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FACTORS INFLUENCING SKIN NECROSIS RESULTING FROM EXTRAVASATION INJURIES AND THE RAPEUTIC APPROACHES IN THE PEDIATRIC INPATIENT WARD (JANUARY-DECEMBER 2019) Iswinarno Doso Saputro; Agus Santoso Budi; Dhitta Aliefia Noverta
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: Skin necrotic injuries from extravasation were associated with age, the type of fluid/drug administered, and the location of the peripheral venous line, but not with gender. Autolytic debridement remains a prevalent and commonly used initial treatment approach for these injuries. Abstract: Introduction: Extravasation injury, a common complication of intravenous therapy in children, Interestingly, the complications arising from extravasation injuries could be more severe than the underlying medical conditions, sometimes even requiring amputation. The study aimed to identify the factors influencing the occurrence of skin necrosis due to extravasation injuries and to categorize the treatment approaches employed at Dr. Soetomo General Academic Hospital's pediatric facility in Surabaya from January to September 2019. Methods: This research takes a descriptive-analytic approach with a cross-sectional method. It involves examining data obtained from medical records. Specifically, the study focuses on the medical records of 44 pediatric patients who received treatment at Dr. Soetomo Hospital in Surabaya for skin necrosis resulting from extravasation injuries from January to December 2019. The analysis includes a retrospective review of patient information, looking at their characteristics, risk factors, the modalities used for wound care therapy, and the outcomes of their cases. Results: There were 44 cases of skin necrotic injury due to extravasation injury, with the largest percentage of neonates group (34%), male gender (66%), hypertonic fluids/drugs (73%), most regions of dorsum and wrist dextra (17%) and the most used therapeutic modality was autolytic debridement (45%). Conclusions: We found that the incidence of skin necrosis due to extravasation injury is influenced by factors such as the patient's age, the type of fluid or drug administered, and the location of the peripheral venous line. However, gender was not found to be a significant factor in the incidence of these injuries. Interestingly, the initial treatment approach that is still commonly employed is autolytic debridement.

EFFICACY OF AMNIOTIC MEMBRANE MESENCHYMAL STEM CELL THERAPY FOR BURN WOUNDS: META-ANALYSIS STUDY Bayu Fasi Bermani; Agus Santoso Budi; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 5 No. 1 (2020): Jurnal Rekonstruksi dan Estetik, June 2020
Publisher : Universitas Airlangga

Highlights: The healing potential of stem cell therapy for burn wounds, primarily attributed to angiogenesis and anti-inflammatory effects. AM-MSC therapy has a beneficial impact on burn wound healing, particularly by promoting angiogenesis and reducing inflammation. Abstract: Introduction: Burn injury is a trauma with high morbidity and mortality that requires special management from the start. stem cells have generated great hopes for the treatment of numerous conditions including burns. The Metaanalysis was performed for these preclinical studies to assess the efficacy and possible mechanisms of Amniotic Membrane Mesenchymal Stem Cell (AM- MSC) in treating burn wounds. Methods: Seven studies identified by searching PubMed, MEDLINE, databases from inception to October 2020. In addition, a manual search of references of studies was performed to obtain potential studies. Stata 16 was used for all data analysis. Results: The overall meta-analysis showed that AM-MSC therapy significantly improved burn healing rate (SMD 3.34, 95% CI 1.82 to 4.86), irrespective of transplant type, burn area, and treatment method in the control group. Conclusions: Meta-analysis showed that AM-MSC therapy exerts appears to exert a positive effect in burn wound healing, mainly through angiogenesis and anti- inflammatory actions. There is, therefore, justification for continued efforts to evaluate variations in future clinical studies using stem cells to treat a burn wound in order to maximize the effectiveness. the use of stem cells as an adjunct to first- line therapies in burns.

