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All Journal Medical Journal of Indonesia Jurnal Plastik Rekonstruksi

Sudjatmiko, Gentur

Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta

Author-ID : 669531

Civil Engineering, Building, Construction & Architecture Medicine & Pharmacology Other

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Chlorhexidine-alcohol versus povidone-iodine as preoperative skin preparation to prevent surgical site infection: a meta-analysis Anggrahita, Tasya; Wardhana, Aditya; Sudjatmiko, Gentur
Medical Journal of Indonesia Vol 26, No 1 (2017): March
Publisher : Faculty of Medicine Universitas Indonesia

Background: Surgical site infection remains substantial problems to surgeons and patients as it increases the morbidity, mortality, length of stay, hospital cost, rate of re-admission, and rate of re-surgery. This study aims to compare the use of chlorhexidine-alcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection.Methods: The literature search was conducted through the PubMed database on November 2015. Included studies were RCTs with the year of publication up to 2015 which compared the use of chlorhexidine-alcohol versus povidone-iodine in its effectiveness reducing surgical site infection in adult patients. The quality of the study was assessed using Jadad Score. A meta-analysis was conducted in the included study to obtain a pooled estimate of the effect size. The evidence of heterogeneity and publication bias was also assessed.Results: Six RCTs with a total of 2,080 patients were included in the meta-analysis. It showed that the use of chlorhexidine-alcohol was associated significantly with fewer SSIs (pooled risk ratio=0.60 (95% CI=0.45-0.79)) and fewer positive skin culture results (pooled risk ratio, RR=0.38 (95% CI=0.28-0.51)) compared with povidone iodine.Conclusion: Preoperative skin antisepsis with chlorhexidine is more effective than povidone-iodine in preventing surgical site infection.

The Role of STSG and Delayed Midline Approximation In Abdominal Wall Reconstruction Irwansyah, Denny; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Acquired abdominal wall defects can result from previous surgery, trauma, infection and tumor resection. Complex abdominal wall defects challenge both general and plastic reconstructive surgeons. Skin grafting of abdominal viscera was originally described by Horton in 1953, demonstrated in dogs that STSG placed on the parietal peritoneum of abdominal viscera and buried in the peritoneal cavity would take well and survive. In 1994, Baker and Millard Jr reported serial cases of abdominal midline wound dehiscence which was treated with two stage abdominal wall reconstruction.Data was taken from medical and surgical records of patients consulted to the plastic surgery division with and acquired abdominal defect. We are reporting, Male, 42 yo, previous history of Perforated appendicitis with general peritonitis. We performed 2 stage reconstruction of abdominal wall for this patient.Treatment for an abdominal defect is selected on the basis of several factors, including the medical status of the patient, wound bed preparedness, depth, size and location of the defect. The goals of abdominal reconstruction are restoration of function and integrity of the musculo-fascial abdominal wall, prevention of visceral eventeration and provision of dynamic muscle support.Skin grafting and delayed midline approximation are one of the reconstructive option available and deserve to be considered in the high risk, septic patient without compromising the patient final reconstructive result.

Problems In Cleft Lip Nose Patients Undergoing Augmentation Rhinoplasty With Rib Graft : A Case Report Kusumastuti, Nadia; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Correction of a cleft lip nasal deformity remains a challenging procedure in reconstructive surgery. Many different procedures have been suggested to address the problem, but few techniques have worked well and consistently. We present a case of secondary cleft nasal deformity after repair of unilateral complete cleft lip and palate on the left side. The corrective procedures carried out included closed method rhinoplasty and dorsal nasal augmentation with rib graft which was fixed to the nasal septum with needle. The patient showed satisfactory immediate post-operative result, with correction of depressed alar base and satisfying dorsal and tip projection. However, 5 months post operative result showed deviation of nasal tip to the cleft side, which we suspected was due to: warping of the rib graft, soft tissue deficiency in the cleft side which exerts pulling forces to the warping graft, and lack of rigid fixation of the graft. After appraising pitfalls encountered in augmenting nasal dorsum of cleft patients with rib graft, we concluded that some preventive measures need to be done to avoid those problems, namely: balanced cross sectional carving of rib graft, cantilever graft with plate and screw to the nasal bone, and addressing pulling force from lack of soft tissue in the cleft side by adding columellar strut graft or alar contour graft.

