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All Journal The ASEAN Journal of Military and Preventive Medicine
Anastasia Dessy Harsono
SMF Bedah Plastik, RSPAD Gatot Soebroto, Indonesia

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Case Report: Effective Use of the Orticochea Flap in the Surgical Treatment of Non-Hodgkin Lymphoma Anastasia Dessy Harsono; Metaudina Chandra Pratiwi; Dominic Melino Tjokrovonco
The ASEAN Journal of Military and Preventive Medicine Vol. 1 No. 2 (2024): July
Publisher : Perkumpulan Kedokteran Militer

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/ajmpm.v1i2.9

Abstract

Non-Hodgkin lymphoma is a malignant disease arising from lymphoid tissues, primarily affecting the lymph nodes. The clinical manifestations and histological appearances of non-Hodgkin lymphoma are diverse, typically presenting with swelling, pain, and ulcers in the head and neck region. This case report discusses the management of a 55-year-old immunocompetent female patient presenting with a large, painless mass extending from the neck to the occipital region of the scalp, mimicking the features of a sarcoma. Closing scalp defects poses a significant challenge for plastic surgeons due to the limited tissue and variable elasticity of the scalp. Orticochea flap, also known as the "banana peel" flap was performed on the patient after the removal of the tumor mass. The orticochea flap technique allows for greater surface area coverage while maintaining vascularity, resulting in quicker procedures and good aesthetic outcomes.
Modified Keystone Flap: A Versatile Reconstruction for Mastectomy Defects – Our Clinical Experience Anastasia Dessy Harsono; Dominic Melino Tjokrovonco
The ASEAN Journal of Military and Preventive Medicine Vol. 1 No. 2 (2024): July
Publisher : Perkumpulan Kedokteran Militer

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/ajmpm.v1i2.10

Abstract

Introduction: The closure of extensive defects in reconstructive surgery is a common challenge. The keystone flap technique has gained popularity due to its adaptability and reliance on fascia, providing a reliable blood supply and offering a better match for skin color compared to skin grafts. However, keystone flap necrosis can occur due to tension and inadequate tissue perfusion. To address this, a modified keystone flap technique called the "doubled-handle saucepan" was developed, resulting in improved flap vitality and reduced tissue necrosis, particularly in mastectomy defects. Materials and method: We assessed 16 female patients who underwent “doubled-handle saucepan” keystone flaps after modified radical mastectomy (MRM). The average dimensions of wounds in this study were 23.1 ± 3.8 cm × 16.9 ± 2.9 cm, with the largest defect measuring 28.0 cm × 21.5 cm. The average size of the modified keystone flap was 36.3 ± 3.8 cm × 21.2 ± 2.2 cm. Results and Discussion: Modified keystone flap demonstrated effective performance in managing extensive defects without any complication. The average operation time in our study was 124.3 ± 11.2 minutes. Conclusion: The "double-handled saucepan" keystone flap technique is a unique and dependable method derived from the original keystone flap which effectively covers defects and maintains flap vitality without tension by ensuring vascularization at the skin bridge. This modified keystone flap technique proves highly effective for reconstruction after modified radical mastectomy (MRM), offering time efficiency and no need for a secondary donor site makes it an appealing alternative to free flaps or other local flap techniques in many cases.
Co-Authors Dominic Melino Tjokrovonco Metaudina Chandra Pratiwi