MyMedR

Fulltext Recalcitrant post-traumatic chronic osteomyelitis/infected non-union of the tibia following open grade-ill fractures: treatment with vascularized osteocutaneous fibular graft

Halim AS, Imran Y

Med J Malaysia, 2006 Feb;61 Suppl A:66-70.

PMID: 17042234

Post-traumatic chronic osteomyelitis and infected non-unions of the tibia following severe type-III open fracture are difficult to treat Refractoy cases often necessitate amputation despite attempts to salvage the limb. We report our experience in treating such difficult cases with an alternative surgical option using free osteocutaneous fibular graft. Eight consecutive patients with post-traumatic chronic osteomyelitis/infected non-union were treated surgically with free vascularized osteocutaneous fibular graft. Outcomes in term of graft-host union and complication were evaluated. Four patients had anastomotic venous thrombosis requiring anastomotic revision. Five patients developed surgical site infections needing extended antibiotic therapy to achieve resolution at an average of 15.2 weeks. Fibular graft fracture occurred in three patients but all grafts survived and united after a mean time to union of 42.3 weeks (range 31 to 82 weeks). At the final follow-up, union of host-graft junction and control of infection were achieved in all patients except one who required a secondary amputation. Free vascularized osteo-cutaneous fibular graft is a viable limb salvage option for refractory chronic osteomyelitis or infected non-union following treatment of grade-III open tibial fractures.

Fulltext Extended pedicle rectus abdominis myocutaneous flap for thigh reconstruction

Halim AS, Zulmi W

Med J Malaysia, 2005 Mar;60(1):109-11.

PMID: 16250294

A rectus abdominis myocutaneous flap can provide a large amount of tissue for defect coverage. Rarely a flabby and redundant abdominal tissue was used as a huge extended flap. We report a case of recurrence malignant fibrous histiocytoma of the thigh which was radically resected. The resultant massive defect was success reconstructed with an extended pedicle inferiorly based rectus abdominis myocutaneous flap.

Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report

Halim AS, Yusof I

J Orthop Surg (Hong Kong), 2004 Jun;12(1):110-3.

PMID: 15237132

Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.

Anomalous arterial supply to the muscles in a combined latissimus dorsi and serratus anterior flap

Halim AS, Wan Z

Clin Anat, 2004 May;17(4):358-9.

PMID: 15108344

The combined latissimus dorsi and serratus anterior flap has been employed for large defect reconstruction and has been shown to be reliable. These flaps are based on the subscapular-thoracodorsal vascular pedicle that usually supplies both muscles. In the case reported, serratus anterior possessed an anomalous arterial supply totally independent of the subscapular pedicle. The latissimus dorsi and serratus anterior muscles were used as a combined flap to reconstruct a massive thigh defect. The combined flap required two arterial anastomoses.

Fulltext High-risk cutaneous squamous cell carcinoma (CSCC): Challenges and emerging therapies

Halim AS, Ramasenderan N

Asian J Surg, 2023 Jan;46(1):47-51.

PMID: 35545474 DOI: 10.1016/j.asjsur.2022.04.079

Cutaneous squamous cell carcinoma (CSCC) is a common type of skin malignancy that affects people who have been exposed to sunlight for a long time. It has been associated to a high mutational load, making treatment problematic, especially for individuals with high-risk CSCC characteristics. Patients with high-risk CSCC are difficult to define since definitions are still imprecise. Firstly, we review the evidence to see how relevant locoregional involvement is in terms of patient survival and recurrence risk. Second, we go through the difficulties and obstacles that come with sentinel lymph node biopsy (SLNB) and their importance in the management of locally progressed CSCC. Methods and findings from a variety of lymph node investigations are described. There is yet no empirical evidence for the involvement of SLNB in CSCC. Finally, we discussed the most recent developments in the treatment of CSCC. The mainstays of treatment are surgery and radiation. To slow the disease progression, cancer medicines have switched to disrupting particular signaling pathways. Advanced nations have more easily accessible drugs like Cetuximab (epidermal growth factor receptor inhibitor) and Cemiplimab (anti-programme receptor-1 antibodies), which are utilized in advanced CSCC. The response rate varies based on the patient, although there is still a lack of proof. This article discusses the misconception that CSCC is a tumor with a favorable prognosis, as well as the difficulties in treating high-risk CSCC.

Internal mammary perforators as recipient vessels for deep inferior epigastric perforator and muscle-sparing free transverse rectus abdominis musculocutaneous flap breast reconstruction in an Asian population

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.

Facial dimensions of Malay children with repaired unilateral cleft lip and palate: a three dimensional analysis

Zreaqat M, Hassan R, Halim AS

Int J Oral Maxillofac Surg, 2012 Jun;41(6):783-8.

