Long-term Outcome of Total Femur Replacement.

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.

Epidemiology of surgically treated patient in road traffic accident with lower extremity vascular injury from a single centre in Kelantan.

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.

Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion.

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.

Alopecia secondary to repaired occipital encephalocele - role of tissue expander in hair restoration.

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.

The use of facial artery musculomucosal (FAMM) readvancement flap in closure of recurrent oronasal fistula.

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.

Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies.

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.

Acute vascular complications (flap necrosis and congestion) with one stage and two stage distally based sural flap for wound coverage around the ankle.

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.

Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries.

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.

Resection and reconstruction of malignant tumor involving sternum.

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.

Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review.

BACKGROUND AND OBJECTIVES: 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. METHODS: A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications. RESULTS: Thirteen patients were included with median age of 39 years (range 13-78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. CONCLUSIONS: Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.

Reconstruction of severe patellar infera syndrome with free vascularised composite tensor fascia lata flap.

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.

The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction.

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.