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The Use Of Control Suture In Cleft Lip Surgery Gentur Sudjatmiko; Mohamad Rachadian Ramadan
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): November Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

To achieve an optimal result in cleft surgery, executing the proper designs and precise techniques are mandatory. Several techniques are proposed for the repair of unilateral and bilateral cleft lip. In 1955, Millard !rst described the techniques of advancing a lateral upper lip "ap combined with downward rotation of the medial segment.1 From experience, the above- mentioned technique may be modi!ed to facilitate better lip rotation and symmetry. Technically, it also provides a more ef!cient work"ow and more accurate results. All efforts in lip repairs have one ultimate goal, which is to achieve corrected lips with minimal scar and as much resemblance to that of the normal lips: by anatomy, symmetry, and muscle function.

Analgesia For Dressing Changes In Burns: A Systematic Review Mohamad Rachadian Ramadan; Aditya Wardhana; Adhrie Sugiarto
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Intense and prolonged pain often caused by burn injuries. The greatest pain is mostly experienced during dressing changes to maintain healing and banish the infection. This review is conducted to assess the effectiveness and safety of different analgesia agents or methods for dressing changes in burn patients. Method: Searches of studies conducted from 4 electronic databases, using keywords “Analgesia”, “Dressing”, “Bandages”, “Changes” and “Burns”. We included randomized and quasi-randomized trials assessing and comparing the effects of different analgesia agents, analgesia methods for dressing changes in burns patients. We excluded trials reporting only pharmacokinetic and physiological outcomes, comparing drug dosages, with exception for those using different drugs in the same class. Result: Multiple databases search retrieved 144 studies. 17 trials are eligible involving 700 patients. Analgesia using pharmacological agents in 7 trials; 5 trials elaborating primary treatments and 2 trials as the adjunct treatment complementing the major analgesia. Two primary analgesia treatments were studying the role of patient-controlled analgesia (PCA), while 3 trials using caregiver delivered. Ten trials were observing the role of non-pharmacological analgesia. Conclusion: There was inadequate evidence from comparisons tested in randomized trials to confirm the dependent effectiveness of various techniques of analgesia, individual methods, or to assess the administration of different drug adjuncts for providing analgesia during dressing changes. Given the unresolved questions about the management of these conditions, we suggest that preference should be focused on the large scale, optionally, multi-center randomized observations of the primary methods.

Early And Recent Development Of Reconstructive Microsurgery Subspeciality In Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia (1983-2020) Mohamad Rachadian Ramadan; Nadhira Anindita Ralena; Sara Ester Triatmoko; Parintosa Atmodiwirjo
Jurnal Plastik Rekonstruksi Vol. 6 No. 2 (2019): September Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Plastic surgery in Indonesia was pioneered and developed by Moenadjat Wiratmadja, MD., in 1958. This specialty experienced many developments and improvements over time with more specific subspecialties to facilitate the advancement of the science of plastic surgery, including the reconstructive microsurgery subspecialty. The reconstructive microsurgery service in the plastic surgery division dr. Ciptomangunkusumo National Hospital (RSCM), Jakarta, Indonesia was first initiated by Sidik Setiamiharja, MD., self-taught from the textbooks. In late 1985, following the success of conducting the first basic microsurgery course in Jakarta, the plastic surgery team in RSCM which consisted of Sidik Setiamihardja, MD, Chaula L. Sukasah, MD and Gentur Sudjatmiko, M.D. pioneered many of the first microsurgery cases, including the first major limb replantation, first penile replantation and the first free flap. Overtime, the reconstructive microsurgery subspecialty has been growing significantly. In 2019, the number of free flap cases at RSCM reached the highest number in Indonesia with 90 free flap cases with 94% success rate.

How to Harvest The Free Fibula Flap Parintosa Atmodiwirjo; Mohamad Rachadian Ramadan; Sara Ester Triatmoko; Nadhira Anindita Ralena
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v7i1.295

Summary: Free fibular flap (FFF) is a composite flap consisting of fibular bone and skin paddle. Muscle may be added to the flap. It has several advantages and disadvantages. The fibular free flap is well suited for any reconstruction of the head and neck. It is suitable for defects of the anterior mandibular arch or lateral defects in patients who wish to undergo osseointegrated dental reconstruction. Meanwhile, its contraindications are related to significant atherosclerotic diseases the patient has or congenital variants of the arteries. Preparations for FFF procedure consist of history taking, physical examinations and supporting examinations, like other free flaps procedure in general. Several intraoperative preparations should also be done.

