15 years review of gastrocnemius flap done in Department Of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Gastrocnemius flap is the workhorse for wound coverage in the proximal tibia. It can be perform by general orthopaedic surgeon because it is done without the need of microscopic instrumentation. Its coverage can be extended to cover the knee and midshaft of tibia when skin overlying it is included in the flap. Materials and method: From July 2002 till January 2017, 47 patients underwent gastrocnemius flap in our hospital (26 muscular and 21 musculocutaneous flap). 41 flaps were raised from medial, 5 lateral and 1 from both muscle belly. There were 41 males and 6 females with the mean age of 21.4 years old (range 13-82). The flaps were done to cover upper third (29), upper half (6), midshaft tibia (6), knee (2) and distal femur (1). The initial problems were open fracture (30), infection following plating (9), necrotising fasciitis (4), degloving injury (2), pin site infection (1) and melioidosis (1). Eight patients have underlying Diabetes mellitus, 2 Hepatitis B, 3 HIV or 1 COAD. Two patients have sciatic nerve palsy. Results: There was no flap necrosis. Complications include persistence infection in 6 patients which require repeated debridement (5), below knee amputation (1), advancement of flap (1) and additional fasciocutaneous flap (1). Two patients with gastrocnemius musculocutaneous flap had partial failure of skin graft that heals with dressing. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Conclusion: Gastrocnemius flap is a reliable and safe procedure in orthopaedic surgery. Problems that occur are associated with inadequate debridement and underestimate the size of the flap

Integration and Islamisation Program for Clinical Post Graduate Students in International Islamic University of Malaysia (IIUM)

Integration and islamisation (INI) programmes for undergraduate medical students have been practiced, reviewed and published in many journals. However, there is only a dearth of study on the implementation of such a programme for postgraduate clinical students. Hence, there is a need to examine such a programme because of the different learning environment and characteristic of the students. The aim of this paper is to examine the existing clinical postgraduate programme at IIUM and attempts to improve the INI curriculum. Method: The study employs an analytical method and important factors for the development of the curriculum are analysed to come out with the objective, content, teaching methodology and assessment method suitable for the program. Result: The study identified the important factors that determine the curriculum to be the needs of National Health Service, the mission of the university, the requirement of the professional body and characteristic of the students. The study proposes that the objective of the program is to produce holistic orthopaedic surgeons who understand the belief of Muslim patients and is able to facilitate them in their ibadah and daily life as a Muslims. This is achieved through offering a course which consists of 4 main subjects on the principles of shariah which include the element of Islamic worldview, fiqh ibadah, fiqh muamalah and Islamic moral values with emphasis on issues related to medicine. The teaching method proposed is having regular seminars which consist of presentations and discussion of important concept in Islamic fiqh and followed by case study on fiqh issues related to Medicine. Finally, the students should be assessed from the case write up which they are required to submit before they can sit for the final professional exam. Conclusion: This improved program enables students to complete their study without compromising their duties to provide services at their respective hospitals

Study of noise robustness of First Formant Bandwidth (F1BW) method

The performance of speech recognition application under adverse noisy condition often becomes the topic of researchers regardless of the language used. Applications that use vowel phonemes require high degree of Standard Malay vowel recognition capability.In Malaysia, researches in vowel recognition is still lacking especially in the usage of Malay vowels, independent speaker systems, recognition robustness and algorithm speed and accuracy. This paper presents a noise robustness study on an improved vowel feature extraction method called First Formant Bandwidth (F1BW) on three classifiers of Multinomial Logistic Regression (MLR), K-Nearest Neighbors (k-NN) and Linear Discriminant Analysis (LDA).Results show that LDA performs best in overall vowel classification compared to MLR and KNN in terms of robustness capability

