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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

Civil Engineering, Building, Construction & Architecture Other

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Articles

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Sole Reconstruction Using Anterolateral Thigh Free Flap: A Review of 4 Cases Atmodiwirjo, Parintosa; Sandhi, Afriyanti
Jurnal Plastik Rekonstruksi Vol. 2 No. 3 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The ideal technique for sole reconstruction should meet such requisite as a durable and comfortable weight-bearing surface, solid anchoring to deep tissue for resistance to shear force and adequate protective sensation. The anterolateral thigh (ALT) perforator free flap provides a large, pliable skin island and sufficient bulk, allowing three-dimensional tailoring to complex defects. The present article is about our experience of sole reconstruction ALT perforator free flap. Patient and Method: Total of 4 flaps in the foot defects was performed in February 2009 to December 2012. We reconstructed soft tissue defects in the sole using ALT free flaps, the complications, aesthetic and function results were monitored. Result: ALT perforator free flap provided stable and durable long-term wound cover in all patients, resulting in early rehabilitation and function outcomes were completely achieved. Complications were few and manageable in all cases. Summary: ALT perforator free flap has become common procedure in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experiences, we found that the use of ALT perforator free flap in sole defect reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

Long Term Follow Up of Hemangioma on Bilateral Cleft Lip Atmodiwirjo, Parintosa; Lestari, Puri Ambar; Kesuma, Ayu Diah
Jurnal Plastik Rekonstruksi Vol. 2 No. 3 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Hemangioma is a common tumor of infancy that exhibits rapid postnatal growth and slow regression during childhood. Cleft lip is a common anomaly found in Indonesia. These entities are twice in common in the Asian population. However, simultaneous occurance of these two abnormalities is rare to be found. Patient and Method: A case of bilateral cleft lip complicated with hemangioma on the left side of lip and the surrounding skin through the mucosa, and the prolabium, which had been performed cheiloplasty procedure at age 9 months old. Cheiloplasty design was made through the hemangioma area with a careful hemostasis to avoid massive bleeding. Result: Hemangioma was partially left behind at the cheiloplasty procedure. There was no bleeding during and after the surgery. Two years following the surgery, there was a fine scar with good shape of the lip and no further growth of the hemangioma. Summary: Hemangioma and cleft lip are very rare to be found in the same location. Because of the involution potential of hemangioma, timing of surgery is very important. Considering the psychosocial aspect, the surgery was performed at the age of 9 months. Two years after surgery, we didn’t find any growth of hemangioma or deformity of the bone and lip. The scar growth is in good esthetic result, no difference with left lip child without hemangioma.

Innervated Bilobed Radial Forearm Free Flap For Tongue Reconstruction Atmodiwirjo, Parintosa; Bangun, Kristaninta; Handayani, Siti; Djamaloeddin, Chaula; Nindita, Eliza
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Hemiglossectomy defects need reconstructions to restore normal functions and aesthetic outcomes. It is therefore prudent that well-planned reconstructive technique is needed for a good functional substitution for the defect.This case report describes a 30 years old male who developed T2N1M0 squamous cell carcinoma of the left tongue. The patient underwent a tongue reconstruction following his hemiglossectomy involving floor of the mouth without mandibular resection.The optimum method of reconstructing a major defect such as hemiglossectomy with floor of the mouth resection is best carried out by using microvascular free tissue transfer. We conclude that the radial forearm free flap is good method for reconstructing major defects of the tongue. The radial forearm free flap is thin, can be raised without patient position change, has constant vascular anatomy, and provides an advantage in the aesthetic aspect at the donor site.

Microsurgery Technique in the Foot Reconstruction of Soft Tissue Defects: A Review of 4 Cases Atmodiwirjo, Parintosa; Sandhi, Afriyanti
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

The restoration of an intact covering is the primary surgical requisite following soft tissue defects in the foot because deep healing can be no better than the surface covering. Soft tissue defects that expose underlying bones, joints, and tendons pose challenging problems and require a free tissue transfer for a successful reconstruction.Total of 4 flaps in the foot was performed between February 2009 to February 2010. We reconstructed soft tissue defects in the foot in 4 patients using 3 free anterolateral thigh (ALT) flaps and 1 free radial forearm (RF) flap. Trauma was the commonest cause in our patients.Free ALT and RF flaps provided stable and durable long-term wound cover in all patients. Complications were few and manageable.Free tissue transfer has become commonplace in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experience, we found that the using of free ALT and RF flaps in foot defects reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

