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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
Civil Engineering, Building, Construction & Architecture Other

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A Five-Year Single-Surgeon Experience: Continuous Series of Microvascular Free Flap and Factors Influencing Its Viability Atmodiwirjo, Parintosa; Mochtar, Rezania; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester; Ralena, Nadhira Anindita
Jurnal Plastik Rekonstruksi Vol. 12 No. 1 (2025): (2025): Jurnal Plastik Rekonstruksi
Publisher : The Lingkar Studi Bedah Plastik Foundation and is affiliated with the Department of Plastic Surgery, Faculty of Medicine, Universitas Indonesia.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v12i1.362

Abstract

Background: Over the past years, microvascular free tissue transfer has become increasingly popular in the field of plastic surgery. Our center has also been actively performing these complex surgeries for extensive defect closure. In this study spanning five years, our objective is to examine the challenges commonly encountered in free flap reconstruction and identify factors that contribute to the failure of such flaps, with the ultimate goal of enhancing our learning curve.Methods: This article presents a retrospective analysis of all patients who underwent microvascular free tissue transfer procedures performed by a single surgeon (PA) and teams of Plastic Reconstructive and Aesthetic Surgery residents from 2014 to 2018. Multivariate analysis was conducted to identify the factors associated with free flap failure.Results: Between 2014 and 2018, a total of 203 microvascular free tissue transfers were performed to reconstruct defects at various anatomical sites. The overall viable flap rate for microvascular free flap reconstructions, irrespective of the indication or anatomical location, was found to be 90.6%. The type of flap, whether it was a perforator or non-perforator flap, emerged as the main significant factor influencing free flap viability.Conclusion: Microvascular free tissue transfer represents an excellent reconstructive option for addressing large defects requiring extensive or composite flaps. By acknowledging the factors contributing to free flap failure, we can optimize outcomes and provide the best possible results for our patients.
A Successful Limb-Sparing Approach in Synovial Sarcoma of The Foot: A Case Report Triatmoko, Sara Ester; Andinata, Bob; Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Siburian, Elida Sari; Hidayat, Andika Prasdipta; Jonathan, Elisa; Sudarman, Jesica Putri
Jurnal Plastik Rekonstruksi Vol. 12 No. 1 (2025): (2025): Jurnal Plastik Rekonstruksi
Publisher : The Lingkar Studi Bedah Plastik Foundation and is affiliated with the Department of Plastic Surgery, Faculty of Medicine, Universitas Indonesia.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v12i1.17

Abstract

Synovial sarcoma, although rare, is commonly diagnosed in patients under 20 years of age. This case presents the case of a 21-year-old female with synovial sarcoma affecting the 1st to 3rd metatarsal and tarsal bones. She underwent extensive tumor resection, followed by fibula free flap. The fibula was reconstructed into an L-shape to provide structural support. A bypass was performed because of compromised blood flow to the first digit, but the digit failed. Skin necrosis occurred after tumor dissection, necessitating a second reconstruction with an anterolateral thigh flap (ALT) after six weeks. At the years follow-up, the reconstruction was stable, and radiation therapy further improved the outcomes. The patient’s gait was satisfactory, with special shoes for weight bearing. This case demonstrates the potential of limb-sparing surgery with free fibula flaps for synovial sarcoma resection, which offers promising functional and psychological benefits.
Effectiveness of Debulking Liposuction in Secondary Inferior Extremity Fat–Predominant Lymphedema: Evaluation of the of Leg Dermal Backflow Improvement Using Indocyanine Green Lymphography Puspasari, Antonia Valentine; Atmodiwirjo, Parintosa; Moenadjat, Yefta; Ramadan, Mohamad Rachadian
Jurnal Plastik Rekonstruksi Vol. 12 No. 2 (2025): Jurnal Plastik Rekonstruksi
Publisher : The Lingkar Studi Bedah Plastik Foundation and is affiliated with the Department of Plastic Surgery, Faculty of Medicine, Universitas Indonesia.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v12i2.30

Abstract

Background:Secondary lymphedema with a predominant composition of fat is not effectively managed with physiological techniques. Instead, it necessitates debulking liposuction that reduces extremity circumference and improves lymph flow. This study aims to discover the effectiveness of improving lymphatic flow through indocyanine green lymphography examination.Methods: This retrospective cohort study involving secondary fat–predominant lower extremity lymphedema patients who underwent debulking liposuction in the Division of Reconstructive Plastic and Aesthetic Surgery, Department of Surgery, CMGH, in December 2022 - August 2024. The variables studied were the subject's lower extremity circumference and degree of leg dermal backflow before and after debulking liposuction.Results: Among 15 subjects, pre- and postoperative debulking liposuction measurements of inferior extremity circumference demonstrated significant reduction at 10 cm and 25 cm above the ankle, the patella, 10 cm and 25 cm above the knee. Postoperatively, 5 subjects with leg dermal backflow stage IV turned to stage II (1), III (4), while 10 subjects with the leg dermal backflow stage V turned to stage IV (9).Discussion: Reduction in the circumference of the inferior extremities after debulking liposuction at almost all measurement points except for the foot and ankle circumference. This related to the anatomy of lymphatic flow. Debulking liposuction showing a significant improvement in lymphatic flow, it clinically proven by the reduction dermal leg backflow degree after procedure.Conclusion: Debulking liposuction in secondary lower extremity lymphedema with a predominant composition of fat effectively reduces extremity circumference and improves lymphatic flow as evidenced by indocyanine green lymphographic examination.
Drain and Debulk: A Dual Approach to Advanced Lower Limb Lymphedema Using Simultaneous LVB and Lymph-Sparing Liposuction Wicaksana, Aditya; Ramadan, Mohamad Rachadian; Atmodiwirjo, Parintosa
Jurnal Plastik Rekonstruksi Vol. 12 No. 2 (2025): Jurnal Plastik Rekonstruksi
Publisher : The Lingkar Studi Bedah Plastik Foundation and is affiliated with the Department of Plastic Surgery, Faculty of Medicine, Universitas Indonesia.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v12i2.51

Abstract

Background: Advanced-stage lymphedema is characterized by lymphatic dysfunction and fibroadipose overgrowth. Single-modality treatments, such as lymphaticovenous bypass (LVB) or liposuction alone, are often inadequate. This case series evaluates the safety and outcomes of simultaneous LVB and lymph-sparing liposuction in advanced lower-limb disease.Method: We conducted a case series involving four patients (n=4) with secondary lower limb lymphedema (ISL stage II–III; LDB stage IV–V). All underwent simultaneous LVB and lymph-sparing liposuction. Limb volume was calculated using the truncated cone formula at baseline, 1 week, and 12 months postoperatively. Quality of life was measured using the LYMPH-Q questionnaire. One patient with bilateral lymphedema received LVB on both limbs but underwent liposuction on only one, allowing for direct internal comparison.Results: In all four patients patients demonstrated immediate postoperative limb volume reductions ranging from 12.13% to 37.68%, with further improvements at 12 months (up to 42.1%). Quality of life scores significantly increased, with improvements of up to 37.29%. In the bilateral case, the limb treated with both LVB and liposuction showed superior outcomes compared to the limb treated with LVB alone. No major complications occurred.Conclusions: Simultaneous LVB and lymph-sparing liposuction is a safe and effective treatment for advanced lymphedema. This dual-modality approach addresses both fluid accumulation and fibrotic hypertrophy, resulting in better functional and aesthetic outcomes than either technique alone. Larger studies with longer follow-up are needed to confirm these findings and optimize patient selection.
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