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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,

Civil Engineering, Building, Construction & Architecture Other

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.

Arjuna Subject : -

Articles 202 Documents

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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.

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 Rational of Colloid Requirements in Burn Patients : Literature Reviews Wardhana, Aditya; Septrisya, Shiera
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): March Issue
Publisher : Lingkar Studi Bedah Plastik Foundation

Backgrounds: For decades, fluid resuscitation in burn patients has been done as a routine process; most clinicians continue to adjust volume requirements using Parkland formula for the initial 24- hour period. In a variety of situations, there is increasing recognition of using significantly greater volumes than anticipated by the Parkland formula; clinicians tend to escalate volume requirements to drive the urine output to the higher end of any desired range. This excessive fluid could result in numerous edema-related complications, which currently coined as “fluid creep” phenomenon. Besides optimizing titration of fluid infusion rate, there have been studies of earlier and more liberal use of colloids, and even the use of hypertonic saline. The overall goal is to reduce the resuscitation volume requirements and subsequently, early edema formation.Conclusion: Current research in fluid resuscitation now concentrates on approaches to minimize fluid creep, including tighter control of fluid infusion rate. The single most important principle in using the Parkland formula, however, is that it should be used only as a guideline. The resuscitation rate and volume must be continually adjusted based on the response of the patient. Studies have been demonstrated to compare the use of crystalloids with early colloid in the first 24 hours post burn. At present, there are still wide variations in the timing of colloid resuscitation. However, use of 5% albumin in the second 24 hours seems to be an acceptable alternative.

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.

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