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Jurnal Plastik Rekonstruksi

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Published by Yayasan Lingkar Studi Bedah Plastik

ISSN : 20896492 EISSN : 20899734 DOI : -

Core Subject : Education, Engineering,

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Jurnal Plastik Rekonstruksi is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery. JPR publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types.

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Articles 17 Documents

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Search results for , issue "Vol. 1 No. 3 (2012): May Issue" : 17 Documents clear

Amniotic Band Sequence, Frequently Misdiagnosed in Cleft Patients Putri, Nandita Melati; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Amniotic band sequence (ABS) is a set of congenital malformations attributed to amniotic bands that entangle fetal parts during intrauterine life. thiopatogenesis of this sequence is still unknown. Because of such a wide spectrum of possible anomalies and many combinations of their simultaneous appearance, there are no two identical cases of ABS. This diagnosis is often missed based on the secondary major defects.Patients and Methods : There are cases of cleft patients treated in Plastic Surgery Division Cipto Mangunkusumo Hospital that has other congenital anomalies. The data is taken from the medical record and surgical photos (in our division from 2010-2011). Results : The patients presented had either facial cleft or cleft lip and palate. These patients had other congenital anomalies such as meningoencephalocele and constriction ring syndrome or other defects on the extremities.Summary : This diagnosis may not be often established because we often only see the secondary major defects such as meningoencephalocele or facial cleft. With this paper we hope that we could make this diagnosis known so we can make a multidisciplinary approach to this sequence.

Facial Hemangioma Treated with Serial Intralesional Corticosteroid Injection: One Year Follow-up Tjipta, Arya; Najatullah, Najatullah
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Hemangioma is the most common tumors of childhood, affecting 5 to 10 percent of infants. They have a predilection for the head and neck region. Although having a somewhat predictable natural history evidenced by periods of proliferation, plateau, and involution; the timing of these distinct stages, the presence of complications, and the response to therapy are best characterized as unpredictable. Corticosteroids have been a component of the medical treatment for hemangiomas for over a half century. Intralesional injections purportedly localize the steroid effect to the given lesion and minimize unwanted systemic actions.Patient and Method : We report six patients with facial hemangioma, who required intralesional corticosteroid injection therapy. The number of corticosteroid injections given varied from 2-5 times at an interval of three weeks. The dosage given was 3-5 mg/kg/injection.Results : In our six cases, we found a significant decrease in bulkiness. And in three of our cases, patients were able to open their eyes on their own.Summary :The intralesional corticosteroid therapy was proven to be effective in our case-series.

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 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.

A Thin Anterolateral Thigh Free Flap for Severe Hand Burn Deformity Atmodiwirjo, Parintosa; Mukarramah, Dewi Aisiyah
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Hand is one of the most commonly involved areas in burn injury, resulting in contracture.1 Reconstruction of severe postburn hand deformity is very challenging. Because there is no adjacent skin laxity to allow for local flaps in the burned hand, distant or free flaps should be considered. 2 Application of the thin anterolateral thigh flap in hand reconstruction has become one of the most preferred options for resurfacing of soft-tissue defects after contracture release. 3 Other than closing the defect after contracture release, restoration of hand function is also essential.Patient and Methods: In 2010, a man, 37 years old presented with severe contracture on the right hand due to an explosive flame burn 1,5 years ago. On the right hand, there was hyperextension at the metacarpophalangeal (MCP) joint with flexion on the wrist and thumb abduction with hyperextension at the interphalangeal joint. Our goal is to reconstruct this severe hand burn deformity using thin ALT free flap with flap thickness 4 mm to achieved good hand contour.Results: The thin ALT free flap was vital, and 1-year follow-up gives good hand contours. Patient under rehabilitation therapy from 2 weeks postoperative to attain good functional hand.Summary: A thin anterolateral thigh free flap gives good alternative for resurfacing defect in reconstruction of burn hand than other fasciocutaneous flaps. The advantage are it provides the same color and texture, thin and pliable flap to form good hand contour.

The Deep Inferior Epigastric Perforator (DIEP) Flaps in Breast Reconstruction After Mastectomy Parikesit, Dyandra; Ashton, Mark
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The continuing advances in breast reconstruction surgery allows for high expectation of excellent outcomes and long-term aesthetic appearance. Transverse rectus abdominis muscle (TRAM) flap has been the flap of choice in breast reconstructions for decades, however it sacrifices muscle and causes donor site complication. Deep inferior epigastric perforator (DIEP) flap is now the preferred flap for microsurgical breast reconstruction, because it holds some advantages over TRAM. This study aim to review, summarize, and discuss the current knowledge of DIEP flap in breast reconstruction.Method: Literature research conducted through Pubmed, Medline, and SCOPUS databases for published articles up to the year 2009. A total of 808 articles were found, and 60 articles reviewed.Result: Women with thick subcutaneous fat and skin on the lower abdomen are the most appropriate candidates for autologous breast reconstruction. Patients might be given oral analgesics instead of intravenous, because DIEP results in less postoperative pain than TRAM. Patients are commonly discharged on the 6–7th day post operation after DIEP flaps. In spite of several reports that DIEP flap has low complication rates, necrosis is the most common and often leads to poor cosmetic outcome.Conclusion: DIEP flap essentially combines all the advantages of TRAM flap without most of its disadvantages. Some complications may occur in smaller percentage. Although DIEP flap has a high patient satisfaction score, it does not mean that it is definitely superior to other methods of autologous breast reconstruction.

