Advanced trauma and limb reconstruction services in the east coast of Malaysia

• Main Author: Mohd Yusof, Nazri
• Format: Conference or Workshop Item
• Language: English; English
• Published: 2020
• Subjects: RD701 Orthopedics
• Online Access: http://irep.iium.edu.my/83811/1/ATLR%20in%20east%20coast%20Malaysiav7.pdf; http://irep.iium.edu.my/83811/15/KOA2020_Abstract_v3.pdf; http://irep.iium.edu.my/83811/; https://2020.koa.or.kr/

Introduction Advanced Trauma and Limb Reconstruction Unit Sultan Haji Ahmad Shah Medical Centre (SASMEC@IIUM) provide service to the part of east coast of Malaysia which include southern part of Terengganu, state of Pahang and the northern part of Johor. It treat cases like post traumatic osteomyelitis, severe open fracture, non-union, deformity and severe intra-articular fracture. It is done through a close collaboration with the Hospital Tengku Ampuan Afzan Hospital which is a public Hospital run by the Ministry of Health. The purpose of this study is to report the outcome of treatment for patients who receive treatment for bone and soft tissue reconstruction in our unit. Methodology We review publish articles, research projects and thesis that were done by our clinical Master postgraduate student on the cases that were done in our unit from 2010 till 2020. Results We retrieved data’s form 4 accepted articles and 3 completed projects that were done during the period of this study. There were 3 research on infection, 3 soft tissue reconstruction and 1 bone reconstruction using ilizarov bone transport in treating non-union. The infection study include 47 cases of post traumatic osteomyelitis of femur or tibia that were treated using stage procedure, 31 cases of femoral osteomyelitis treated with monorail external fixation (LRS Orthofix, Verona) and 11 cases of infected open grade IIIB open tibial fractures treated with local flap followed by bone reconstruction either with bone graft or bone transport. The success rate was higher in femur (98%) compare to tibia (82%). The presence of bone gap was associated with failure of treatment. Fracture after removal of external fixator is a common complication (26%) following femoral reconstruction. 40 cases of non-union tibia with a mean bone defect of 3.9 cm was treated with ilizarov bone transport. 38 (95%) fracture united with the mean union time of 11.6 month. The mean external fixator index is 3 months/cm. We review 32 patients underwent gastrocnemius flap, 12 gastrocnemius musculocutaneous flap and 29 sural flap surgery for soft tissue reconstruction. Gastrocnemius muscle and musculocutaneous flap is a safe and effective procedure. Sural flap was associated with acute vascular complication in 24% of cases. Conclusion Osteomyelitis with bone gap has poorer outcome especially in the tibia. Bone transport is effective in treating non-union of tibia with bone defect. Gastrocnemius flap is a reliable flap to be used for soft tissue reconstruction.