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Adzhar AL, Faisham WI, Zulmi W, Azman WS, Sahran Y, Syurahbil AH, Nor-Azman MZ. Long-term Outcome of Total Femur Replacement. Malays Orthop J 2023; 17:21-27. [PMID: 37583532 PMCID: PMC10425001 DOI: 10.5704/moj.2307.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/02/2022] [Indexed: 08/17/2023] Open
Abstract
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.
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Affiliation(s)
- A L Adzhar
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - W S Azman
- Department of Plastic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Y Sahran
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - A H Syurahbil
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M Z Nor-Azman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Murugan K, Faisham WI, Zulmi W. Assessment of Extra-Cortical Bone Bridge Interface in Cemented Mega Endoprosthesis for Limb Salvage Surgery. Malays Orthop J 2021; 15:93-99. [PMID: 33880154 PMCID: PMC8043634 DOI: 10.5704/moj.2103.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Mega endoprosthesis replacement for resection of primary malignant bone tumour requires immediate and long-term stability, particularly in the young and active patient. Extracortical bone bridge interface (EBBI) is a technique whereby autograft is wrapped around the interface junction of bone and porous-coated implant to induce and enhance bone formation for biological incorporation. This procedure increases the mean torsional stiffness and the mean maximum torque, which eventually improves the implant's long-term survival. Material and methods: The extracortical bone bridge interface's radiological parameter was evaluated at the prosthesis bone junction two years after surgery utilising a picture archiving and communication system (PACS). The radiograph's anteroposterior and lateral view was analysed for both thickness and length in all four cortices. The analysis was done in SPSS Version 24 using One-Way ANOVA and independent T-Test. Results were presented as mean and standard deviation and considered significant when the p-value was < 0.05. Results: The mean average thickness was 2.2293mm (SD 1.829), and the mean average length was 31.95% (SD 24.55). We observed that the thickness and length of EBBI were superior in the young patient or patients with giant cell tumour that did not receive chemotherapy, compared to patients treated for osteosarcoma. The distal femur also had better EBBI compared to the proximal tibia. However, the final multivariable statistical analysis showed no significant difference in all variables. EBBI thickness was significantly and positively correlated with EBBI Length (p<0.001). We conclude that, for each 1mm increase in EBBI thickness, the length will increase by 0.06% on average. About 17.2% of patients out of the 29 showed no radiological evidence of EBBI. Conclusion: From our study, there were no factors that significantly contributed to the formation and incorporation of EBBI
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Affiliation(s)
- K Murugan
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Abstract
Introduction The role of surgery in skeletal metastasis is to reduce morbidity and improve the quality of life in terminally ill patients. We report our experience with patients who underwent skeletal reconstructive surgery for metastatic bone tumour of the femur. Materials and Methods Twenty nine operations for skeletal metastasis of the femur performed in our centre between 2009 and 2015 were included in this study. We evaluated the choice of implant, complications, survival rate and functional outcome. Fourteen patients were still alive at the time of this report for assessment of functional outcome using Musculoskeletal Tumour Society (MSTS) form. Results Plating osteosynthesis with augmented-bone cement was the most common surgical procedure (17 patients) performed followed by arthroplasty (10 patients) and intramedullary nailing (2 patients) There were a total of five complications which were implant failures (2 patients), surgical site infection (2 patients), and site infection mortality (1 patient). The median survival rate was eight months. For the functional outcome, the mean MSTS score was 66%. Conclusion Patients with skeletal metastasis may have prolonged survival and should undergo skeletal reconstruction to reduce morbidity and improve quality of life. The surgical construct should be stable and outlast the patient to avoid further surgery.
