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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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Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction Atmodiwirjo, Parintosa; Anggrahita, Tasya
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

Early And Recent Development Of Reconstructive Microsurgery Subspeciality In Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia (1983-2020) Ramadan, Mohamad Rachadian; Ralena, Nadhira Anindita; Triatmoko, Sara Ester; Atmodiwirjo, Parintosa
Jurnal Plastik Rekonstruksi Vol. 6 No. 2 (2019): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Plastic surgery in Indonesia was pioneered and developed by Moenadjat Wiratmadja, MD., in 1958. This specialty experienced many developments and improvements over time with more specific subspecialties to facilitate the advancement of the science of plastic surgery, including the reconstructive microsurgery subspecialty. The reconstructive microsurgery service in the plastic surgery division dr. Ciptomangunkusumo National Hospital (RSCM), Jakarta, Indonesia was first initiated by Sidik Setiamiharja, MD., self-taught from the textbooks. In late 1985, following the success of conducting the first basic microsurgery course in Jakarta, the plastic surgery team in RSCM which consisted of Sidik Setiamihardja, MD, Chaula L. Sukasah, MD and Gentur Sudjatmiko, M.D. pioneered many of the first microsurgery cases, including the first major limb replantation, first penile replantation and the first free flap. Overtime, the reconstructive microsurgery subspecialty has been growing significantly. In 2019, the number of free flap cases at RSCM reached the highest number in Indonesia with 90 free flap cases with 94% success rate.

How To Harvest the Anterolateral Thigh Free Flap Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Ralena, Nadhira Anindita
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v7i1.294

Summary: The anterolateral thigh (ALT) flap is the flap with various components based on perforators from the descending branch of the lateral circumflex femoral artery. This flap has a number of advantages and disadvantages. It can be used to reconstruct defects after oncologic resection and coverage following amputation or to preserve limb length. The contraindications include unsuitable donor sites, inadequately debrided recipient sites, and morbid obesity. Preparations for ALT procedure consist of history taking, physical examinations, and supporting examinations.

How to Harvest The Free Fibula Flap Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Ralena, Nadhira Anindita
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v7i1.295

Summary: Free fibular flap (FFF) is a composite flap consisting of fibular bone and skin paddle. Muscle may be added to the flap. It has several advantages and disadvantages. The fibular free flap is well suited for any reconstruction of the head and neck. It is suitable for defects of the anterior mandibular arch or lateral defects in patients who wish to undergo osseointegrated dental reconstruction. Meanwhile, its contraindications are related to significant atherosclerotic diseases the patient has or congenital variants of the arteries. Preparations for FFF procedure consist of history taking, physical examinations and supporting examinations, like other free flaps procedure in general. Several intraoperative preparations should also be done.

How to Harvest The Radial Forearm Free Flap Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Ralena, Nadhira Anindita
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v7i1.296

Summary: Radial forearm flap is fasciocutaneous flap from the volar aspect of the forearm that based on the perforator of radial artery. Radial forearm free flap (RFFF) has several advantages and disadvantages. It has unique characteristic of thin and pliable tissue. It may be indicated when a defect requires a thin flap with little bulk of soft tissue or multiple skin islands are needed to be provided. Physical signs and symptoms of poor peripheral digit perfusion or healing contraindicate the harvest of the radial artery pedicle. Preparations for RFFF procedure include history taking, physical examinations and supporting examinations. Several steps of intraoperative preparations should also be conducted.

Multi-stages Aesthetic Refinement Following Anterolateral Thigh Free Flap for Head and Neck Reconstruction Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Arina, Maryam Nur
Jurnal Plastik Rekonstruksi Vol. 7 No. 1 (2020): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Introduction: Multi-stages refinement of a bulky flap after composite defects reconstruction of multiple facial units has been a challenging situation. Goals including restoration of periorbital and malar area and redefining the aesthetic aspects of the units as well as the surrounding nasolabial area with multiple refinements and microfat graft. Methods: A 50-year-old male patient with a history of solitary fibrous tumor underwent wide excision of left periorbital, infraorbital, lateral nasal sidewall, and malar area. The defect is enclosed with Anterolateral Thigh Free Flap (ALT). Bulkiness of the flap, sunken left nasolabial, and asymmetric alar nasal unit were found during outpatient follow-up. These problems lead to the necessity of refinement procedure to reduce the bulkiness to improve the aesthetic outcome of the patient. Microfat graft was the method chosen to volumized the sunken nasolabial and asymmetric alar nasal unit. Results: Patient is satisfied with the result due to improvement of alar nasal units symmetricity and reduced bulkiness of the flap area. No complication was observed. Conclusion: Meticulous planning and staging of the surgical refinement procedures in conjunction with microfat graft results in good aesthetic outcome and satisfies the patient and reduces the possibility of complications.