Multi-stages Aesthetic Refinement Following Anterolateral Thigh Free Flap for Head and Neck Reconstruction Parintosa Atmodiwirjo; Mohamad Rachadian Ramadan; Sara Ester Triatmoko; Maryam Nur Arina
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Introduction: Multi-stages refinement of a bulky flap after composite defects reconstruction of multiple facial units has been a challenging situation. Goals including restoration of periorbital and malar area and redefining the aesthetic aspects of the units as well as the surrounding nasolabial area with multiple refinements and microfat graft. Methods: A 50-year-old male patient with a history of solitary fibrous tumor underwent wide excision of left periorbital, infraorbital, lateral nasal sidewall, and malar area. The defect is enclosed with Anterolateral Thigh Free Flap (ALT). Bulkiness of the flap, sunken left nasolabial, and asymmetric alar nasal unit were found during outpatient follow-up. These problems lead to the necessity of refinement procedure to reduce the bulkiness to improve the aesthetic outcome of the patient. Microfat graft was the method chosen to volumized the sunken nasolabial and asymmetric alar nasal unit. Results: Patient is satisfied with the result due to improvement of alar nasal units symmetricity and reduced bulkiness of the flap area. No complication was observed. Conclusion: Meticulous planning and staging of the surgical refinement procedures in conjunction with microfat graft results in good aesthetic outcome and satisfies the patient and reduces the possibility of complications.

Microsurgical Reconstruction During Covid-19 Pandemic Setting: A Systematic Review and Clinical Applications Parintosa Atmodiwirjo; Mohamad Rachadian Ramadan; Nadhira Anindita Ralena; Sara Ester Triatmoko
Jurnal Plastik Rekonstruksi Vol. 8 No. 1 (2021): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v8i1.321

Introduction: The outbreak of the novel coronavirus disease 2019 (COVID-19) has taken almost all countries worldwide. This situation has compromised the safety and health of all medical workers, including microsurgeons. Given that there have been various articles published about the recommendations in microsurgical reconstruction during the COVID-19 pandemic, We felt compelled to compile all relevant studies about the microsurgical reconstruction in the COVID-19 pandemic setting, describe the various actions from different perspectives, as well as providing suggestions based on evidence-based medicine. Method: We did a systematic literature search using electronic databases such as PubMed, Embase, Medline, Wiley, and Cochrane using keywords reconstruction, Microsurgery, coronavirus, and COVID-19. All included studies were critically appraised and reviewed. Results: Nine relevant articles were included for the final review, four of them were qualitative studies, and 5 were guidelines. Studies look at various surgeon's experiences from different healthcare systems during the COVID-19 pandemic. The focuses of the included studies are also diverse from head and neck surgery, breast surgery, limb surgery, and general Reconstructive Microsurgery. Conclusion: Microsurgical reconstruction is not suggested to perform during the peak of the COVID-19 pandemic. It is indicated only if necessary after a rigorous review by the multi-disciplinary team. A full PPE, including a Powered Air Purifying Respirators (PAPR) system, fit-tested N95 respirator masks, face shield, and tight-fitting eye protection goggles, are recommended in performing the surgeries.

Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review Parintosa Atmodiwirjo; Nadhira Anindita Ralena; Mohamad Rachadian Ramadan; Sara Ester Triatmoko
Jurnal Plastik Rekonstruksi Vol. 8 No. 1 (2021): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v8i1.322

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ? 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

Aesthetic Evaluation After Three-Dimensional Shaping of Free Flap for Nasal Reconstruction without Additional Paramedian Forehead Flap Parintosa Atmodiwirjo; Reinhart Jonathan; Mohamad Rachadian Ramadan; Sara Ester Triatmoko; Maryam Nur Erina; Nadhira Anindita Ralena
Jurnal Plastik Rekonstruksi Vol. 9 No. 2 (2022): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v9i2.344

Nasal reconstruction has continued to advance in accordance with Menick's vision as it was first conceived. His combination of radial forearm free flaps with the gold standard of paramedian forehead flaps is highly regarded for producing superior outcomes, and it has received widespread praise as a consequence. In this study, we present nine patients who had nose reconstruction using free flaps. All of the patients had successful outcomes. Using the FACE-Q questionnaire, we assessed the degree to which patients were satisfied with both the functional and aesthetic aspects of their appearance. The outcomes were positive for nine of the patients.