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Affiliation(s)
- N H Mohamed-Haflah
- Department of Orthopaedics, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Y Kassim
- Department of Orthopaedics, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - I Zuchri
- Department of Orthopaedics, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Prince Court Medical Centre, Kuala Lumpur, Malaysia
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Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, Bhavaraju VMK, Salzihan MS, Hasnan J, Ezane AM, Ariffin N, Norsarwany M, Ziyadi MG, Wan Azman WS, Halim AS, Zulmi W. Prognostic factors and survival rate of osteosarcoma: A single-institution study. Asia Pac J Clin Oncol 2015; 13:e104-e110. [PMID: 25870979 DOI: 10.1111/ajco.12346] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Wan Ismail Faisham
- Department of Orthopaedics; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Laith N Alsaigh
- Department of Orthopaedics; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Mat Z Nor Azman
- Department of Orthopaedics; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Musa Kamarul Imran
- Department of Community Medicine; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Biswa M Biswal
- Department of Radiation Therapy and Oncology; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Venkata MK Bhavaraju
- Department of Radiation Therapy and Oncology; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Md Salleh Salzihan
- Department of Pathology; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Jaafar Hasnan
- Department of Pathology; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Aziz M Ezane
- Department of Radiology; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Nasir Ariffin
- Department of Pediatric (Oncology); Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Mohamad Norsarwany
- Department of Pediatric (Oncology); Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Mohamad G Ziyadi
- Cardiothoracic Unit; School of Medical Sciences; Health Campus; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Wan Sulaiman Wan Azman
- Reconstructive Sciences Unit; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Ahmad Sukari Halim
- Reconstructive Sciences Unit; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
| | - Wan Zulmi
- Department of Orthopaedics; Universiti Sains Malaysia; Kubang Kerian Kelantan Malaysia
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Anuar Ramdhan I, Zulmi W, Hidayah A, Kamel M, Fadhil M, Anwar Hau M. Comparative study between coaptive film versus suture for wound closure after long bone fracture fixation. Malays Orthop J 2015; 7:52-5. [PMID: 25722808 PMCID: PMC4341050 DOI: 10.5704/moj.1303.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Coaptive film (i.e., Steri-Strips™) is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients' wound closed with sutures, 23 with coaptive film). RESULTS The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.
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Affiliation(s)
- Im Anuar Ramdhan
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - An Hidayah
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - Mjm Kamel
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - Msm Fadhil
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
| | - M Anwar Hau
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
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Mohd Ariff S, Joehaimey J, Ahmad Sabri O, Zulmi W. Langerhans cell histiocytosis with extensive spinal and thyroid gland involvement presenting with quadriparesis: an unusual case in an adult patient. Malays Orthop J 2014; 5:28-31. [PMID: 25279033 DOI: 10.5704/moj/1111.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT Langerhans cell histiocytosis of the spine frequently presents as a solitary lesion and rarely results in neurological deficit. Involvement of thyroid tissue is also rare, even in multifocal disease presentations. We present an unusual variant of Langerhans cell histiocytosis in a 37-year-old man presenting with profound quadriparesis and incidental thyroid involvement. MR imaging and skeletal radiographs revealed widespread involvement of the spine. The patient underwent surgical resection of the tumour and stabilization of the spine. Diagnosis was confirmed by histological and immunohistochemistry analysis. Langerhans cell histiocytosis should be included in the differential diagnosis of radiolucent lesions of the spine in adults. KEY WORDS Langerhans Cell Histiocytosis, Spine Tumours, Thyroid Mass, Cord Compression With Quadriparesis, Adult.
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Affiliation(s)
- S Mohd Ariff
- Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, Malaysia
| | - J Joehaimey
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II (HRPZII), Kota Bharu, Malaysia
| | - O Ahmad Sabri
- Department of Orthopaedics, Hospital Raja Perempuan Zainab II (HRPZII), Kota Bharu, Malaysia
| | - W Zulmi
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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Jagdish K, Paiman M, Nawfar A, Yusof M, Zulmi W, Azman W, Halim A, Mat Saad A, Shafei M, Faisham W. The outcomes of salvage surgery for vascular injury in the extremities: a special consideration for delayed revascularization. Malays Orthop J 2014; 8:14-20. [PMID: 25279079 PMCID: PMC4093557 DOI: 10.5704/moj.1403.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results.
