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  • Author: James G. Gollogly x
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Background: Cambodia boasts one of the highest incidences of TB in the world. As such, healthcare providers are experienced with types of extrapulmonary TB such as septic Mycobacterium tuberculosis arthritic infections, not seen in developed countries.

Objective: Examine the incidence and distribution of TB arthritis cases at a Cambodian surgical center, explore the problems of diagnosis and current methods of treatment for this disease.

Methods: The written charts, operation records, and electronic database of patients with clinically diagnosed extrapulmonary TB, confirmed with a positive biopsy between January 2001 and July 2010 were searched. While medical treatment for the TB was given at other facilities, the operations performed and the result for patients with follow-up was reviewed.

Results: Between January 2001 and July 2010, 38 cases of TB arthritis at the CSC in Cambodia were histologically confirmed. Twenty-eight cases affected the lower extremity with the majority affecting the knee and ankle. All 13 patients receiving arthrodesis reported positive surgical outcomes.

Discussion/Conclusion: TB arthritis persists as an ongoing problem at CSC with a significant level of incidence. Arthrodesis is a viable and cost effective mean of treating TB arthritis in Cambodia.


Background: Marjolin’s ulcer is a rare malignancy often associated with burn scars, traumatic wounds and chronic infections. Cambodia is still contaminated with landmines and unexploded ordinance, and a significant number of people suffer from related injuries, as well as latent development of Marjolin’s ulcers.

Objectives: Report on the incidence of suspected and histopathologically confirmed cases of Marjolin’s ulcers at the Children’s Surgical Centre (CSC), Phnom Penh, Cambodia. Comment on 2 similar cases of landmine injuries to the lower limb resulting in Marjolin’s ulcers.

Methods: Independent retrospective analysis of electronic and hardcopy patient records (January 2003 to January 2012) was performed by two examiners. Patients were selected based on primary and secondary inclusion criteria.

Results: Forty-eight patients were selected from the initial analysis and of those selected, 8 patients met secondary inclusion criteria. From these 8 cases, the preceding pathology included burns (62.5%), landmine blast injuries (25%) and chronic infection (12.5%).

Conclusion: The high prevalence of landmine blast victims in Cambodia suggests that there is likely to be a correspondingly high incidence of Marjolin’s ulcers in the population. Improved surveillance for malignancy and prompt intervention in these patients may improve outcomes.


Background: Decubitus ulcers are severe challenges to paraplegic patients, as well as to the medical providers caring for such disabled persons. Severe, chronic infection often can lead to death, especially in developing countries. Sometimes, hip disarticulation is the most appropriate surgical response to chronic ulceration. Objective: Report the results of bilateral disarticulations in 3 patients, one in Cambodia, and two in Australia. Methods: Chart reviews, examinations, and interviews with the patients were conducted to identify appropriate details of the indications and results. Results: Severe decubitus ulcers were successfully treated using the technique, without undue surgical complications. The general health of the patients was much improved. Conclusion: Bilateral hip disarticulations were performed as last stage salvage operations in three patients, who expressed satisfaction with the results, even though some problems with balance and recurrent ulceration persisted.


Background: A new case of congenital pseudarthrosis of the tibia (CPT) presents yearly to CSC, but treatment is prolonged, and not always successful.

Objective: To study the outcomes of treatment, and to determine whether a relationship with neurofibromatosis (NF) was of significance.

Methods: A review of the medical records at our centre revealed 11 cases of CPT, 5 of which were associated with neurofibromatosis.

Results: Most patients had multiple operations for their case of CPT, which did finally lead to union in 6 out of 6 cases with no NF, but in only 1 case out of 5 when NF was present.

Conclusion: Late presentation and severe deformity can be overcome, and union can be achieved, but NF has a deleterious effect on obtaining union.



A bent femoral intramedullary nail is a rare complication following secondary trauma to an unhealed femoral fracture site. Existing strategies for removal require the use of specialized instrumentation such as a diamond tipped drill or a high speed burr. Specialized orthopedic instrumentation is often expensive and frequently unobtainable in the developing world.


To provide a solution in resource poor settings and describe a unique approach to managing such complex cases.


Novel, low cost, and successful use of industrial instruments for removing a femoral nail bent in situ in a 43 year old man who would have likely required a much more extensive operation without it.


Instrumentation was obtained from a local market and at a fraction of the cost of specific orthopedic instruments. This case presents a technical tip for managing this complication in the developing world.


In a resource poor setting, we can recommend the judicious use of inexpensive industrial materials and instruments to manage complex cases.


Background: Melanoma is a highly malignant skin cancer. Acral lentiginous melanoma (ALM) is most common among Asians. The prevalence of ALM among melanoma cases in Cambodian is not known.

Objective: To describe the prevalence of ALM among cases of melanoma and the stage of disease at presentation to the health facilities and health providers.

Method: Electronic clinical records were obtained from Children’s Surgical Centre (CSC) database between January 2002 and April 2014. Types and stages melanoma at presentation were documented.

Result: A total of 10 out of 26 melanoma patients had ALM. Their average age at diagnosis was 65.3 years. Most primary lesions were located on the plantar or lateral surfaces of the foot. Most histopathological descriptions were consistent with ALM. Seventy percent had lymph node metastases.

Conclusion: A high proportion of ALM was found associated with trauma as a potential risk factor. Most frequency presented at a late stage of disease. Providers must be made aware of the disease and render appropriate management early for good outcome.


Background: Surgical care is often regarded as too expensive and complex for people in poor countries and so has long been neglected.

Objective: We demonstrated that the cost per disability-adjusted life year (DALY) saved of reconstructive surgery in Cambodia is competitive with many basic public health interventions.

Methods: The Children’s Surgical Centre (CSC) in Phnom Penh provides orthopedic, plastic, ophthalmological, and general reconstructive surgical services free to disabled people in Cambodia. Following standard guidelines for calculating operation costs and assigning disability weights we calculated the cost effectiveness of surgical treatment for 343 patients treated at CSC in January and March, 2012.

Results: Our data for these two months yielded 1785 DALYs averted and operating costs totaling $164,543; resulting in $99 per DALY averted.

Conclusion: Reconstructive surgery is cost effective compared to other basic public health interventions and should not be neglected when designing integrated health care services in a developing country.


Background: Elevated levels of arsenic in drinking water in Cambodia were first identified in 1999. The first cases of suspected arsenicosis were identified by the WHO in 2002, and the first laboratory confirmed cases were found in 2006. Objective: Present three patients with ulcerating tumors of the legs who came from two different districts in Cambodia. Results: Cutaneous lesions characteristic of chronic arsenicosis were exhibited, and squamous cell carcinomas requiring amputation had developed. The clinical features of chronic arsenicosis and its surgical management were examined, in addition to its impact in Cambodia and current preventive strategies Conclusion: There will be an increased incidence of these problems in the future. Medical practitioners in the Mekong River Basin should be aware of them, so as to recognize them early, and treat them appropriately.