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All Journal JHN: Journal of Health and Nursing Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Melky Rendy Papea
Universitas Sam Ratulangi
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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COMPREHENSIVE RECONSTRUCTION OF FACIAL DEFECTS: A CASE STUDY UTILIZING COMBINED SKIN FLAP TECHNIQUES AND COMPOSITE GRAFT CHONDROCUTANEOUS Nico Lumintang; Sherly Tandililing; Sunarto Reksoprawiro; Melky Rendy Papea
JHN: Journal of Health and Nursing Vol. 3 No. 1 (2025): JHN: Journal of Health and Nursing, May 2025
Publisher : ASIAN PUBLISHER

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58738/jhn.v3i1.685

Abstract

Post-operative defects of skin tumor removal in the facial area, especially the nasal area, are very common. Reconstruction of defects in the nasal, presents a great challenge for surgeons where the presence of asymmetric conditions, changes in skin color and texture will be easily visible and cause changes in facial shape. In addition, to maintain and restore the function of the defective part that will be reconstructed, it requires high precision and expertise to obtain good results aesthetically and functionally. In this article, we present 3 cases of the combined use of auricular chondrocutaneous composite graft and paramedian forehead flap in defect reconstruction full thickness nasal ala after tumor excision. Two cases were unilateral reconstruction and 1 other case was bilateral reconstruction. Previously, the patient had been educated about the choice of surgical technique, risks and benefits of the surgical technique to be used and the patient had agreed to it. The reconstruction results in all three cases showed excellent results both aesthetically and functionally. The shape and contour of the thin auricular cartilage are very suitable for forming the nasal ala without the need for surgical molding as in other cartilage graft donors. The thin skin attached to the cartilage not only forms a lining which is perfect but also forms a wide nostril space. The weakness of the auricular chondrocutaneous composite graft in terms of vascularization supply can be overcome with paramedian forehead flap, which is also a large skin donor with contours and skin color that are most similar to the skin of the nasal. This procedure provides excellent results in terms of aesthetics and functionality, as well as minimal complications and donor mobility, so it can be the procedure of choice for reconstruction of large defects in the nasal after tumor removal.
Dekortikasi VATS vs Open pada Empiema Stadium II–III: Peran Fibrinolitik Intrapleural (Literature Review) Melky Rendy Papea; Christha Tamburian; Rigel Kent Paat; Wega Sukanto; Adrian N. Tangkilisan
Jurnal Ilmu Kedokteran dan Kesehatan Indonesia Vol. 6 No. 3 (2026): Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Publisher : Lembaga Pengembangan Kinerja Dosen

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/jikki.v6i3.12593

Abstract

Empyema remains a significant clinical challenge globally, particularly in stages II–III where fibrinous loculations and thick pleural rind complicate lung expansion. This literature review aims to compare clinical outcomes between VATS and open decortication in stage II–III empyema and evaluate the role of intrapleural fibrinolytic therapy (IPFT) in influencing surgical decision-making and outcomes. A systematic literature search was conducted on PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between 2022–2026, yielding 15 articles that met inclusion criteria. Data were synthesized narratively due to heterogeneity across study designs. Findings indicate that VATS offers advantages in perioperative outcomes including reduced morbidity, shorter hospital stay, and faster recovery compared to open decortication in stage II empyema, while open decortication remains a crucial salvage option for complex stage III cases. IPFT, particularly tPA-DNase regimen, serves as an effective adjuvant therapy to improve drainage and reduce loculation complexity, yet bleeding risk remains a significant concern. The evidence supports a multimodal approach integrating IPFT, VATS, and open decortication based on individual patient characteristics and disease stage. However, high-quality evidence from large-scale randomized controlled trials is still needed to establish definitive recommendations. This review provides practical guidance for clinicians in selecting optimal treatment strategies for stage II–III empyema.
Co-Authors Adrian N. Tangkilisan Christha Tamburian Nico Lumintang Rigel Kent Paat Sherly Tandililing Sunarto Reksoprawiro Wega Sukanto