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Affiliation(s)
- Krishnan Jagdish
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M Paiman
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - As Nawfar
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mi Yusof
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ws Azman
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - As Halim
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Az Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Md Shafei
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wi Faisham
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Sharil A, Nawaz A, Nor Azman M, Zulmi W, Faisham W. Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee. Malays Orthop J 2013; 7:30-5. [PMID: 25722804 PMCID: PMC4341046 DOI: 10.5704/moj.1303.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED We evaluated functional outcomes for patients who underwent surgery for resection and endoprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur (DF) and proximal tibia (PT) placements. The study sample included 34 cases of distal femur and 20 cases of proximal tibia endoprosthesis replacement. Primary tumours were classified as follows: 33 osteosarcoma, 20 stage III giant cell tumour (GCT) and one case of mesenchymal chondrosarcoma. The mean MSTS score for both DF and PT endoprosthesis together was 21.13 (70.43%), and The MSTS scores for DF was 21.94 (73.13%) and PT was 19.75 (65.83%) Infection developed in 7 cases and 5 of which were PT endoprosthesis cases. Three deep infections required early, two-stage revision and resulted in poor MSTS scores. We conclude that endoprosthesis replacement for primary bone tumours had early good to excellent functional outcome. There were no differences in functional outcomes when comparing distal femur endoprostheses with proximal tibia endoprostheses. KEY WORDS functional outcome, bone tumour, knee, and endoprosthesis.
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Affiliation(s)
- Ar Sharil
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Ah Nawaz
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mz Nor Azman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wi Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Ariff M, Zulmi W, Faisham W, Nor Azman M, Nawaz A. Outcome of surgical treatment of pelvic osteosarcoma: hospital universiti sains malaysia experience. Malays Orthop J 2013; 7:56-62. [PMID: 25722809 PMCID: PMC4341051 DOI: 10.5704/moj.1303.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Ms Ariff
- Department of Orthopaedics, Traumatology and Rehabilitation,International Islamic University Malaysia, Kuantan, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan
| | - Wi Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan
| | - Mz Nor Azman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan
| | - Ah Nawaz
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Mat Saad AZ, Halim AS, Faisham WI, Azman WS, Zulmi W. Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review. ScientificWorldJournal 2012; 2012:702904. [PMID: 22629187 PMCID: PMC3353558 DOI: 10.1100/2012/702904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- A Z Mat Saad
- Reconstructive Sciences Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia.
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Faisham WI, Ziyadi MG, Azman WS, Halim AS, Zulmi W, Biswal BM. Resection and reconstruction of malignant tumor involving sternum. Med J Malaysia 2012; 67:224-225. [PMID: 22822652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- W I Faisham
- Orthopedic Department, School of Medical Sciences Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Faisham WI, Nawaz AH, Ezane AM, Zulmi W, Ibrahim S, Abdul Halim AR. Non-Operative Treatment Versus Steroid Injections in the Management of Unicameral Bone Cysts. Malays Orthop J 2011. [DOI: 10.5704/moj.1107.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Shahrulazua A, Faisham WI, Norazman MZ, Zulmi W. Radial Forearm Wrapped-around Iliac Graft: Alternative Option for Thumb Reconstruction. Malays Orthop J 2011. [DOI: 10.5704/moj.1103.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Faisham WI, Zulmi W. Giant Solitary Forearm Exostosis in A Child. Malays Orthop J 2009. [DOI: 10.5704/moj.0905.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Faisham WI, Muslim DAJ, Bhavaraju VMK, Nawaz AH, Zulmi W. Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease. Malays Orthop J 2009. [DOI: 10.5704/moj.0905.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Eskandar H, Zulmi W, Suzina AH, Samsudin AR. The use of coral as a graft in a large cortical bone defect. Nat Prec 2008. [DOI: 10.1038/npre.2008.2264.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Accepted: 09/10/2008] [Indexed: 09/01/2023]
Abstract
AbstractThe use of coral as space filler in a large cortical bone defect was studied. Twelve Australian White Rabbit were divided into 8 and 12 week group. All rabbits were operated to create a 2.5cm defect in right tibia and replaced with coral; partially covered with the free autologous non-vascularized periosteum harvested from contralateral tibia. The coral was transfixed and the leg was immobilized with Plaster of Paris. At the end of 8th and 12th week, all the rabbits were assessed clinically, radiologically and sacrified for histology evaluation. Bony union achieved in 3 out of 5 rabbits at 8th week while 3 out of 4 at 12th supported by radiological studies. Histological examination showed healing at coral-cortical junction by callus formation with simultaneous osteoblasts invasion into the coral at 8th week and later coral disintegration and calcification of newly formed bony matrices with marrow fat formation at 12th week.
