study is comparable with other studies using vascularised fibula graft.
    Matched MeSH terms: Limb Salvage/methods
  20. Dorai AA, Halim AS, Zulmi W
    Med J Malaysia, 2004 Dec;59 Suppl F:42-6.
    PMID: 15941160
    Reconstructive surgeons often encounter complex soft tissue and skeletal defects following oncological surgery. Soft tissue defects after wide resection in upper extremities posses a difficult challenge to find adequate tissue for reconstructing these defects. Paucity of local tissues dictates the requirement of loco-regional or distant flaps for these complex soft tissue defects which often exposes tendons, bones, nerves and joints. The latissimus dorsi muscle is a near ideal flap for the reconstruction because of the long neurovascular pedicle, ease of mobilization and its expendability. It can be rotated, with or without overlying skin, to cover soft tissue defects of the shoulder arm and elbow. Due to the large size of the muscle, it can be used to resurface the soft tissue defects and cover all major structures. Eleven consecutive cases were reviewed in which latissimus dorsi myocutaneous flap was used to reconstruct soft tissue defects of the upper limb following radical tumor resection. Flap survival was 100% with nominal donor site morbidity.
    Matched MeSH terms: Limb Salvage/methods*
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