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All Journal Jurnal Plastik Rekonstruksi

Atmodiwirjo, Parintosa

Reconstructive Microsurgery Section, Division Of Plastic Surgery, Faculty Of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital. Jakarta, Indonesia

Author-ID : 1015957

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Free Vascularized Dermofat Flap For Contouring Maxilla In Fibrous Dysplasia Patients Atmodiwirjo, Parintosa; Martina, Nungki Ratna
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Fibrous dysplasia is a disease that causes bone thinning and growth of lesions in one or more bones and leads to bone weakness and scar formation within the bones. Especially when involving the skull or facial bones, the lesions can cause externally visible deformities. We reported one case of fibrous dysplasia of the maxilla reconstructed in our Plastic Surgery Division of Cipto Mangunkusumo Hospital. Data was taken from the medical and surgery records. In this case, we used the Antero Lateral Thigh (ALT) flap to reconstruct the maxilla and facial contour in 26 years old girl with fibrous dysplasia. After the operation we had daily observation to evaluate the blood flow to the flap and it had satisfactory result without any complication. Ultimately, free vascularized dermofat flap with ALT seems to be suitable for craniofacial contouring surgery, in this case for contouring maxilla. Facial contour could further be improved after secondary reshaping of the healed flaps. This led to nearly perfect long-term facial symmetry in all cases. The ALT proved to be a reliable donor site, providing enough well-vascularized fatty tissue for facial contour augmentation.

Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation Atmodiwirjo, Parintosa; Handayani, Siti; Djaprie, Shelly Madona
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

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

Evaluation of Free Tissue Transfer in The Reconstruction of Soft Tissue Defect in The Leg Atmodiwirdjo, Parintosa; Hendra, Fakhrul
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: There are many possible reconstructive options for reconstruction of defects in the lower limb. These include:skin grafts, local flaps, distant flaps and free flaps.Patients and Methods: We present four cases with soft tissue defects in the legs who were admitted to the Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital, Jakarta, between February 2009 and February 2010. Result: In all four cases, the free anterolateral thigh (ALT) flaps have been performed for reconstruction of soft tissue defect in the upper third of the leg (3 patients) and lower third of the leg (1 patient). The cause of soft tissue defect was trauma in 3 patients and malignancy in 1 patient. All of the donor sites have similar size with the defect tissue with 15 to 20 cm in length and 10 to 15 cmin width. End-to-end microvascular anastomosis was performed in 2 cases while end-to-side anastomosis was done in the other 2 cases. Arterial thrombosis and infection were complications found in early post-operative period. Arterial thrombosis caused failure in 1 case of free ALT flap which were reconstructed further with free radial forearm flap. Summary: Free ALT flap is relatively easy to harvest once the technique of perforator flap dissection has been learnt. It has a reliable blood supply despite some anatomic variability, it is pliable and can be thinned to a significant degree without compromising blood supply, and can provide a long pedicle with large-diameter vessels.

Pectoralis Major Musculocutaneous Flap and Splitthickness Skin Graft for The Reconstruction of Pharyngocutaneous Fistula After Total Laryngeal Resection Atmodiwirjo, Parintosa; Pribadi, Sweety
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Pharyngocutaneous fistula (PCF) is the most frequent complication in the early postoperative period after total laryngectomy. Most PCF respond well to conservative management, but when it fails and the fistula persists surgical closure in indicated. Patients and Methods: Sixty-five year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous fistula. We performed a pectoralis major musculocutaneous flap (PMMCF) to close the fistula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal fistula, the exteriorized muscle part of the "ap was then covered by skin graft.Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled flap to cover defect on the neck area. The skin island of the flap provided an adequate air-thight cover and successfully closed the laryngeal fistula.Summary: PCF is a problematic complication resulting from the resection of head and neck tumor. Early diagnosis and proper multidisciplinary management is required to prevent further morbidity. PMMCF is a simple, easy to perform and reliable option for closure of PCF.

Reconstruction of Distal Phalangeal Injuries with Homodigital Island Flap: a Case Report Atmodiwirjo, Parintosa; Laidding, Sachraswaty
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Reconstruction of distal phalangeal defects with exposure of bone, tendon, or joint can be a difficult reconstructive problem, particularly since immediate coverage is of paramount importance for preserving function. The objectives of distal phalangeal defect or fingertip reconstruction included preservation of functional length and sensibility, prevention of symptomatic neuromas, acceptable donor site morbidity, the absence of cold intolerance, mineralization of aesthetic deformity, and quick return to occupational activities.Patients and Method: A review of one case, 26 years old male with phalangeal defect at tip to radial site of 3th finger of right hand, with tendon and bone exposed. After adequate debridement, shape and size of the defect are measured, the flap designed at the ulnar site of the same finger and the vascular of the flap is marked to palmar arch. Lazy “S” incision performed, donor flap is elevated with pedicle and transferred to the recipient site. Donor site was covered up with skin graft. Result: After follow up the homo digital island flap was healed nicely and the skin graft take was 100%, length is less diminish, sensibility conformed with two-point description, joint flexibility is good.Summary: Homodigital island flap is a useful safe option for fingertip or distal phalangeal reconstruction because it offers multiple advantages in comparison with advancement, regional, and free flaps, with an almost negligible donor site defect and can be done in a 1-stage procedure.