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Abstract
PURPOSE To assess the association between tumour volume and occurrence of lung metastasis in patients with osteosarcoma and to determine the cut-off value. METHODS Records of 70 patients with histopathologically confirmed primary osteosarcoma in the extremities who had magnetic resonance imaging and computed tomography of the thorax less than one month before treatment were reviewed, with reference to the official report of tumour dimensions and lung metastasis by radiologists. The status of lung metastasis was assessed. Tumour volume was measured using the formula for an ellipsoidal mass. RESULTS Of the 70 patients with osteosarcoma, 33 (47%) had evidence of lung metastasis. Tumour volume was directly associated with occurrence of lung metastasis (p=0.048). The proportion having lung metastasis when the primary tumour volume exceeded 371 cm3 was 69%, compared to 34% in those with smaller tumours. CONCLUSION Larger tumours are more likely to correlate with lung metastasis. Both features are predictive of patient survival and prognosis.
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Affiliation(s)
- I Munajat
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
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Mohana R, Faisham WI, Zulmi W, Nawfar AS, Effat O, MS S. The Incidence of Malignant Infiltration in the Biopsy Tract of Osteosarcoma. Malays Orthop J 2007. [DOI: 10.5704/moj.0711.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
BACKGROUND AND OBJECTIVE Tramadol is metabolized by the highly polymorphic enzyme cytochrome P450 (CYP)2D6. Patients with different CYP2D6 genotypes may respond differently to tramadol in terms of pain relief and adverse events. In this study, we compare the pharmacokinetics and effects of tramadol in Malaysian patients with different genotypes to establish the pharmacokinetic-pharmacodynamic relationship of tramadol. STUDY DESIGN AND SETTING All patients received an intravenous dose of tramadol 100mg as their first postoperative analgesic. Blood was sampled at 0 minutes and subsequently at 15 and 30 minutes, 1, 2, 4, 8, 16, 20, and 24 hours for serum tramadol and analyzed by high-performance liquid chromatography (HPLC). Patients were genotyped for CYP2D6*1, *3, *4, *5, *9, *10, and *17 alleles and duplication of the gene by means of an allele-specific PCR. Pain was measured using the Visual Analog Scales, and adverse effects were recorded. RESULTS About half of the patients had the wild-type allele (CYP2D6*1), with the 'Asian'CYP2D6*10 allele accounting for most of the rest (40%). None of the genotypes predicted poor metabolism. Twenty-seven percent of the patients were intermediate metabolizers (IM) and 2.9% were ultra-rapid (UM) metabolizers; the remaining 70% were extensive metabolizers (EM). The mean total clearance (CL) predicted by the model was lower (19 L/h) and the half-life longer (5.9 hours) than those reported in Western populations. This may due to the high frequency of the CYP2D6*10 allele amongst Malaysian patients. The UM and EM groups had 2.6- and 1.3-times faster CL, respectively, than the IM. CL was 16, 18, 23, and 42 L/h while mean half-lives were 7.1, 6.8, 5.6, and 3.8 hours among the IM, EM1, EM2, and UM groups, respectively. However, the analgesic effects of tramadol were not measured adequately among the postoperative patients to establish its full therapeutic effects. There were significant differences in the adverse-effect profiles amongst the various genotype groups, with the IM group experiencing more adverse effects than the EM, and the EM having more adverse effects than the UM. CONCLUSION CYP2D6 activity may play an important role in determining the pharmacokinetics of tramadol and in predicting its adverse effects. If these results can be confirmed in a larger population, genotyping may be an important tool in determining the dose of tramadol.
