1.Acute vascular complications (flap necrosis and congestion) with one stage and two stage distally based sural flap for wound coverage around the ankle
Nazri Mohd Yusof ; Ahmad Fadzli Sulong ; Wan Azman Wan Sulaiman ; Mohammed Azril Mohammed Amin
The Medical Journal of Malaysia 2016;71(2):47-52
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.
2.Quality of life of diabetes amputees following major and minor lower limb amputations
Nazri Mohd Yusof ; Aminudin Che Ahmad ; Ahmad Fadzli Sulong ; Mohd Jazlan Mohd Adnan ; Jamalludin Abdul Rahman ; Ramli Musa
The Medical Journal of Malaysia 2019;74(1):25-29
Minor amputation was performed as a salvage
procedure because most of the patients were not able to
ambulate and become dependent following major
amputation. Minor amputation is defined as amputation at
the level of ankle joint and below while major amputation is
defines by amputation above the ankle joint. The aim of this
study was to compare the quality of life among diabetes
patients following major and minor amputations.
3.Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems.
Nazri Mohd YUSOF ; Jamalludin Ab RAHMAN ; Ahmad Hafiz ZULKIFLY ; Aminudin CHE-AHMAD ; Kamarul Ariffin KHALID ; Ahmad Fadzli SULONG ; Naveen VIJAYASINGHAM
Singapore medical journal 2015;56(11):626-631
INTRODUCTIONDiabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood.
METHODSThis cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients' profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis.
RESULTSA total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis.
CONCLUSIONT2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems.
Adult ; Aged ; Aged, 80 and over ; Amputation ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Foot ; epidemiology ; etiology ; surgery ; Female ; Humans ; Incidence ; Lower Extremity ; surgery ; Malaysia ; epidemiology ; Male ; Middle Aged ; Prognosis ; Risk Factors