Modalities to Treat Penile Glans Amputation: Case Series Sukasah, Chaula L.; Atmodiwirjo, Parintosa; Anindhawati, Nur
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: In Indonesia, a country with Muslim population as a majority, circumcision is the most common operation performed in males. However, since circumcisions are also commonly performed by inexperienced individuals and during communal circumcision event, we frequently come across complications. One of the most severe complications is amputation of the penile glans. There are several techniques that can be used to treat this complication. In this paper we present some which have been used in our division and the result. Patient and Methods: We report three cases of traumatic penile glans amputation as a complication of circumcision that has been admitted to Cipto Mangunkusumo Hospital during January 2011 – January 2012. In first case we performed full thickness skin graft, in the second one we performed groin flap, and scrotal flap to reconstruct the third case. We evaluate the result for several months. Results: The three techniques showed no complication, good result in function and also aesthetically acceptable for patient and the family. Choice of technique that has been used to repair the amputated penis depended on the patient condition, and surgeon’s choice.Summary: The three techniques each has advantages and disadvantages, but all of them are acceptable, functionally and aesthetically.

Chimeric Flap for Reconstruction of Severe Traumatic Injuries of the Hand (a Case Report) Atmodiwirjo, Parintosa; Harihadi, Eko
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Injuries of the hand, including loss of digits, are devastating events. Patients often require multiple operative procedures, with prolonged recovery periods. The challenge for the reconstructive surgeon is to minimize the number of operations, shorten the recovery period, and restore the function and aesthetic appearance of the hand. When faced with a difficult reconstruction, the expense, morbidity of the donor site, and operative time must be taken into consideration. The chimeric composite flaps is combination of microanastomoses consist of two flaps or tissue, each with an isolated pedicle and a single vascular source. Patients and Methods: We reported a case of 32-year-old man presenting with skin defect of hand, flexor and extensor tendon expose due to traffic accident after passed critical event and debridement we did chimeric flaps consist of free radial forearm flap and free dorsalis pedis flap based on radial pedicle system and dorsalis pedis pedicle system. Result: 2 weeks postoperative, flap were vital with satisfactory functional and aesthetic outcome and almost all of graft was take as well as all of donor site graft.Summary: In selected cases, the chimeric flap is a good option for the reconstruction of extensive, composite, and three-dimensional defects.

Long Term Follow-up of Vascularized Dermal Fat Transfer Atmodiwirjo, Parintosa; Boaz, Grace
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Backgrounds: Fibrous dysplasia is an uncommon, benign disorder characterized by a tumor-like proliferation of fibro-osseous tissue. It can present as an autosomal dominant disorder affecting the mandible and maxilla bones in children in their teenage years. The patient manifests with unilateral firm swelling of cheek. It can be managed by excision and resulting contour defect that can be managed by reconstructing using vascularized dermal fat. Resorption is the main problem due to an insuf!cient blood supply, and vascularized dermal fat have been described to minimize this problem.Patients and Methods: In this study we report the results after insertion of vascularized dermal fat into zygomatic-maxilla region. The method consists of implantation of vascularized dermis with attached subcutaneous fat from the antero-lateral thigh (ALT) into the right zygomatic-maxilla region, anastomosing the vascular with temporal superficial vessel. During a one-year follow up, the patient showed good results. Graft atrophy was observed. Despite the more extensive surgery and some minor complications the safety of this method with good functional and cosmetic results makes vascularized dermal fat an excellent alternative to reconstruct facial contour defect.Results: Compared with free-fat grafts, resorption rates for vascularized adipose tissue transfers are very low. Satisfactory cosmetic results were also achieved.Summary: The advantages of this method is the minimized resorption and an excellent functional and cosmetic result. Therefor, we imply that vascularized dermal fat is an excellent method to reconstruct facial contour defect.

Vein-Supercharged Peroneal Artery Perforator Propeller Flap for Achilles Soft Tissue Coverage Atmodiwirjo, Parintosa; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

Co-Authors Adhistana, Prasasta Aditya, Timothy Andinata, Bob Anggrahita, Tasya Anindhawati, Nur Arina, Maryam Nur Bangun, Kristaninta Boaz, Grace Diani Kartini Djamaloeddin, Chaula Djaprie, Shelly Madona Erina, Maryam Nur Harihadi, Eko Hendra, Fakhrul Hidayat, Andika Prasdipta Indri Aulia Jonathan, Elisa Jonathan, Reinhart Kesuma, Ayu Diah Laidding, Sachraswaty Laureen Supit Lestari, Puri Ambar Martina, Nungki Ratna Mochtar, Rezania Mohamad Rachadian Ramadan Mukarramah, Dewi Aisiyah Nazwan Sani, Fadli Nindita, Eliza Pribadi, Sweety Puspasari, Antonia Valentine Putri, Nandita Melati Ralena, Nadhira Anindita Sandhi, Afriyanti Sapphira, Elrica Siburian, Elida Sari Siti Handayani Sudarman, Jesica Putri Sukasah, Chaula Luthfia Tafdhil Tardha, Muhammad Tikyayala, Amila Triatmoko, Sara Ester Wicaksana, Aditya Yefta Moenadjat

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