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Affiliation(s)
- Siew Hua Gan
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
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Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS, Ezane AM. Aggressive giant cell tumour of bone. Singapore Med J 2006; 47:679-83. [PMID: 16865207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION The surgical treatment of Stage III or aggressive giant cell tumour of the bone, whether to perform intralesional or en-bloc resection, remains controversial. The aim of this study is to identify the effectiveness of en-bloc resection for local control and final oncological outcome of the disease. METHODS The data of 20 consecutive patients with Stage III giant cell tumour were retrospectively reviewed to determine the local control and oncological outcome after treatment with wide resection. RESULTS The majority of the patients presented late with mean duration of symptoms of 24 months, and four patients presented with recurrences. All patients were treated with wide resection except for two patients who underwent ablative surgery due to major neurovascular involvement. Ten patients required free vascularised tissue transfer to cover massive soft tissue defect. Local recurrence occurred in one patient who was again treated with wide resection and vascularised flap. Six patients had pulmonary metastases. Two patients with resectable disease were treated with thoracoscopic surgery and they remained disease-free 36 months after surgery. Two patients with multiple lung metastases were treated with chemotherapy and the disease remained non-progressive. The remaining two patients who refused chemotherapy showed radiological progression, and one succumbed to the disease with massive haemoptysis. CONCLUSION Aggressive giant cell tumour of bone should be treated with wide resection for better local control, and treatment of pulmonary metastases is mandatory for overall prognosis.
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Affiliation(s)
- W I Faisham
- Department of Orthopaedics, Musculoskeletal Oncology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
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Sulaiman AR, Nordin S, Faisham WI, Zulmi W, Halim AS. Residual nonunion following vascularised fibular graft treatment for congenital pseudarthrosis of the tibia: a report of two cases. J Orthop Surg (Hong Kong) 2006; 14:64-6. [PMID: 16598090 DOI: 10.1177/230949900601400114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.
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Affiliation(s)
- A R Sulaiman
- Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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22
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Faisham WI, Zulmi W, Nor Azman MZ, Rhendra Hardy MZ. Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited. Med J Malaysia 2006; 61 Suppl A:57-61. [PMID: 17042232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.
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Affiliation(s)
- W I Faisham
- Musculoskeletal Oncology Unit, School of Medical Science Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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23
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Faisham WI, Zulmi W, Ezane AM, Biswal BM. Abdominal aorta and inferior vena cava thromboses in advanced stage of malignant fibrous histiocytoma. Med J Malaysia 2005; 60:495-7. [PMID: 16570715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Asymptomatic simultaneous thrombosis of abdominal aorta and inferior vena cava is a rare complication in advanced malignancy. We described an incidental finding of this clinical entity in our patient who presented with advance stage of malignant fibrous hystiocytoma of soft tissue and pathological fracture. The radiological evaluation with spiral computed tomography scan of abdominal aorta and inferior vena cava are presented and the subsequent management highlighted.
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Affiliation(s)
- W I Faisham
- Department of Orthopaedic, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
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Faisham WI, Zulmi W, Halim AS. Modular endoprosthetic replacement after total femur resection for malignant bone tumor. Med J Malaysia 2005; 60 Suppl C:45-8. [PMID: 16381283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- W I Faisham
- Musculoskeletal Oncology Unit, Department of Orthpaedics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
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25
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Halim AS, Zulmi W. Extended pedicle rectus abdominis myocutaneous flap for thigh reconstruction. Med J Malaysia 2005; 60:109-11. [PMID: 16250294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- A S Halim
- Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
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26
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Dorai AA, Halim AS, Zulmi W. Versatility of the latissimus dorsi flap in upper limb salvage tumour surgery. Med J Malaysia 2004; 59 Suppl F:42-6. [PMID: 15941160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
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.
