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Triatmoko, Sara Ester
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Journal : Jurnal Plastik Rekonstruksi

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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.
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.
Co-Authors Andinata, Bob Arina, Maryam Nur Atmodiwirjo, Parintosa Diani Kartini Erina, Maryam Nur Hidayat, Andika Prasdipta Jonathan, Elisa Jonathan, Reinhart Kartini, Dian Mochtar, Rezania Mohamad Rachadian Ramadan Ralena, Nadhira Anindita Sapphira, Elrica Siburian, Elida Sari Sudarman, Jesica Putri