Central Facial Soft-Tissue Defect Following Surgical Resection: An Algorithm for Reconstruction Mohamad Rachadian Ramadan; Parintosa Atmodiwirjo; Amila Tikyayala
Jurnal Plastik Rekonstruksi Vol. 9 No. 2 (2022): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v9i2.347

Background: Central facial soft tissue defect poses a unique challenge for the reconstructive surgeon. The three-dimensional properties of the aesthetic facial subunit and its related function are the goals for reconstruction. Considering the prominent social role of the face, the procedure to achieve a good quality of life for patients may cost more than a single surgery. This single-center study presents an algorithm of treatment for central facial soft tissue defect and it’s proposed classification according to the authors’ experiences. Methods: A retrospective review of medical records and photos of patients who underwent central facial soft tissue defect reconstruction in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia, from 2009 to 2019. Patients who underwent free flap reconstruction were followed up, and the primary outcomes were assessed using the FACE-Q head and neck cancer (FACE-Q H&N) scale. A classification system for central facial soft tissue defect with seven subtypes (1–7) based on the facial subunit and its treatment was proposed. Results: Twenty-five patients were included. The malignant tumor was the main etiology (88%), with basal cell carcinoma being the primary cancer pathology (64%). The average defect size was 120 cm2 (32-416 cm2) and most defects fell into subtype 6 of the classification (32%). Anterolateral thigh free flap (ALT) was the main flap of choice (64%), followed by radial forearm free flap (36%), with 92% of flaps succeeding rate from this series. All of the patients underwent at least one ancillary procedure following the reconstruction, while the average was 2 (1-6) procedures. FACE-Q H&N outcomes, especially on the appearance and appearance distress scale, showed a low to moderate score with a 72% response rate. Conclusions: Central facial soft-tissue defect continues to challenge reconstructive surgeons. While the advances in free tissue transfer might improve the general outcomes, the numerous and costly secondary procedures do not usually end up in the best appearance. This study displayed the need for modern reconstruction modalities that provide high satisfaction in aesthetic and functional outcomes with fewer secondary procedures. Vascularized Composite Allotransplantation (VCAT) might be the future choice.

Free Flap Evaluation Following Reconstruction of Locally Advanced Squamous Cell Carcinoma of The Tongue Atmodiwirjo, Parintosa; Kartini, Diani; Arina, Maryam Nur; Sapphira, Elrica; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 10 No. 2 (2023): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v10i2.361

Background: Neoadjuvant chemotherapy (NAC) is a crucial component in the management of tongue-based locally advanced squamous cell carcinoma (LASCC) due to its ability to decrease tumor mass and facilitate free tissue transplantation. The utilization of adjuvant radiation and chemotherapy has been observed to decelerate the progression of post-operative tumor growth. Probability of free flap failure is elevated. Post-operative complications and the long-term functional outcomes of speaking, salivation, and swallowing determine the quality of free flaps. Methods: A retrospective review of tongue LASCC patients who underwent NAC followed by glossectomy and free tissue transfer from 2015 to 2018. Tongue functional outcomes of speaking, swallowing, and salivation were assessed using FACE-Q scale in 3 times follow-up period. Result: This study included 7 patients who underwent tongue reconstruction. Treatment modalities were based on tumor presentation, with 4 patients (57.1%) receiving Taxane, 5-Fluorouracil, and Paclitaxel/Doclitaxel (TPF), and 3 patients (42.1%) receiving Paclitaxel and 5-Fluorouracil (PF). Tongue reconstruction utilized the radial forearm free flap in 5 patients (71.4%) and the anterolateral thigh free flap in 2 patients (28.6%). Intraoperatively, NAC had no impact on the integrity of small and reliable donor vessels. Three patients died from tumor metastases after the second follow-up assessment, while one patient was lost to follow-up. The study found no significant association between chemotherapy dosage and free flap vitality (P = 0.629). FACE-Q assessments revealed moderate to low scores in speaking, eating, and drinking outcomes. Conclusion: Tongue reconstruction after NAC in LASCC patients remains a challenging procedure for surgeons. While the consideration of surgical difficulties due to damage of the donor vessels demands a more structured pre-operative plan. No correlation between the exposure of NAC or AR to free flap complication as well as functional outcome.

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