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Affiliation(s)
- A A Dorai
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Imran Y, Zulmi W, Faisham WI, Zainal M. Resection and reconstruction of retroperitoneal sarcoma of spinal roots. Med J Malaysia 2004; 59 Suppl F:75-7. [PMID: 15941171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Y Imran
- Spine Unit, Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Imran Y, Zulmi W, Halim AS. Early complication following long bone reconstruction using vascularised fibula graft. Med J Malaysia 2004; 59 Suppl F:35-8. [PMID: 15941158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
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.
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Affiliation(s)
- Y Imran
- Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Faisham WI, Zulmi W, Saim AHM, Biswal BM. Pulmonary metastases of giant cell tumour of the bone. Med J Malaysia 2004; 59 Suppl F:78-81. [PMID: 15941172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The clinical presentation and behaviour of giant cell tumour of bone vary. The progression of the disease and metastasis are unpredictable, but the overall prognosis is good. Six patients with pulmonary metastases of giant cell tumour have been treated at our institution since 1998. This represents 15% of all patients treated for giant cell tumour of the bone. Early detection and treatment of this tumour is important as complete resection of this tumour have favourable prognosis. Multiple lung nodules which preclude resection may remain dormant and asymptomatic with systemic chemotherapy.
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Affiliation(s)
- W I Faisham
- Musculoskeletal Oncology Unit, School of Medical Science, University Sains Malaysia, Kubang Kerian, Kelantan
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Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS. Osteosarcoma: the outcome of limb salvage surgery. Med J Malaysia 2004; 59 Suppl F:24-34. [PMID: 15941157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
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.
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Affiliation(s)
- W I Faisham
- Musculoskeletal Oncology Unit, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan
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Abstract
BACKGROUND AND OBJECTIVE Although the kinetic behaviour of tramadol has been described, the present study is the first to our knowledge, to report specifically on the population pharmacokinetic modelling of tramadol hydrochloride. METHODS The parametric Iterative Two-stage Bayesian Population Model (IT2B) program followed by the Non-parametric Expectation Maximization Population Model (NPEM2) program was used to determine population pharmacokinetic parameter values of tramadol in 138 postoperative orthopaedic Malaysian patients. All patients had received a 100 mg intravenous dose of tramadol, infused over 2-3 min, as their first postoperative analgesic. Blood was sampled at 0 min and subsequently at 15, 30 min, 1, 2, 4, 8, 16, 20 and 24 h for serum tramadol high-performance liquid chromatography analysis. RESULTS AND DISCUSSION The one-compartmental model pharmacokinetic parameters--volume of distribution (Vd), elimination rate constant (kel) and the total clearance rates (ClT)--found were: mean Vd = 167.6 +/- 63.84 L; median Vd = 161.48 L; mean kel = 0.1241 +/- 0.056 h(-1); median kel = 0.1138 h(-1); ClT = 19.57 +/- 9.51 L/h; median ClT =18.12 L/h. The interindividual coefficient of variation of ClT (48.56%) was higher than that of Vd (38.09%), indicating the presence of other possible influencing factors on tramadol's ClT such as CYP2D6 polymorphism, gender and age. Overall, NPEM2 suggested more diversity in the population than did IT2B.
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Affiliation(s)
- S H Gan
- Department of Pharmacology, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
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Gan SH, Ismail R, Wan Adnan WA, Zulmi W, Kumaraswamy N, Larmie ET. Relationship between Type A and B personality and debrisoquine hydroxylation capacity. Br J Clin Pharmacol 2004; 57:785-9. [PMID: 15151524 PMCID: PMC1884512 DOI: 10.1111/j.1365-2125.2004.02076.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM A person with Type A personality is an 'aggressor' compared with the rarely harried Type B. Although debrisoquine hydroxylase (CYP2D6) capacity has been associated with personality, no study has specifically investigated its association with personality Type A and B. Therefore the aim of this research was to study the impact of CYP2D6 on Type A and B personality. METHODS Type A and B personality questionnaires were administered to 48 healthy patients undergoing elective orthopaedic surgery. After obtaining informed consent, patients were genotyped for the various CYP2D6 alleles by allele-specific polymerase chain reaction. Based on the genotypes, patients were grouped as extensive metabolizer (EM)1 (normal) (CYP2D6*1/*1), EM2 (intermediate) (CYP2D6*1/*4, CYP2D6*1/*5, CYP2D6*1/*9 and CYP2D6*1/*10) and EM3 (slow) (CYP2D6*4/*10, CYP2D6*5/*10, CYP2D6*10/*10 and CYP2D6*10/*17). Chi(2) was used to determine the relationship between the groups and personality types. RESULTS The percentages of patients who were of the EM1, EM2 and EM3 groups were 20.8%, 52.1% and 27.1%, respectively. There was a significant difference (P = 0.032) between the three groups in terms of personality type, in which EM1 showed a tendency to be of personality Type A while EM2 and EM3 tended to be of personality Type B. CONCLUSION The study suggests that there is a relationship between CYP2D6 activity and Type A and B personality.
