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Cleft lip and palate review: Epidemiology, risk factors, quality of life, and importance of classifications Supit, Laureen; Prasetyono, Theddeus O.H.
Medical Journal of Indonesia Vol 17, No 4 (2008): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Cleft lip with or without cleft palate is the most occurring craniofacial anomaly in human, resulting from a complex etiology involving multiple genetic and environmental factors. The defect carries lifelong morbidity and economic burden. Children with clefts will require continuous medical interventions for at least the first 18 years of life, affecting many aspects of their lives. The extent and complexity of clefts vary infinitely, later determining individual management and outcome. Identification and classification play significant roles in initial assessment of these unique cleft cases, which affect options for following correctional attempts. Some classifications even allow measurement of progress after anatomical repositioning, and success rate after surgical repairs. The challenge of developing one such widely inclusive classification is discussed. (Med J Indones 2008; 17: 226-39)Keywords: Cleft lip, cleft palate, congenital anomaly, cleftÂ classfications

Surgical Management of Giant Congenital Hairy Nevi Without Skin Graft or Other Methods of Closure Sukasah, Chaula L; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Congenital hairy nevus refers to pigmented skin lesion presents at birth. Giant hairy nevus (GHN) is disfiguring and carries a great emotional distress on the patient and family. It also imposes a higher risk for developing malignant melanomas and other tumors. The management of GHN depends on the lesions’ size, location and its propensity to become malignant. When surgery is indicated, the simplest approach is a staged serial excisions. The longstanding challenge is in reconstructing the raw surface defect, especially if large. A case of congenital GHN on the trunk, abdomen and bilateral upper thighs was presented and the data was taken from the medical record from the Plastic and Reconstructive Surgery Division of Cipto Mangunkusumo Hospital. Patient was managed surgically with a technique similar to dermabrasion, by scalpel instead of dermabrator, to peel the skin in partial-thickness. In each surgery, not more than 10% of the total body surface area was excised and left to heal secondarily. Compression was used to reduce risk of hypertrophic scar formation. Subsequent operation was ideally 3 weeks apart, to allow for the excised surface to epithelialize and the body to return to homeostasis. Although visible, the patient’s family prefer the resulting scar than the initial lesion, because the skin is lighter, hairless, and less frightening. At two-years follow up, the patient still refuse further operation due to economical and social issues.

Granulocyte-Macrophage Colony Stimulating Factor and Steroid on Neovascularization and Keratinocyte Proliferation in Wound Healing Naim, Zainul; Supit, Laureen; Sutrisno, Eddy; Buchari, Frank Bietra
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: This study aim to evaluate the effect of subcutaneous application of recombinant human granuloctyte-macrophage colony stimulating factor (rhGM-CSF) around wounds and how it in"uences the speed of wound healing. Methods: The study utilizes Mus musculus mice in a controlled laboratory setting. Mice are divided into 3 groups: A (n = 4) receiving rhGM-CSF 10?g/kg, B (n = 4) receiving dexamethasone 10 mg/kg and C (n = 5) receiving placebo as control. Full thickness wound was made, and either rhGM-CSF, dexamethasone, or nothing were given on the wound subcutaneously for 6 days. On day 7, all rats were sacrificed and a 4-mm area from the edge of the wound were subjected for histologic examinations. Pattern of neovascularization and keratinocyte proliferation were analyzed.Results: The data shows a higher rate of neovascularization and keratinocyte proliferation in the rhGMCSF group compared to the steroid and placebo groups (p = 0.001). Not difference in the rate of keratinocyte proliferations (p = 0.085) and neovascularization (p = 0.935) are found between the dexamethasone and control groups.Discussion: Granulocyte macrophage colony stimulating factor (GM-CSF) hastens wound healing in wildtype mice by increasing the rate of keratinocyte proliferation and neovascular formation, while dexamethasone has a tendency to hinder wound healing because it acts as a GM-CSF inhibitor.

Management of Root Like Man: Case from Gatot Soebroto, The Indonesian Army National Hospital Sundoro, Ali; Supit, Laureen; Surachman, Asrofi S.; Adam, Harun; Budiman, Budiman; Guntoro, Guntoro
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Patients and clinicians experience the frustration of cutaneous viral warts due to human papilloma virus (HPV) infection. Verruca vulgaris, the common warts, appear in various forms at different body sites. Over 118 types of papilloma virus have been identified. The most common cutaneous warts are caused by types 1, 2, 4, 27, 57, and 19 HPV. The rare cases of generalized warts around the world are suspected to be caused by type 2 HPV. There are many treatment modalities for this disease but none is 100% effective yet. Patient and Method :We report a 39-year-old male with generalized warts on various body parts (scalp, forehead, trunk, arms, lower leg and foot). The team consist of plastic surgeons, dermatologist, psychiatrist, pathologist, medical rehabilitationist, and internist. The treatment goals were to remove all warts, prevent recurrence of the disease, and improve the immunological status of the patient. Serial excisions were performed and closure attained using a combination of primary sutures, skin grafts (split- and full-thickness), and skin flaps. 5 Fluorouracil was administered on the raw surfaces before closure. Staged excisions were performed 11 times, with 3-4 weeks interval over a1-year period. Interferon and cimetidine injection were also given to augment the immune system.Results : All lesions were successfully excised and reconstructed. On a few fingers, hypertrophic scar and minor contracture ensued after closure by skin graft. Patient is able to carry out daily living activities independently. Patient was profoundly delighted and his quality of life improved.Summary : Management of a rare generalized verruca vulgaris through a team approach, by multiple staged excision, 5-FU application before defect closure, combined with antiviral therapy, proved effective in a case.

