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Halim, Ahmad Sukari,Wan Ahmad Kamal, Wan Syazli Rodzaian,Noor, Norizal Mohd,Abdullah, Shafie Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.6
Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18- hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.
Keloid Scarring: Understanding the Genetic Basis, Advances, and Prospects
Halim, Ahmad Sukari,Emami, Azadeh,Salahshourifar, Iman,Kannan, Thirumulu Ponnuraj Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.3
Keloid disease is a fibroproliferative dermal tumor with an unknown etiology that occurs after a skin injury in genetically susceptible individuals. Increased familial aggregation, a higher prevalence in certain races, parallelism in identical twins, and alteration in gene expression all favor a remarkable genetic contribution to keloid pathology. It seems that the environment triggers the disease in genetically susceptible individuals. Several genes have been implicated in the etiology of keloid disease, but no single gene mutation has thus far been found to be responsible. Therefore, a combination of methods such as association, gene-gene interaction, epigenetics, linkage, gene expression, and protein analysis should be applied to determine keloid etiology.
Ahmad Sukari Halim,Wan Syazli Rodzaian Wan Ahmad Kamal,Norizal Mohd Noor,Shafie Abdullah 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.6
Background Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. Methods Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. Results The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. Conclusions In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.
Keloid Scarring: Understanding the Genetic Basis, Advances, and Prospects
Ahmad Sukari Halim,Azadeh Emami,Iman Salahshourifar,Thirumulu Ponnuraj Kannan 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.3
Keloid disease is a fibroproliferative dermal tumor with an unknown etiology that occurs after a skin injury in genetically susceptible individuals. Increased familial aggregation, a higher prevalence in certain races, parallelism in identical twins, and alteration in gene expression all favor a remarkable genetic contribution to keloid pathology. It seems that the environment triggers the disease in genetically susceptible individuals. Several genes have been implicated in the etiology of keloid disease, but no single gene mutation has thus far been found to be responsible. Therefore, a combination of methods such as association, gene-gene interaction,epigenetics, linkage, gene expression, and protein analysis should be applied to determine keloid etiology.
Sankaralakshmi Gomathysankar,Ahmad Sukari Halim,Nik Soriani Yaacob 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.5
In the field of tissue engineering and reconstruction, the development of efficient biomaterialis in high demand to achieve uncomplicated wound healing. Chronic wounds and excessivescarring are the major complications of tissue repair and, as this inadequate healing continuesto increase, novel therapies and treatments for dysfunctional skin repair and reconstructionare important. This paper reviews the various aspects of the complications related to woundhealing and focuses on chitosan because of its unique function in accelerating wound healing. The proliferation of keratinocytes is essential for wound closure, and adipose-derived stemcells play a significant role in wound healing. Thus, chitosan in combination with keratinocytesand adipose-derived stem cells may act as a vehicle for delivering cells, which would increasethe proliferation of keratinocytes and help complete recovery from injuries
Gomathysankar, Sankaralakshmi,Halim, Ahmad Sukari,Yaacob, Nik Soriani Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.5
In the field of tissue engineering and reconstruction, the development of efficient biomaterial is in high demand to achieve uncomplicated wound healing. Chronic wounds and excessive scarring are the major complications of tissue repair and, as this inadequate healing continues to increase, novel therapies and treatments for dysfunctional skin repair and reconstruction are important. This paper reviews the various aspects of the complications related to wound healing and focuses on chitosan because of its unique function in accelerating wound healing. The proliferation of keratinocytes is essential for wound closure, and adipose-derived stem cells play a significant role in wound healing. Thus, chitosan in combination with keratinocytes and adipose-derived stem cells may act as a vehicle for delivering cells, which would increase the proliferation of keratinocytes and help complete recovery from injuries.
Mohd Shahrul Suondoh,Wan Azman Wan Sulaiman,Ahmad Sukari Halim,Arman Zaharil Mat Saad,Mohammad Ali Mat Zain,Normala Basiron 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.3
Purpose: Extensive studies regarding vascular anatomy and clinical applications of anterolateral thigh (ALT) flap has been conducted for many years. However, the ALT flap perforator vessels anatomy in the Malaysian population is not well-analyzed. The purpose of this study was to determine the distribution of ALT flap perforator vessels and its clinical applications in reconstructive surgery. Methods: This is a retrospective cross-sectional study conducted in two main centers of reconstructive surgery. A total of 142 cases of ALT flaps that used as an option for soft tissue reconstruction was selected. Vascular anatomy of ALT flaps was studied precisely including the origin of vessels, location of perforators, and types of perforator vessels intraoperatively during the flap harvest. Results: The distribution of ALT flap perforator vessels can be found at three specific locations on the thigh namely perforators A, B, and C. The highest number of cutaneous perforator vessels that supplied the ALT flap was musculocutaneous perforator with 72.3%, and dominantly at perforators B and C. The remaining perforator vessels were septocutaneous perforator with 27.7%, presented mainly at perforator A. A majority of cases involved the reconstruction of wound defects following tumor resection and trauma. The most area of reconstruction was the lower limb with 33.8%. Conclusion: The distribution of ALT flap perforator vessels can be predicted during flap harvest and can be applied in numerous clinical applications for wound defect coverage. The knowledge regarding vascular anatomy of ALT flap perforator vessels can aid plastic surgeons in reconstructive surgery.
A Lucky Case of Successful Free Fibula Osteocutaneous Flap Harvest in Peronea Arteria Magna
Rosli Mohamad Aizat,Wan Sulaiman Wan Azman,Halim Ahmad Sukari 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.2
The free fibula flap (FFF) is based on the peroneal artery (PA) system, and it is well known that several anatomical variations of the lower limb vascular system exist, including peronea arteria magna (PAM). PAM is a rare congenital variation in which both anterior tibial artery and posterior tibial artery are either aplastic or hypoplastic, and as a result, PA will be the dominant blood supply to the foot. This variation was described as type III-C in Kim-Lippert's Classification of the Infra-Popliteal Arterial Branching Variations. The awareness of its existence is crucial as it often precludes FFF from being harvested due to the risk of significant limb ischemia and limb loss. Despite some literature reporting donor site complications and impending limb loss following FFF harvest in PAM, preoperative vascular mapping before FFF transfer remains controversial among the microsurgeons. We present a case with an incidental intraoperative finding of PAM that had a successful FFF harvest by luck, without preoperative vascular mapping.