UMBILICAL RECONSTRUCTION WITH DOUBLE OPPOSING SEMILUNAR FLAP, AN APPEALING RESULTS: A CASE SERIES Arif Rahmat Muharram; Agus Santoso Budi; Lobredia Zarasade
Jurnal Rekonstruksi dan Estetik Vol. 3 No. 1 (2018): Jurnal Rekonstruksi dan Estetik, June 2018
Publisher : Universitas Airlangga

Highlights: A double opposing semilunar flap has good result for umbilicus reconstruction. A double opposing semilunar ensures a natural appearance and avoids visible scarring while maintaining appropriate depth and size. Abstract: Introduction: Umbilical loss is not a common problem encountered in plastic surgery routine cases. The absence of umbilicus will cause significant effect in total aesthetic appearance of the abdomen, thus making it an essential part of anatomy landmark. Congenital defect, oncologic and abdominoplasty complication are the most often causes, and tremendous psychological trauma will cause patient to seek help. Case Illustration: There are many proposed technique for such reconstruction, based on original scar or wound and final expected shape, of course with their advantages and disadvantages. We used a double opposing semilunar flap for our cases. Along with its technical detail, we will present three cases comprises of the defect after omphalocele scar removal, umbilical endometriosis excision and postcentral abdominal tumor excision. Reports will be presented with preoperative and postoperative result. Discussion: This technique avoids the appearance of scarring and secondary stenosis by hiding the circular scar incision and maintaining its position in the middle of the new form. Conclusion: The reconstruction technique of the umbilicus presented for the anatomical units, provides a very natural look, and generates slight excess of skin on the upper part over time and giving a more graceful appearance.

A CASE SERIES : HYMENOPLASTY BASED ON THE TYPE OF THE TEAR OR CLEFT PREOPERATION FINDING FOR GOOD SATISFACTION POSTOPERATIVE RESULT Rianto Noviady Ramli; Agus Santoso Budi
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Surgical hymenoplasty technique based on the type of the tear or cleft finding preoperative for satisfaction postoperative approach yields satisfactory results. Surgical hymenoplasty technique, tailored to the specific type of hymenal tear or cleft identified preoperatively. Abstract: Introduction: To describe our surgical hymenoplasty technique based on the type of the tear or cleft finding preoperative for satisfaction postoperative. Case Illustration: Hymenoplasty was performed on 4 patient on January 2017 until March 2017, we found three patients with U-type. We performed hymenoplasty which is to create a new surface raw, on the right and left cleft to be stiched, we use a rapid absorbable suture material, with horizontal mattress technique. Discussion: No complications developed in the patients who had undergone hymenoplasty and all patients stated that the sexual intercourse they experienced was similar to the night of the initial experience. Conclusion: Our new apporach for hymenoplasty is a technique that has good results, and this is a good approach in doing hymenoplasty. A comprehensive preoperatif consultation is essential to ensure patient and surgeon satisfaction postoperatively. Preoperative evaluation of the hymenal tissue is the basis on which a surgical technique is selected. The surgical technique is determining factor for a succesful hymenorrhaphy.

CORRELATION OF HYPERNATREMIA TO SUCCESS RATE OF SKIN GRAFT IN BURN PATIENTS DR. SOETOMO GENERAL ACADEMIC HOSPITAL BURN CENTER FROM 2014-2018 Ephora Christina Wulandari; Agus Santoso Budi
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Patients with hypernatremia had a relative risk of experiencing graft failure, especially if the graft involved more than 10% of the affected area. The importance of managing electrolyte imbalances to enhance the success of skin graft procedures. Abstract: Introduction: From collective data from 2014 – 2018 from Burn Center in Dr. Soetomo General Academic Hospital, the rate of failed skin graft was 26%. This high number became a concerned because skin graft was the main procedure to close large burn wound. This event is affected by many problems, one of them is electrolyte imbalance. Hypernatremia was seen in major burn patients that causes the disruption of wound healing process of skin graft. Methods: A cross sectional study of patients with burns admitted to the Burn Centre of Dr. Soetomo Hospital between January 2014 and December 2018 were evaluated. Results : 143 subjects were involved in this study. 44 subjects are female (31%) and 99 subjects are male (69%). 66% of the burn injuries are caused by fire (93 subjects), 14% caused by electricity (20 subjects), 8% caused by scald (12 subjects), 6% caused by boiled oil (8 subjects), 4% caused by chemical agent (6 subjects) and 2% caused by blast injury (1 subject). 77% of all subjects (110 subjects) underwent split thickness skin graft less than 10% while 23% (33 subjects) underwent the procedure 10% or more than it. Hypernatremia is found in 16% of all subjects (23 subjects), 19% with hyponatremia (28 subjects) and majority of it, 65%, with normonatremia (92 subjects). From the study, it was found that the risk of failed skin graft was higher on hypernatremia subjects than normonatremia subjects, the relative risk was 6,06 to fail. This number was higher if the skin graft procedure took more than 10%. But, it was found the risk was higher on hyponatremia subjects than the rest of subjects, with the relative risk was 7.75 to fail. Conclusions: Hypernatremia caused high risk of failed skin graft on major burn patients.