PMID: 22424709 DOI: 10.1016/j.ijom.2012.02.003

This comparative cross-sectional study assessed the facial surface dimensions of a group of Malay children with unilateral cleft lip and palate (UCLP) and compared them with a control group. 30 Malay children with UCLP aged 8-10 years and 30 unaffected age-matched children were voluntarily recruited from the Orthodontic Specialist Clinic in Hospital Universiti Sains Malaysia (HUSM). For the cleft group, lip and palate were repaired and assessment was performed prior to alveolar bone grafting and orthodontic treatment. The investigation was carried out using 3D digital stereophotogrammetry. 23 variables and two ratios were compared three-dimensionally between both groups. Statistically significant dimensional differences (P<0.05) were found between the UCLP Malay group and the control group mainly in the nasolabial region. These include increased alar base and alar base root width, shorter upper lip length, and increased nose base/mouth width ratio in the UCLP group. There were significant differences between the facial surface morphology of UCLP Malay children and control subjects. Particular surgical procedures performed during primary surgeries may contribute to these differences and negatively affect the surgical outcome.

Fulltext Early complication following long bone reconstruction using vascularised fibula graft

Imran Y, Zulmi W, Halim AS

Med J Malaysia, 2004 Dec;59 Suppl F:35-8.

PMID: 15941158

Long bone reconstruction using vascularized fibula graft is becoming more popular despite the difficulties and its post-operative complications. We reviewed our early experience dealing with vascularized fibula graft for the management of massive long bone defect. Thirteen patients had undergone long bone reconstruction using vascularized fibula graft. Early complications that had been encountered include superficial wound infection (23%), transient common peroneal nerve palsy (23%), stage 1 bed sore (7.7%), anastomotic venous thrombosis (30.8%), DIVC (15.4%), flap loss and amputation (7.7%), and reactive psychiatric problem (7.7%). The early complications following this procedure are comparable with other major orthopaedic surgery and most of them are minor and treatable. The complication rates are also comparable with similar surgery done elsewhere.

Superior long term functional and scar outcome of Meek micrografting compared to conventional split thickness skin grafting in the management of burns

Lee SZ, Halim AS

Burns, 2019 09;45(6):1386-1400.

PMID: 31054957 DOI: 10.1016/j.burns.2019.04.011

INTRODUCTION: Autologous skin grafting is the mainstay of treatment in burn patients. Extensive full thickness burns remains a challenge to the burns surgeon due to the lack of autologous skin donor sites. The conventional split thickness skin grafting (SSG) and the Meek micrografting (Meek) technique are part of the armamentarium of the burns surgeon to curtail the challenge of paucity of donor sites. With advances in burn care, mortality rates of burn patients have reduced. As a result, with more patients surviving acute burn, there is a paradigm shift of research towards assessment of functional outcomes and quality of life of the burn survivors. As there is lack of research regarding the functional outcome of the Meek technique, this study was designed to examine the long term functional outcome of the Meek technique and SSG in burns.

METHOD: A cross-sectional study was conducted in Hospital Universiti Sains Malaysia to assess patients with burns between 10 to 40% total body surface area (TBSA) and with at least one year after injury. The Burn Specific Health Score-brief (BSHS-B) was utilized to compare the functional outcome whilst the Vancouver Scar Scale (VSS) was used for comparison on the scar outcome of the two skin grafting techniques.

RESULTS: Forty three patients (Meek,15; SSG,28) were included. The mean current age (years old) of Meek and SSG was 24.7 (range, 7-75) and 25.9 (range, 7-65) respectively. The mean TBSA (%) of the Meek group was 26.7 (range, 13-40) while that of the SSG group was 16.1 (range, 10-32). A simplified domain structure was used for the BSHS-B questionnaire. The work and sexuality subscale were analyzed separately due to missing data. There mean scores of affect and relations was higher in Meek compared to SSG (Meek, 3.86; SSG, 3.75; p > 0.05). Function domain was also better in Meek compared to SSG (Meek, 3.88; SSG, 3.73; p > 0.05). The Meek group displayed superior scar outcome compared to SSG as evidenced by the statistically significant difference in score for the pigmentation, pliability, height and total VSS score.

CONCLUSION: The Meek group showed more favorable BSHS-B scores compared to the SSG group. The scar outcome of the Meek technique is significantly superior to SSG. Therefore, the Meek technique is superior in the management of burns because the long term scar and functional outcome of this technique is better compared to conventional SSG.

Fulltext In vitro models in biocompatibility assessment for biomedical-grade chitosan derivatives in wound management

Keong LC, Halim AS

Int J Mol Sci, 2009 Mar;10(3):1300-1313.