Recurrent Cranial Bone and Scalp Defect : A Case Report Hakim, Intan Friscilla; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Partial defect of the cranial bone and scalp remains a dificult problem for surgeons. Longterm morbidity is due to dif!culty in finding the right material for closure and the resulting repeated surgery. This paper discusses the effectiveness of honey application as a simple and effective method for scalp defect treatment. One case of a patient with partial and cranium defect was referred to Cipto Mangunkusumo hospital with several prior attempt to close the defect with an acrylic implant. The cultured swab on patient revealed MRSA. Application of honey to the raw surface on the cranial defect shows resulting spontaneous epithelialization without clinical evidence of local infection. The use of honey as a topical treatment for cranial and scalp defect provide a safe and effective alternative method for closing the wound secondarily.

Self Made Nostril Retainer Raymond, Benni; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

The main feature of the unilateral cleft lip nasal deformity is the asymmetry of the nose compared with the non cleft side. Nasal stents or nostril retainers are suggested to be useful in the management of these patients in order to maintain the new morphology and to mold the shape during healing process. To date, there are many types of factory made nostril retainer, but the price is relatively expensive and in contrary, most of our patient came from low-income population. The idea is to provide an easy and practical nostril retainer to obtain, easy to manufacture and easy to apply preoperatively and postoperatively, and it is also cost effective. Primary nose model including the nasal cavity is designed on the basis of non cleft side of patient’s nose. It is made by injecting alginate as negative impression. We use gypsum powder as positive impression material. From that positive impression, we mirror it to create other side of the nostril. Nostril retainer is then made using home-use silicone gel. We postulate that by using self-made nostril retainer which is made using cheap material. All of our patients could afford one, because the use of nostril retainer has been found effective post operatively after cleft primary rhinoplasty, avoiding relapse of the nasal reconstruction and drop of the nasal ala.

Antibacterial Activity of Indonesian Local Honey Against Strains of P. Aeruginosa, S. Aureus and MRSA K. P., Ayu Diah; Sundoro, Ali; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Honey has been used in wound care since ancient times. Many publications attest antibacterial activity of manuka honey against Pseudomonas aeruginosa, S. aureus, and Methicillin-resistant S. aureus (MRSA). However, antibacterial effect of local honey from Indonesia has never been studied and compared to medical grade honey before. This study aim to compare antibacterial activity of local honey and manuka honey against P. aeruginosa, S. aureus and MRSA.Methods: The honeys were tested for their antimicrobial activities with broth dilution method. Different concentrations of honey were prepared in reaction tubes. Strains of P.aeruginosa, S. aureus, and MRSA were grown in nutrient broth. These strains of bacteria then added to the different concentrations of honey. Minimum Inhibitory Concentrations (MIC) is the lowest concentration of the honey that yielded no growth of bacteria.Results: MIC of local honey for P. aeruginosa is 50%, for S. aureus is 100% and for MRSA is 100%. MIC of manuka honey for P. aeruginosa is 12,5%, for S. aureus is 25%, and for MRSA is 12,5%.Conclusion: Nusantara Manuka have the similar antibacterial activity spectrum against P. aeruginosa, MRSA and S. aureus, but it must be given in greater concentration to exert the same level of antibacterial activity with Manuka honey.

Topical Honey Application In Treating Large Ulcerated Wound As a Complication of Vascular Malformation In a 5-Month-Old Baby Djoenaedi, Intania; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The ancient Egyptians and Greeks have used honey for wound care, and a broad spectrum of wounds are treated all over the world with natural unprocessed honeys from different sources. In lots of studies, honey as a conventional wound treatment may help improve wound healing, prevent invasive infections and eliminate colonization. With the increasing frequency of antibiotic-resistant bacteria, modern medicine give attention to natural products. The aim of this report is to gain insight into the practical use of topical honey in wound management. Methods: We report a case of five-month-old girl with sepsis and large ulcerated necrotizing wound at the external genitalia and perineum extending to gluteal area as complication of vein malformation after treated with intravenous injection of Bleomycin and Vincristine. Result: She was successfully treated with unprocessed local honey. Conclusion: Honey is shown to be a good option for treating infected chronic wound with dramatic result.