Maxillary Growth Evaluation After Cleft Palate Repair Using Goslon Criteria: Preliminary Study Simamora, Huntal; Lamtiur, Evie; A., Nur; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The goal of palatoplasty is to achieve normal maxillofacial growth, normal speech, and prevent hearing loss. Disturbance of maxillary growth may occur in cleft lip palate patients after palatoplasty. To determine how many patients later developed a disrupted maxillary growth following operations, a retrospective study was designed to evaluate patients with complete unilateral cleft lip and palate who have undergone two-flap palatoplasty.Methods:A retrospective analytic study evaluated the maxillary growth of 15 consecutive unilateral cleft lip and palate patient aged around 8-year-old treated in the Division of Plastic Surgery Cipto Mangunkusumo Hospital, Jakarta. Cephalogram and dental study models were used to assess growth. Cleft lip and palate repair were performed to all patients without alveolar bone graft or any orthodontic treatment. Result: The cephalogram shows that 53,3% of the patients developed maxillary hypoplasia post palatoplasty. Mean value of the Goslon Yardstick was 3,53 (intermediate category by Goslon criteria).No patient fell into the Goslon 1 or 5 categories. Discussion: Disturbed maxillary growth is postulated to be caused by the manipulation and suturing of the maxillary vomer, and scarring of the dentoalveoli post-surgery. Another contributing factor is the intrinsic tissue deficiency. Conclusion: Maxillary hypoplasia is a possible complication following two !ap palatopasty, affecting either anteroposterior, transversal and vertical maxillary growth. This finding needs to be proven especially after the process of growth ceased. It is highly probable that maxillary disruption is higher when the two flap palatoplasty technique leaves lateral areas of denuded bone on the maxillary tuberosity.

Multidisciplinary Approach in Treating Undiagnosed Severe Temporo Mandibular Joint Ankylosis : A Case Report Sandhi, Afriyanti; Pakpahan, Evie Lamtiur; Handayani, Siti; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Temporo Mandibular Joint (TMJ) ankylosis refers to bone or fibrous adhesion of the anatomic joint component and the ensuing loss of their function. The TMJ forms the very cornerstone of craniofacial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Difficulty in mouth opening and mastication, poor oral hygiene and rampant caries pose a severe physical and psychological burden in the tender minds of children. Patient and Method: Bony ankylosis on the right TMJ in a female patient was not diagnosed until the patient reached her early teens, at which the condition was treated by bony fusion release on the right condyle. We managed the patient for further orthognathic surgery (Le Fort I Ostoeotomy and Bilateral Sagittal Split Osteotomy) to correct the skeletal deformity. Result: In collaboration with the Orthodontist for pre-surgery and post-surgery orthodontic treatment, and Physiotherapist for mouth opening and masticatory muscles exercises, a good functional and aesthetic result was achieved. Summary: Multidisciplinary approach in treating severe TMJ ankylosis is mandatory to achieve the optimum results. Awareness among all plastic surgeon and dentist involved in the treatment of craniofacial pathologies in children must be build to allow early diagnosis and treatment.

The Correction of The Auricle in Neurofibroma with Aggressive Tumor Removal Principle and Two Stages Total Ear Reconstruction Bangun, Kristaninta; Chen, Zung Chung
Jurnal Plastik Rekonstruksi Vol. 1 No. 3 (2012): May Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Neurofibroma is a major facial hamartoma and is one of the most destructive and debilitating disease affecting the skin, muscle, mucosa, and the skeletal systems. Involvement of the ear usually increases the dimensions of the auricular skin and underlying tissues, distorts normal architecture along with auricular malpositioning, producing an ear that is abnormal in size, shape and position. The correction of the auricle in neurofibroma and benign tumors of the head and neck has been reported, but overall favorable results appear difficult to attain. We present a case of neurofibroma of the auricle in which radical resection was performed, and reconstruction was done in a two-stage surgery with satisfactory result. Patient and Methods: A 30 years-old female presented with type-1 neurofibroma to our office, especially concerned of a large tumor growth on the right auricle. With prior experience in treating microtia cases by Nagata’s method, we performed a two-stage operation on the patient. The first operation involved excising the whole auricular mass, and fabricating as well as grafting of a three-dimensional costal cartilage framework. In the second stage, the ear was elevated.Result: Nine months after the second surgery, the result was satisfactory with good auricular definition attained, and proper elevation of the ear at the correct anatomical site. No sign of neurofibroma recurrence was found on the surrounding reconstructed auricle.Summary: In our experience, the correction Neurofibroma of the ear by using the aggressive tumor removal principle combined with Nagata’s two-stage total ear reconstruction delivered a satisfactory result.

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.

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