Microsurgical Reconstruction During Covid-19 Pandemic Setting: A Systematic Review and Clinical Applications Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Ralena, Nadhira Anindita; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 8 No. 1 (2021): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v8i1.321

Introduction: The outbreak of the novel coronavirus disease 2019 (COVID-19) has taken almost all countries worldwide. This situation has compromised the safety and health of all medical workers, including microsurgeons. Given that there have been various articles published about the recommendations in microsurgical reconstruction during the COVID-19 pandemic, We felt compelled to compile all relevant studies about the microsurgical reconstruction in the COVID-19 pandemic setting, describe the various actions from different perspectives, as well as providing suggestions based on evidence-based medicine. Method: We did a systematic literature search using electronic databases such as PubMed, Embase, Medline, Wiley, and Cochrane using keywords reconstruction, Microsurgery, coronavirus, and COVID-19. All included studies were critically appraised and reviewed. Results: Nine relevant articles were included for the final review, four of them were qualitative studies, and 5 were guidelines. Studies look at various surgeon's experiences from different healthcare systems during the COVID-19 pandemic. The focuses of the included studies are also diverse from head and neck surgery, breast surgery, limb surgery, and general Reconstructive Microsurgery. Conclusion: Microsurgical reconstruction is not suggested to perform during the peak of the COVID-19 pandemic. It is indicated only if necessary after a rigorous review by the multi-disciplinary team. A full PPE, including a Powered Air Purifying Respirators (PAPR) system, fit-tested N95 respirator masks, face shield, and tight-fitting eye protection goggles, are recommended in performing the surgeries.

Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review Atmodiwirjo, Parintosa; Ralena, Nadhira Anindita; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 8 No. 1 (2021): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v8i1.322

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ? 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

Aesthetic Evaluation After Three-Dimensional Shaping of Free Flap for Nasal Reconstruction without Additional Paramedian Forehead Flap Atmodiwirjo, Parintosa; Jonathan, Reinhart; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Erina, Maryam Nur; Ralena, Nadhira Anindita
Jurnal Plastik Rekonstruksi Vol. 9 No. 2 (2022): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v9i2.344

Nasal reconstruction has continued to advance in accordance with Menick's vision as it was first conceived. His combination of radial forearm free flaps with the gold standard of paramedian forehead flaps is highly regarded for producing superior outcomes, and it has received widespread praise as a consequence. In this study, we present nine patients who had nose reconstruction using free flaps. All of the patients had successful outcomes. Using the FACE-Q questionnaire, we assessed the degree to which patients were satisfied with both the functional and aesthetic aspects of their appearance. The outcomes were positive for nine of the patients.

Central Facial Soft-Tissue Defect Following Surgical Resection: An Algorithm for Reconstruction Ramadan, Mohamad Rachadian; Atmodiwirjo, Parintosa; Tikyayala, Amila
Jurnal Plastik Rekonstruksi Vol. 9 No. 2 (2022): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v9i2.347

Background: Central facial soft tissue defect poses a unique challenge for the reconstructive surgeon. The three-dimensional properties of the aesthetic facial subunit and its related function are the goals for reconstruction. Considering the prominent social role of the face, the procedure to achieve a good quality of life for patients may cost more than a single surgery. This single-center study presents an algorithm of treatment for central facial soft tissue defect and it’s proposed classification according to the authors’ experiences. Methods: A retrospective review of medical records and photos of patients who underwent central facial soft tissue defect reconstruction in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia, from 2009 to 2019. Patients who underwent free flap reconstruction were followed up, and the primary outcomes were assessed using the FACE-Q head and neck cancer (FACE-Q H&N) scale. A classification system for central facial soft tissue defect with seven subtypes (1–7) based on the facial subunit and its treatment was proposed. Results: Twenty-five patients were included. The malignant tumor was the main etiology (88%), with basal cell carcinoma being the primary cancer pathology (64%). The average defect size was 120 cm2 (32-416 cm2) and most defects fell into subtype 6 of the classification (32%). Anterolateral thigh free flap (ALT) was the main flap of choice (64%), followed by radial forearm free flap (36%), with 92% of flaps succeeding rate from this series. All of the patients underwent at least one ancillary procedure following the reconstruction, while the average was 2 (1-6) procedures. FACE-Q H&N outcomes, especially on the appearance and appearance distress scale, showed a low to moderate score with a 72% response rate. Conclusions: Central facial soft-tissue defect continues to challenge reconstructive surgeons. While the advances in free tissue transfer might improve the general outcomes, the numerous and costly secondary procedures do not usually end up in the best appearance. This study displayed the need for modern reconstruction modalities that provide high satisfaction in aesthetic and functional outcomes with fewer secondary procedures. Vascularized Composite Allotransplantation (VCAT) might be the future choice.

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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