SURGICAL TECHNIQUE FOR COMPLEX SYNDACTYLY IN APERT SYNDROME: A SERIAL CASE Williams Mesang; Agus Santoso Budi; Magda Rosalina Hutagalung
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 2 (2019): Jurnal Rekonstruksi dan Estetik, December 2019
Publisher : Universitas Airlangga

Highlights: Complex syndactyly in Apert syndrome, particularly when complicated with synonychia and synostosis, poses a significant surgical challenge. Successful surgical techniques for Apert syndrome syndactyly are crucial to achieving these goals. Abstract: Introduction: Complex syndactyly in Apert syndrome, especially complicated with synonychia and synostosis, is a surgical challenge. The incidence of Apert Syndrome is reported to be approximately 1 per 100,000 to 160,000 live births and its incidence in Indonesia is not yet known. It is practically symmetrical causing significant dysfunction and infection if not treated properly. The goals in the treatment are the separation of independent digits without disturbing function and growth, the creation of a lined commissure, the provision of skin cover for the denuded nail edge and exposed bone, and to creation of aesthetically pleasing individual fingertips with proper nails, nail folds, and adequate pulp fullness. This is due to the unreliability of the vascular branching pattern to the digits. Case Illustration: In this serial case, we reported 5 cases of Apert syndrome. We described the clinical findings, incision design, immediate and post-surgery follow-ups. Discussion: In this case, we combined dorsal rectangular flap and palmar triangular flap to make a new web space, Buck Gramcko pulp flap for the nail fold reconstruction, and full thickness skin graft w was taken from the groin to cover the raw areas. Absorbable 5.0 simple interrupted sutures were used in each patient. The results were uneventful, with satisfying function and aesthetic appearance. Conclusion: Choosing the best surgical technique for releasing the web space in syndactyly depends on the patient’s condition and the plastic surgeon’s decision was needed. In 5 patients, up there was no meaningful complication attained from the postoperative result.

PALATE FRACTURE PROFILE IN PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY OF DR. SOETOMO GENERAL ACADEMIC HOSPITAL: JANUARY 2012- DECEMBER 2017 Priscilla Valentine N.; Agus Santoso Budi; Lobredia Zarasade
Jurnal Rekonstruksi dan Estetik Vol. 4 No. 1 (2019): Jurnal Rekonstruksi dan Estetik, June 2019
Publisher : Universitas Airlangga

Highlights: The demographic data of patients with palate fractures is young adult men aged 19-30 years, the most common of palatal fracture type is parasagittal type, and causes of trauma being traffic accidents. The use of transmolar wiring and plating, occlusion was achieved well. Abstract: Introduction: Palatal fractures are often associated with maxillofacial fractures and Le Fort fractures. The diagnosis and management of palatal fractures in the midface area is a challenge for a plastic surgeon in restoring function and aesthetics. With the results of this study, it is expected to be a database of maxillofacial fractures treated at SMF Reconstructive Plastic Surgery and Aesthetic Dr. Soetomo General Academic Hospital, Surabaya and gave the ability to make a fast and precise diagnosis for time and technical maxillofacial fractures. Methods: This study uses medical record data for all patients diagnosed with palatal fractures in Dr. Soetomo General Academic Hospital, Surabaya during January 2012 to December 2017. The variables studied were demographic data including sex, age, mechanism of occurrence of accidents, types of fractures, management, complications that occur and length of treatment. Discussion: There were 82 patients with palatal fractures, with traffic accidents being the most common cause of palate fracture (n=61) followed by workplace accidents and households in second place (12 and 9%). Most sufferers were men (68%), women (14%) with the highest age range of men aged 19-30 years who were followed by ages 31-45. The most were parasagittal fractures (56%), then Sagittal (15%), paraalveolar (9%), alveolar (1%), comminutive (1%). no fractures with anterior and posterolateral alveolar types, posterolateral type or transverse type fractures. Hospitalization period with plating (12 days), transmolar wiring (10.6 days), and conservative (13.8 days). Conclusions: In this study assessed the experience in the reconstruction and aesthetic plastic surgery department of Dr. Soetomo General Academic Hospital regarding palatal fractures and accompanying demographic data. The type of fracture that occurs is also related to the management performed. Incomplete medical records caused problems in this study.

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