The Difficulties of Reconstruction in The Achilles Area Septrina, Rani; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Scar management on the achilles region is also challenging due to its anatomical position, bony prominences, relatively limited skin, less subcutaneous fat, and less vascularization. Primary suture cannot be performed on the wide defect, whilst serial excisions are inapplicable to be done on a thick and tough scar. Wound healing in the lower limbs also typically get impaired due the gravitational effect on the venous system and the unlimited joint movement.Patient and Methods: A 21-year-old woman presented with a hard and thick hypertrophic scar on the achilles area due to deep dermal burns caused by hot metal two years ago. The patient had pruritic chronic ulcer on her scar. Scar excision was performed. In order to reduce the tension, a V-Y advancement flap was used to close the defect primarily. Foreslab was applied to reduce mobilization, and then continued by pressure garment application. On her next visit to the clinic, wound dehiscent was found. 10 days after the first excision, debridement was performed, wound re-sutured and dressed using topical honey covered by gauze.Result: Follow up results after 8 weeks showed a fully epithelialized wound. Compression bandage and limited mobility by foreslab application prevented the vertical growth of scar effectively. Patient no longer complaints about itchiness nor movement limitation.Summary: Planning surgical procedures for achilles reconstruction must take consider the followings: (1) choice of skin graft or flap, (2) choice of donor sites, (3) type of excision (4) hemostasis (5) fixation of skin grafts and splinting, and (6) dressings. Adjuvant preventive measures must also be implemented postsurgery to prevent regrowth of hypertrophic scar.

The Non-denuded Mucoperiosteal Palatoplasty Technique in Precipitating Healing Process of Palatal Lateral Defect Irwansyah, Denny; Bangun, Kristaninta; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Conventional two-flap palatoplasty technique which is a very common technique used including in our center, will result in lateral defects without any periosteal coverage. In this conventional technique, epithelialization of lateral defect was achieved within 3-4 weeks. These denuded lateral defects are prone to contamination and infection. The wound healing process in these wound will involve wound contraction, trigger scar formation, and will result in maxillary growth impairment. In our center, the retrospective study showed that conventional two-flap palatoplasty technique resulted in a fair maxillary growth (mean Goslon score=3.5). Thus, we explore other technique, which is non-denuded mucoperiosteal palatoplasty technique. We intend not to elevate all layers of mucoperiosteal flap in order to gain lateral defect covered by a thin sub-mucosa and periosteal layer. We assume that this technique will precipitate the re-epithelialization process. Faster re-epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. Method: Total 48 patients with unilateral or bilateral cleft palate were divided into 2 groups. Twenty-four patients underwent the non-denuded mucoperiosteal technique (intervention group) and another 24 patients underwent the conventional two-flap palatoplasty technique (control group). Evaluation of lateral defect closure was done in both groups and compared statistically. Result: Faster epithelialization was significantly influenced by age, WBC count and non-denuded mucoperiosteal technique.Summary: The non-denuded mucoperiosteal technique, along with age and WBC count, significantly accelerate the process of epithelialization of lateral defect post palate repair.

Application of Honey and Transparent Dressing to Split Thickness Skin Graft Donor Site and Its Effect on Epithelialization Rate A., Teuku; P., Nandita Melati; Sudjatmiko, Gentur; S., Asrofi; D., Ishandono
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Split thickness skin graft (STSG) is one of the modalities used to close a defect. The donor site can be healed secondarily with tulle grass and moist gauze after 14 days and with transparent dressing will take about 10-13 days. Recently the wound healing by using honey application has been used. Whether or not using honey application with transparent dressing will hasten the epithelialization rate of the STSG donor site is now in question. Method: This research is an open, non-randomized clinical trial with a parallel design and intervention using honey application with transparent dressing. A total of 19 patients (7 female and 8 male) were included in this study. The reapplication of honey was done every two days. The patients was followed up every day, with clinical photograph taken and complaints such as pain, odor and infection noted. Results: The mean epithelialization rate of the donor site treated with honey and transparent dressing was 9,74 (+0,24) days compared to 10,79 (+1,23) days in the transparent-dressing-only group (p=0,00). Conclusion: The application of honey with transparent dressing to cover for STSG donor site led to a faster epithelialization rate, less odor and less pain. Commercial honey was used, and readily available.

Co-Authors A., Nur A., Teuku Anggrahita, Tasya Anindhawati, Nur Atmadja, Tessa Miranda Bangun, Kristaninta Buchari, Frank D., Ishandono Djaprie, Shelly M Djoenaedi, Intania eko heryadi, eko Hakim, Intan Frischilla Hakim, Intan Friscilla Harsono, Anastasia Dessy Ibadurahman, Ibadurahman Irwansyah, Denny K. P., Ayu Diah K., Nadia Kreshanti, Prasetyanugraheni Kusumastuti, Nadia Laureen Supit Lestari, Puri Ambar Mahandaru, Danu Marita, Adinda Mukarramah, Dewi A. Mukarramah, Dewi Aisyah P., Nandita Melati Pribadi, Sweety Rani Septrina Raymond, Benni Raymond, Benny S., Asrofi Sandhi, Afriyanti Sari, Tessa Puspita Simamora, Huntal Sundoro, Ali Tania, Vika Tedjo, A. Tiza, Melina Utama, Defry Yundari, Yundari

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