The Extended Lateral Forehead Flap: Today as Was 50-years Ago Supit, Laureen; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): July Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: In the era of surgical advances where institutional pride and status resonates with their progress in the minimal invasives, latest technologies, stem cells, and supermicrosurgeries; some things in plastic surgery never change. The extended lateral forehad flap (ELFF) was first introduced by Ian McGregor in 1963 to reconstruct an intraoral defect, he called it the temporal flap. Gillies and Millard each modified and utilized the flap for patching various facial and intraoral defects and published their experience a year later. Until today in 2012, the ELFF is still largely useful for the reconstruction of wide defects post neoplasms ablation in the face or oral region, which would otherwise require distant flaps or free flaps.Patients and Methods: Three cases of oral and perioral carcinoma were resected and reconstructed using the ELFF to cover for: a full-thickness cheek defect including the lip commisure, an inner oral lining, and a hemipalatal defect.Results: In all, the flaps were tunneled subcutaneously, and donor area grafted by full-thickness skin. All flaps survived and functional outcomes are attained in all patients, with acceptable aesthetic results.Summary: A flap once introduced 49 years ago, is today as consistent and applicable in plastic surgery. This article is an appraisal to the ELFF, and a reminder to the general plastic surgeons, of the simple yet versatile role of ELFF in the reconstruction of facial and intraoral defects.

Vein-Supercharged Peroneal Artery Perforator Propeller Flap for Achilles Soft Tissue Coverage Atmodiwirjo, Parintosa; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): April Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

Random Perforator Flap : Some Experiences with Keystone Flap Sudjatmiko, Gentur; Pribadi, Sweety; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): April Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: In reconstructing challenging defects, surgeons are considered fairly fortunate when they are able to obtain a similar donor tissue quality to that of the missing tissue; in regards to their color, texture, size, and the ease of donor transfer to the defect. Several methods may be used, which frequently include the free tissue transfers using microvascular anastomoses bearing their specific consequences. We report a select of challenging cases which were successfully reconstructed using the Keystone flaps and avoid microvascular anastomoses, where otherwise the free tissue transfers would be the typical option for closure in such defects. Patient and Method: Nine cases of relatively large defect in various locations were reconstructed using the Keystone flaps supplied by either non-identified perforators or identified reliable perforators. Result: Out of the 9 defects located on various region of the body (lumbar, thorax, dorsum of the foot, plantar of the foot, posterior leg, sacrum, and cervicofacial) only the first 2 cases had identifiable perforators. All flaps survived completely without problem of vascularization. Summary: The Keystone flap is a useful and reliable random perforator-based flap even when the perforator vessels are not identified.

Perigenital Defect Reconstruction Post Giant Condyloma Acuminata Resection: Experience With The Double Keystone Flap Suhartadi, Bayu; Supit, Laureen; Sukasah, Chaula
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): October Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Abstract: Due to its high recurrence, genital condyloma acuminata should be widely excised to include the full dermal thickness. Currettage is not advisable, as the rate of recurrence is high. The bigger the lession, the bigger donor area needed to close the defect. The reconstructive options do not merely depend on the defect area, but also on selecting a tissue donor of similar color, thickness, sensation and durability. The ease of donor transfer is equally important. Not many case of giant genital condyloma acuminata wide excision and reconstruction has been reported. For coverage of larger soft tissue defect, skin graft is the most common option; however durability is of concern and the perigenital area is a challenging area to graft. Two cases of perigenital reconstruction after giant genital condyloma excision is reported in this paper, using random perforator based flaps, the double keystone flap. Patient and Method: Both cases of giant genital condyloma underwent wide excision by the urologist and referred to our division for reconstruction. Both patients are male, and the defects were reconstructed using the double keystone flap. One patient needed a split thickness skin graft to cover remaining defect on the penile shaft. Result: In both cases, the double keystone flap successfully covered for the defects on the perigenital with tissue quality similar to its original characteristics. No complication ensued. All flaps were vital, no dehisence nor local infection occurred. Summary: The double keystone flap is a reliable option for the reconstruction of large defects on the perigenital region.

Sidik-Chaula Urethroplasty and the Manset Flap for Non-Glanular Hypospadias Repair Sukasah, Chaula L; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): January Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Hypospadias present with a wide array of meatal position and curvature. Choosing an operative technique for the different types of hypospadias has been challenging and controversial among the plastic, urologic, and pediatric surgeons. Regardless of the selected techniques, primary hypospadias repair still frequently results in complications requiring further surgery, such as fistula, residual chordee, and stricture. Owing to its practicality, the single stage urethroplasties are more-popular and widely used at present. However, our experience found higher rates of postoperative complications with the one-stage procedure compared to the two-stage for repair of non-glanular hypospadia. This article details the operative techniques of the two-stage Sidik-Chaula urethroplasty, a technique that we have implemented in our institution over two decades. It is applicable for the primary repair of any distal, middle, and proximal hypospadias. We also introduce the Manset Flap, a simple modification to the first stage of urethroplasty, which ease neourethra creation in the second stage. However, due to prior insufficient medical recordkeeping, we are yet unable to produce a quantified rate of success and complications by utilizing this technique. A study is currently being done to produce the numbers.

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