Tualang honey is obtained from large honeycombs produced by Asian bees (Apis dorsata) in gigantic Tualang trees. It has been used traditionally by local communities to treat wounds. However, unlike manuka honey its medicinal uses are not well researched. An open, prospective study into the efficacy of wound healing in full thickness wounds in rats, was designed to compare two honey impregnated dressings with silver-impregnated hydrofibre dressings. A full-thickness wound was created on the dorsum of Sprague-Dawley rats (n=45).Tualang honey impregnated paraffin tulle (P-honey) and tualang honey impregnated hydrofibre dressings (H-honey) were compared with silver-containing hydrofibre dressing (positive control; H-Ag). The wounds were inspected on days 4, 7, 14, 21 and 28. The dressings and wounds were assessed for adherence, ease of removal, fluid accumulation, dryness of skin and exudates, rate of epithelization, healing and wound contraction. Three rats treated with each dressing were sacrificed on the days that wounds were inspected. The wounds and scars were histologically analysed for inflammatory parameters. Tualang honey impregnated dressings were comparable to the commercially available silver impregnated hydrofibre dressing in terms of adherence, ease of removal, fluid accumulation, dryness of surrounding skin and exudates; p > 0.05 for non-parametric Kruskal-Wallis tests and post hoc corrections with a Mann-Whitney test. The rates of wound healing, wound contracture and subsequent histological analysis of inflammatory reaction by each dressing were also comparable. Tualang honey impregnated dressings were as effective as silver impregnated hydrofibre dressings in terms of dressing properties, promotion of wound healing and inflammatory reaction.

BACKGROUND: Aplasia cutis congenita is a rare newborn malformation characterized by focal absence of skin. It possesses difficulty in reconstruction surgery for neurosurgeons and plastic surgeons. We report a challenging case of aplasia cutis congenita who received treatment in our center. CLINICAL CASE: A 2-year-old boy, presented to Plastic and Reconstructive Surgery, Hospital USM, with bilateral vertex defect with encephalocele who received a series of surgical interventions since 1 month old. Unfortunately, he returned after 2 years with a chronic nonhealing scalp wound associated with dura defect and cerebral spinal fluid leakage. The wound was debrided and the swab culture result showed no organism growth. Part of the wound bed with dura defect was repaired using a small piece of transplanted fascia lata and Integra was applied. DISCUSSION: There is scarcity in the medical literature on the reconstructive technique of aplasia cutis congenita. In the case we described here, we successfully managed the wound with multiple application of dermal substitute (Integra) dressing with negative pressure wound therapy and split-thickness skin graft. CONCLUSIONS: Management of aplasia cutis congenita with skull defect remains a controversy. Its management varies depends on its pattern and underlying condition. We successfully develop a new simple method in treating scalp accutilizing Integra.

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons. CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure. DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting. CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.