15 Years Review of Gastrocnemius Flap Done in Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Gastrocnemius flap is the workhorse for wound coverage in the proximal tibia. It can be perform by general orthopaedic surgeon because it is done without the need of microscopic instrumentation. Its coverage can be extended to cover the knee and midshaft of tibia when skin overlying it is included in the flap. Materials and method: From July 2002 till January 2017, 47 patients underwent gastrocnemius flap in our hospital (26 muscular and 21 musculocutaneous flap). 41 flaps were raised from medial, 5 lateral and 1 from both muscle belly. There were 41 males and 6 females with the mean age of 21.4 years old (range 13-82). The flaps were done to cover upper third (29), upper half (6), midshaft tibia (6), knee (2) and distal femur (1). The initial problems were open fracture (30), infection following plating (9), necrotising fasciitis (4), degloving injury (2), pin site infection (1) and melioidosis (1). Eight patients have underlying Diabetes mellitus, 2 Hepatitis B, 3 HIV or 1 COAD. Two patients have sciatic nerve palsy. Results: There was no flap necrosis. Complications include persistence infection in 6 patients which require repeated debridement (5), below knee amputation (1), advancement of flap (1) and additional fasciocutaneous flap (1). Two patients with gastrocnemius musculocutaneous flap had partial failure of skin graft that heals with dressing. One patient develops transient peroneal nerve palsy following the lateral gastrocnemius transfer. Conclusion: Gastrocnemius flap is a reliable and safe procedure in orthopaedic surgery. Problems that occur are associated with inadequate debridement and underestimate the size of flap required

Early Experience with Local Custom Made Synthetic Bone Construct for the Treatment of Bone Defect

Introduction: Segmental bone defect can be treated with autologous bone graft and bone transport. Synthetic bone graft has successfully been used for the treatment of metaphyseal fracture or bone cyst. However, their use for the treatment of segmental bone defect has not been establish. Recently, a local company has produced a biodegradable custom made synthetic bone construct phosphate-based materials that is used to treat fractures and bone defect. Materials and Methods: After getting approval from Medical Device Agency, we used SBC to treat segmental bone defect in our patients. A case series review was conducted in these cases. Results: Three patients underwent surgery using SBC as a spacer to fill the defect at the docking site to prevent soft tissue collapse in one patient and as a replacement for bone autologous bone grafting in two patients. In our observation granules resorbtion ranged from 40-80% by 6 months with no radiological evidence of new bone formation. SBC mixed with bone marrow aspirate failed to harden into a palette. Although no new bone formation was seen at the docking site, insertion of SBC prevents soft tissue invagination and reduced the need of a second surgery to remove other conventional spacers. Conclusion: SBC may be used as a spacer to prevent soft tissue interposition and skin invagination in bone transport. However mixing it with bone marrow aspirate resulted in failure to form beads and does not form bone

Non vascularized fibular strut graft at the docking site following tibial bone transport

Docking site non-union is common following bone transport of the tibiae. Option to improve healing of the docking site includes refashioning both bone end and removing the interposition of soft tissue or iliac bone graft. However, some patients refuse iliac bone grafting because of pain at the donor site. Non-vascularised fibular bone graft is an option for this patient. We reported 3 successful cases of non-vascularized fibular grafts following bone transport at the tibia. Method Three male patients aged between 20 to 31 underwent the operation following grade IIIB open tibial fracture and infected nonunion of the tibia. All were done for proximal to distal transport for tibial shaft defect. The bone gap is between 4 to 5 cm. The length of the fibula strut is 2 cm taken 10 cm from the syndesmotic joint. Result All achieved union between 4 to 6 months. There is no wound complication at the donor site or at the docking site. Conclusion Fibular strut graft is another option for the management of docking site problems. It has the advantages of less donor site pain, helps to align the bone and does not interfere with wound closure because it is in the medullary canal

Charcot disease: diagnosis and management goal

Charcot Disease is a neuropathic condition that affect the bone and joint which is commonly seen in the foot of patient with diabetes. It is characterised by inflammation in the acute phase which can be mistaken as infection, deep vein thrombosis or gouty arthritis. This process if left unchecked can lead to destruction of bone and joint which leads to deformity. The aim of treatment is to off load and protect the foot from deformed. The mainstay of treatment is casting or foot orthosis. Surgical management is reserve for infection, non-healing ulcer, severe deformity and unstable joint

Distraction osteogenesis: Basic science, principles and development

Distraction osteogenesis is production of new bone between vascular bone surfaces created by an osteotomy and separated by gradual distraction. The prerequisite for good bone regeneration is a stable fixation usually by means of a circular external fixator or a monorail system, It is use for bone lengthening, deformity correction and filling the bone gap by a process called bone transport. Recent development includes the hexapod system which use computer software for planning and generate prescription for patients management and intramedullary lengthening device which use magnet or electrical stimulation