The Advantages of Vascularized Fibular Bone Graft For Mandibular Tumor Reconstruction Atmodiwirjo, Parintosa; Putri, Nandita Melati
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Mandibular reconstruction are often indicated in patient who underwent ablation or excision of the mandible due to malignancy of the oral cavity.In this paper we will discuss about the mandibular reconstruction with use of alloplastic implant, and vascularized bone graft. Four cases of oral cavity tumor which were referred to the plastic surgery division at Cipto Mangunkusumo hospital during 2005-2011, after being diagnosed with oral cavity tumor were re-viewed. Mandibular reconstruction can be done using alloplastic implant, non-vascularized bone graft or vascularized bone graft. In this paper we studied four patients who needed mandibular reconstruction after ablation of oral cavity tumors. Patients who underwent reconstruction with alloplastic implants all had complications such as broken hardware. Where as in patient who underwent free fibular tissue transfer there were no complications at all. We can conclude that in less vascularized surrounding tissue as in cases that received or will receive other treatment such as chemotherapy or radiation that vascularized bone graft are superior. The bone healing in vascularized bone graft also does not depend on creeping substitution like in non vascularized bone graft.

Squamous Cell Carcinoma Arising From Marjolin’s Ulcer Due To Post Burn Scar: A Case Report Atmowirdjo, Parintosa; Laidding, Sachraswaty
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Marjolin’s ulcers are a rare squamour cell carcinomas which develops in non-healing scar tissue. The most frequent predisposing lesion is in a post burn wound, especially after flame burns. Incidence appears to be on the rise and outcome of treatment remains poor. A 51-years old male with burn scar at the posterior left calf since 43 years ago. After burnt, the wound was left to heal spontaneously with minimal treatment. Three years later an unhealing wound emerged on the scar. This wound got bigger, spreaded further, turned into a mass 15 x 8 x 5 cm in size. The tumor was mobile, ulcerative with unprovoked bleeding, malodorous, and painful. Biopsy and imaging concluded a diagnosis of Squamous Cell Carcinoma from Marjolin’s Ulcer, Stage III (T4N0M0). Wide excision was performed 1-2 cm from hiperemis area, neighboring muscles sacri"ced. Frozen section revealed a free-tumor margin and wound covered by split thicknes skin graft. On folllow up, STSG’s “take” was 100%. Four months postoperation, a wound the size of 1 x 1 x 0,5 cm appeared at the distal left posterior calf. Biopsy was performed, result showed granulating tissues with no sign of malignancy. The wound was treated in the outpatient, and healed well. Marjolin Ulcer’s prognosis is not very favorable so it best to prevent at the best first place.

Microsurgery Recontruction in Plastic Surgery Division FKUI-RSCM, From 2009 - 2010 Atmodiwirjo, Parintosa; Adhistana, Prasasta
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Microvascular surgery is the ability to repair very small blood vessels. Once the technique is mastered it becomes possible to revascularize and replant incomplete or complete digital amputations, and to design free tissue transfer procedures for the reconstruction of a large variety of damaged parts. This study included 17 cases of microsurgery in the last 1 years admitted to Division of Plastic and Reconstructive Surgery RSCM between February 2009 to February 2010. All patient were subjected to through clinical examination and appropriate laboratory and radiological investigations. Trauma is the most common etiology of soft tissue defect (10 cases, 58,8%), followed by tumor and infection (5 and 2 cases respectively). Defect is located 35,3% on the head/neck, 23,6% on the knee/lower leg, 23,6% on ankle/foot, and 17,6% on upper extremity. In this study we performed 9 anterolateral thigh (ALT), 6 radial forearm, 1 chimera flap, and 1 fibula flap. Flaps were vital in 13 cases, compromised in 4 cases, with 2 of them salvaged and survived. Vitality rate of ALT flap was 88,9% (7 vital, 1 non vital, 1 salvaged), 83,8% in RFFF (4 vital, 1 non vital, 1 salvaged) and 100% in fibular flap. The use of microvascular techniques has revolutionized reconstruction method and expanded the range of options for reconstructing a large anatomic defects in patients. If compare with advance center, the success of micro-surgery in our division is still under them. Expected to be approached with increasing operator experience and number of cases was undertaken.