PMID: 19399250 DOI: 10.3390/ijms10031300

One of the ultimate goals of wound healing research is to find effective healing techniques that utilize the regeneration of similar tissues. This involves the modification of various wound dressing biomaterials for proper wound management. The biopolymer chitosan (beta-1,4-D-glucosamine) has natural biocompatibility and biodegradability that render it suitable for wound management. By definition, a biocompatible biomaterial does not have toxic or injurious effects on biological systems. Chemical and physical modifications of chitosan influence its biocompatibility and biodegradability to an uncertain degree. Hence, the modified biomedical-grade of chitosan derivatives should be pre-examined in vitro in order to produce high-quality, biocompatible dressings. In vitro toxicity examinations are more favorable than those performed in vivo, as the results are more reproducible and predictive. In this paper, basic in vitro tools were used to evaluate cellular and molecular responses with regard to the biocompatibility of biomedical-grade chitosan. Three paramount experimental parameters of biocompatibility in vitro namely cytocompatibility, genotoxicity and skin pro-inflammatory cytokine expression, were generally reviewed for biomedical-grade chitosan as wound dressing.

Fulltext Outcomes of infected grade IIIB open tibial fractures

Yusof NM, Halim AS

Singapore Med J, 2012 Sep;53(9):591-4.

PMID: 23023900

Infection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.

Fulltext Skin paddle as an indicator of the viability of vascularised fibular graft

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.

Fulltext Skeletal union following long bone reconstruction using vascularised fibula graft

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.

Fulltext Extended double pedicle free tensor fascia latae myocutaneous flap for abdominal wall reconstruction

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.

Fulltext Proliferation of keratinocytes induced by adipose-derived stem cells on a chitosan scaffold and its role in wound healing, a review

Gomathysankar S, Halim AS, Yaacob NS

Arch Plast Surg, 2014 Sep;41(5):452-7.

PMID: 25276634 DOI: 10.5999/aps.2014.41.5.452

In the field of tissue engineering and reconstruction, the development of efficient biomaterial is in high demand to achieve uncomplicated wound healing. Chronic wounds and excessive scarring are the major complications of tissue repair and, as this inadequate healing continues to increase, novel therapies and treatments for dysfunctional skin repair and reconstruction are important. This paper reviews the various aspects of the complications related to wound healing and focuses on chitosan because of its unique function in accelerating wound healing. The proliferation of keratinocytes is essential for wound closure, and adipose-derived stem cells play a significant role in wound healing. Thus, chitosan in combination with keratinocytes and adipose-derived stem cells may act as a vehicle for delivering cells, which would increase the proliferation of keratinocytes and help complete recovery from injuries.

Reconstruction of large sacral defects following tumour resection: a report of two cases

Cheong YW, Sulaiman WA, Halim AS

J Orthop Surg (Hong Kong), 2008 Dec;16(3):351-4.

PMID: 19126905

Sacral tumours often present surgical resection and reconstruction challenges. Wide resections result in large sacral defects and neoadjuvant radiotherapy impairs wound healing. The wounds need to be covered with bulky, well-vascularised, healthy tissues. We present 2 cases where large sacral defects were reconstructed following tumour resection. Both defects were reconstructed with inferiorly based, transpelvic, pedicled vertical rectus abdominis myocutaneous flaps. This is a robust flap and carries a well-vascularised muscle bulk and skin paddle. The donor site is distant from the lesion site and is thus unaffected by both the resection and radiotherapy. This is a useful flap for reconstructing large sacral defects.

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.

Fulltext Modular endoprosthetic replacement after total femur resection for malignant bone tumor

Faisham WI, Zulmi W, Halim AS

Med J Malaysia, 2005 Jul;60 Suppl C:45-8.

PMID: 16381283

Total femur endoprothesis is an alternative replacement for massive malignant bone tumor with intramedullary extension or skip lesion. Four patients underwent total femoral resection and replacement with megaprosthesis: three had primary malignant bone tumor and one had salvage procedure for aseptic loosening of the distal femoral replacement. Tumor-free margins were achieved in all patients with two patients required vascularized latissimus dorsi free flap cover for reconstruction of soft tissue defects. The average follow-up was 24 months (range 16 - 60 months). All four patients were still alive with three of them being disease-free and one survived even with the presence of lung metastasis. The functional results obtained were either excellent or good in all patients in accordance to the Musculoskeletal Tumors Society grading system.

Fulltext Versatility of the latissimus dorsi flap in upper limb salvage tumour surgery

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.

Reconstructive treatment following resection of high-grade soft-tissue sarcomas of the lower limb

Leow AM, Halim AS, Wan Z

J Orthop Surg (Hong Kong), 2005 Apr;13(1):58-63.

PMID: 15872402

To review the role of free tissue transfer in reconstructive surgery following resection of high-grade soft-tissue sarcomas of the lower limb.

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