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Affiliation(s)
- S H Gan
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Imran Y, Zulmi W, Halim AS. Skin paddle as an indicator of the viability of vascularised fibular graft. Singapore Med J 2004; 45:110-2. [PMID: 15029411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION 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. METHODS We report the effectiveness of using a skin paddle as an indicator of the vascularised fibular graft viability in 13 cases which had undergone various types of long bone reconstruction using fasciocutaneous free vascularised fibular graft. RESULTS Early detection of anastomotic failure in 100 percent of the patients (4 out of 4) with 92 percent (12 out of 13 patients) success rate shows the effectiveness of this method. CONCLUSION The skin paddle offers the best method of post-operative monitoring of fibular graft viability.
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Affiliation(s)
- Y Imran
- Department of Orthopaedics, Universiti Sains Malaysia, Kota Bharu, 16150 Kelantan, Malaysia.
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Faisham WI, Zulmi W, Mutum SS, Shuaib IL. Natural history of giant cell tumour of the bone. Singapore Med J 2003; 44:362-5. [PMID: 14620730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The clinical presentation and behaviour of giant cell tumours of bone vary. The progression of the disease and metastases are unpredictable, but the overall prognosis is good. We describe the natural history and different clinical presentations of two cases of giant cell tumour of bone where the patients had refused the initial treatment and presented several years later with the disease.
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Affiliation(s)
- W I Faisham
- Department of Orthopaedics, School of Medical Science, University Science of Malaysia, 16150 Kubang, Kerian, Kelantan, Malaysia.
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35
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Imran Y, Zulmi W, Halim AS. Skeletal union following long bone reconstruction using vascularised fibula graft. Singapore Med J 2003; 44:286-7. [PMID: 14560858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
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.
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Affiliation(s)
- Y Imran
- Department of Orthopaedics, School of Medical Science, USM, 16150 Kubang Kerian, Kelantan, Malaysia.
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Faisham WI, Zulmi W, Biswal BM. Metastatic disease of the proximal femur. Med J Malaysia 2003; 58:120-4. [PMID: 14556337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Since January 1999, ten patients had undergone surgical treatment for metastatic bony lesions of proximal femur at this centre. Seven of these patients were treated for complete pathological fractures, one for impending fracture and one for revision of internal fixation and loosening of hemiarthroplasty. Primary malignancies were located in breast in four cases, prostate in three and one in lung, thyroid and neurofibrosarcoma. Two patients had died within six months after surgery, four after 1 year while the remaining four were still alive. The mean duration of survival was eleven months. Nine patients had been ambulating pain free and there were no failure of reconstruction.
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Affiliation(s)
- W I Faisham
- Department of Orthopaedic, School of Medical Science, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
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Faisham WI, Zulmi W, Aidura M, Yazid MD, Sallehuddin AY, Azman MZ, Nawfar S. Partial resection of pelvis and salvage of the lower limb in the treatment of malignant pelvic tumours. Med J Malaysia 2001; 56:248-51. [PMID: 11771089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
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.
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Affiliation(s)
- W I Faisham
- Department of Orthopaedic, School of Medical Science HUSM, 16150 Kubang Kerian, Kelantan
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