Early Dangling Protocol Post Lower Extremity Free Flap Surgery: An Evidence-based Case Report Atmodiwirjo, Parintosa; Aditya, Timothy; Tafdhil Tardha, Muhammad; Nazwan Sani, Fadli
Jurnal Plastik Rekonstruksi Vol. 10 No. 2 (2023): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v10i2.346

Background: Free flap is tissue transplantation by including its feeding artery from one body part to another. Intravascular thrombosis is the main obstacle commonly faced in the anastomosed part. Yet, postoperative extremity mobilization has widely become the main question related to flap failure. Only a few studies explained the best time to perform lower extremity mobilization post free flap surgery to maintain adequate flap viability. This study aimed to find the effectiveness of the dangling protocol in reducing lower extremity free flap surgery complications. Methods: A literature search was conducted through PubMed, Cochrane, and Embase in March 2022 using “Free tissue flap” or “free flap” AND “dangling protocol” or “early ambulation” AND “postoperative complication” keywords. Title and abstract screening, full-text reading, and eligibility assessment were performed to find related evidence regarding our clinical question. Results: The two relevant articles are a systematic review and a clinical trial study. Both studies showed 94-100% flap viability after applying early dangling protocol as early as three days post lower leg free flap surgery with level evidence of IIB up to IV without any incidence of flap necrosis. Conclusion: Early dangling protocol can be implemented safely after free flap surgery of the lower extremity without postoperative complications such as total or partial necrosis.

Free Flap Evaluation Following Reconstruction of Locally Advanced Squamous Cell Carcinoma of The Tongue Atmodiwirjo, Parintosa; Kartini, Diani; Arina, Maryam Nur; Sapphira, Elrica; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 10 No. 2 (2023): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v10i2.361

Background: Neoadjuvant chemotherapy (NAC) is a crucial component in the management of tongue-based locally advanced squamous cell carcinoma (LASCC) due to its ability to decrease tumor mass and facilitate free tissue transplantation. The utilization of adjuvant radiation and chemotherapy has been observed to decelerate the progression of post-operative tumor growth. Probability of free flap failure is elevated. Post-operative complications and the long-term functional outcomes of speaking, salivation, and swallowing determine the quality of free flaps. Methods: A retrospective review of tongue LASCC patients who underwent NAC followed by glossectomy and free tissue transfer from 2015 to 2018. Tongue functional outcomes of speaking, swallowing, and salivation were assessed using FACE-Q scale in 3 times follow-up period. Result: This study included 7 patients who underwent tongue reconstruction. Treatment modalities were based on tumor presentation, with 4 patients (57.1%) receiving Taxane, 5-Fluorouracil, and Paclitaxel/Doclitaxel (TPF), and 3 patients (42.1%) receiving Paclitaxel and 5-Fluorouracil (PF). Tongue reconstruction utilized the radial forearm free flap in 5 patients (71.4%) and the anterolateral thigh free flap in 2 patients (28.6%). Intraoperatively, NAC had no impact on the integrity of small and reliable donor vessels. Three patients died from tumor metastases after the second follow-up assessment, while one patient was lost to follow-up. The study found no significant association between chemotherapy dosage and free flap vitality (P = 0.629). FACE-Q assessments revealed moderate to low scores in speaking, eating, and drinking outcomes. Conclusion: Tongue reconstruction after NAC in LASCC patients remains a challenging procedure for surgeons. While the consideration of surgical difficulties due to damage of the donor vessels demands a more structured pre-operative plan. No correlation between the exposure of NAC or AR to free flap complication as well as functional outcome.

Microsurgery : From Basic Skill of Plastic Surgery to The Top of Reconstruction Ladder Atmodiwirjo, Parintosa
Jurnal Plastik Rekonstruksi Vol. 2 No. 3 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

For more than 5 decades, microvascular surgery has been growing and found its place in reconstructive surgery. In Indonesia, microsurgery became popular since 30 years ago. In the past, this subspecialty was developed for soft tissue transfer and replantation of amputated extremities.

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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