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All Journal Medical Journal of Indonesia Jurnal Plastik Rekonstruksi
Mohamad Rachadian Ramadan
Reconstructive Microsurgery Section, Division Of Plastic Surgery, Faculty Of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital. Jakarta, Indonesia
Civil Engineering, Building, Construction & Architecture Medicine & Pharmacology Other

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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

Abstract

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

Abstract

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.
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.
How to Harvest Deep Inferior Epigastric Perforator Free Flap Ramadan, Mohamad Rachadian; Keusuma, Khanza Isdiharana; Ali, Gary; Maharani, Anisa Ayu; Sarena, Ayu Putri Balqis
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.v12i2.47

Abstract

Summary : The Deep Inferior Epigastric Perforator (DIEP) free flap is a microsurgical breast reconstruction technique that uses skin and subcutaneous fat from the lower abdomen while preserving the rectus abdominis muscle. This approach provides a natural breast mound with minimal donor-site morbidity compared to TRAM flaps, reducing risks of muscle weakness and abdominal wall hernia. Advantages include improved postoperative recovery, better abdominal contour, and long-lasting aesthetic results, as the reconstructed breast maintains its volume over time. However, it is technically demanding, requires longer operative time, and carries risks of flap loss or vascular complications if microsurgery fails. The procedure involves dissecting perforator vessels from the deep inferior epigastric system, transferring the tissue to the chest, and connecting vessels under a microscope. Expected outcomes include a soft, natural breast shape with improved patient satisfaction, though surgical expertise and careful patient selection are essential to minimize complications and ensure optimal results.
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.
Free Flap Evaluation Following Reconstruction of Locally Advanced Squamous Cell Carcinoma of The Tongue Atmodiwirjo, Parintosa; Kartini, Dian; Arina, Maryam Nur; Sapphira, Elrica; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 10 No. 2 (2023): (2023) 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.v10i2.361

Abstract

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.
Flaps or flat: a case report of double free flap survival after a prolonged cardiac arrest Atmodiwirjo, Parintosa; Ramadan, Mohamad Rachadian; Djohan, Michael; Amanda, Nadira Fildza
Medical Journal of Indonesia Vol. 33 No. 2 (2024): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.cr.247422

Abstract

This case addressed patient and free flap survival after cardiac arrest with the contentious use of vasopressors amid concerns about potential vasoconstrictive effects on flap vitality. A 59-year-old male with mucoepidermoid carcinoma underwent post-total maxillectomy and double free flap reconstruction (free fibular flap and anterolateral thigh free flap). Intraoperatively, he experienced cardiac arrest after anastomosis due to hypovolemia or hypoxia, requiring external cardiac massage and vasopressor administration. Despite the initial restoration of circulation, subsequent cardiac arrest ensued, necessitating further resuscitation. Postoperatively, vasopressors were also administered due to hemodynamic instability. Contrary to concerns, both flaps demonstrated sustained vitality, challenging prevailing apprehensions about vasopressor-induced vasoconstriction compromising flap viability. This observation suggests that vasopressors may not significantly threaten flap viability, prompting reconsideration of hesitations and encouraging further investigation. The study advocates for a judicious evaluation of vasopressor administration in free flap procedures, enriching clinical considerations for optimal patient care.
Co-Authors Aditya Wardhana Ali, Gary Amanda, Nadira Fildza Andinata, Bob Arina, Maryam Nur Atmodiwirjo, Parintosa Diani Kartini Djohan, Michael Erina, Maryam Nur Hidayat, Andika Prasdipta Jonathan, Elisa Jonathan, Reinhart Kartini, Dian Keusuma, Khanza Isdiharana Maharani, Anisa Ayu Mochtar, Rezania Puspasari, Antonia Valentine Ralena, Nadhira Anindita Sapphira, Elrica Sarena, Ayu Putri Balqis Siburian, Elida Sari Sudarman, Jesica Putri Sudjatmiko, Gentur Sugiarto, Adhrie Tikyayala, Amila Triatmoko, Sara Ester Wicaksana, Aditya Yefta Moenadjat