The Rotated Bipedicled Tram Flap: Maximising Breast Projection but Minimising Donor Morbidity - A Case Report Autologous breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap remains a cornerstone of breast reconstructive surgery. However, with the classical TRAM flap, it is challenging to close a large post mastectomy defect in nulliparous and/or slim women. The resultant reconstructed breast also lacks projection. This case reported a novel modified TRAM flap technique performed in a nullipara. She had previously undergone a hysterectomy and oophorectomy for endometrial carcinoma via a pfannenstiel incision. She presented with a large left breast invasive micropapillary carcinoma (ER/PR negative HER2 3+) with only marginal response to neoadjuvant chemotherapy. She underwent a left mastectomy with axillary dissection and immediate breast reconstruction. The rotated bipedicled TRAM Flap was used to close the large defect, maximising breast projection while minimising donor site morbidity.

THE OUTCOMES OF GLIOBLASTOMA MULTIFORME: THE UNIVERSITY MALAYA MEDICAL CENTRE EXPERIENCE 2008-2018 Glioblastoma multiforme (GBM) is the most common and biologically aggressive adult primary brain tumour. The standard of care treatment is maximal safe resection (MSR) followed by post-operative concurrent chemoradiotherapy (CCRT) and adjuvant temozolomide (TMZ). This retrospective single-centre study was carried out at a tertiary academic hospital, University Malaya Medical Centre, between 2008–2018. This study aims to analyse the overall survival (OS) and progression free survival (PFS) and identify the prognostic factors affecting survival in our cohort of patients. Data including patient demographics, clinicopathologic characteristics and treatment characteristics were collected and correlated with survival. Survival analysis was performed with the Kaplan–Meier method. The multivariate analysis using Cox proportional hazard regression was performed to evaluate the prognostic clinicopathological for survival. A total of 100 patients were analysed. The median OS and PFS for the whole sample population was seven months (95% CI = 4-10 months) and four months (95% CI = 3.2-4.8 months) respectively. The factors associated with worse median OS were no adjuvant treatment (HR = 6.03; 95% CI = 2.40-15.16; p = 0.00), age older than 65 years old (HR = 2.22; 95% CI = 0.10-4.96; p = 0.05), post-operative ECOG PS >2 (HR = 6.13; 95% CI = 1.70-22.11; p = 0.01), and the temporal-lobe-located tumour (HR = 3.89; 95% CI = 1.51-10.01; p = 0.01). The fundamental points that could be deduced from the observed difference in survival outcome from our study to the literature are (1) age and PS were the two crucial pre-treatment factors that influenced the outcome, and (2) radiotherapy (RT) was demonstrated as the essential treatment in GBM and that the dose fractionation played an essential role on the outcome.