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All Journal Medical Journal of Indonesia Jurnal Plastik Rekonstruksi

Sudjatmiko, Gentur

Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta

Author-ID : 669531

Civil Engineering, Building, Construction & Architecture Medicine & Pharmacology Other

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Therapy For Unilateral Lower Extremity Lymphedema With Compression Bandage Only Or Compression Bandage Combined With Surgery Hakim, Intan Frischilla; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Lymphedema on lower extremity is a disorder which is still hard to manage nowadays. Many therapeutic modalities had been done, but there weren’t any satisfying outcome. It is all due to the continuous exudation of the lymph which is rich in protein to extravascular that induce tissue inflammation and soft tissue fibrosis process. In case of constriction band, the lymph trapped in the lower extremity, so it also requires surgical procedure.Patient and Method : We reported 2 cases, a woman 71 years old with right limb lymphedema with vulva polyp and a man 58 years old with constriction band on chronic left limb lymphedema and right limb poliomyelitis. We conducted circumference measurement of afected limb 5 minutes after application compression bandage in first two weeks. Case one had quiet good result with compression bandage only while in case two continued with surgical procedure consist of mass reduction using suction-assisted lipectomy, z-plasty constriction band release continue with excise skin redundancy. In both patients pressure garment used for daily treatment.Results : Both patients gave aceptable result on compression bandage in acute case and in chronic case was continued with surgery. Summary : Management for lymphedema can be done by conservative therapy in acute case when edema is in pitting formor combined with surgery when in chronic case, then pressure.

Accelerated Healing of The Wider Lateral Defects in Adult Cleft Palate Repairs Mukarramah, Dewi Aisyah; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Adult primary palatoplasty is more challenging tha n in infants because the gaps are wider. The risk ofintraoperative bleeding and palatal fistula are higher. Most adults with un-operated palatal cleft have good maxillary growth but poor speech. The aim of this study is to introduce our technique in repairing wide cleft palate in adult patients. Patients and Methods: We report four patients with cleft palate who underwent palatoplasty at adulthood. The age ranges from 17 to 20 years. Interspina distance were between 2 to 3.5 cm. All of them were nonsyndromic and had normal maxillary growth. The surgical technique used on these patients was two-flap palatoplasty with an additional 3 mm gingival bulk on the lateral side of the flap. Honey was given as oral drops postoperatively. Result: Lateral palatal defect healed well and epithelialized completely between 7 -14 days postoperative and only one small palatal fistula was found with this modified technique. All subjects had good maxillary growth, and speech outcome was poor to begin with.Summary: Two-flap palatoplasty can adequately provide palatal closure, especially with an additional lateral flap extension to include gingival components. This extension widens the flaps and aid palatal closure by not leaving lateral defects too wide.

The Effect Of Honey Give As Oral Drops In Precipitating Epithelialization Of Lateral Palatal Defects Post TwoFlap Palatoplasty Kreshanti, Prasetyanugraheni; Sudjatmiko, Gentur; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 5 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Two-flap palatoplasty, which is a very common technique used including in our institution, will result in lateral palatal defects without any periosteal coverage. Faster epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. In our institution, the retrospective study showed a fair maxillary growth (mean GOSLON score=3.5). Thus, we explore possibilities to precipitate the epithelialization process in pursuit of good maxillary growth in the future.Method :This is a prospective cohort study conducted in Cipto Mangunkusumo Hospital, on consecutive patients who underwent two-flap palatopasty from October 2010-February 2011. We followed up these patients weekly for 4 consecutive weeks to observe the rate of epithelialization of the lateral palatal defects.Result : Two-flap palatoplasty was performed in 48 patients, 23 among them were given honey as oral drops. Eighty-seven point five percent had unilateral complete cleft lip and palate and 12.5% had bilateral complete cleft lip and palate. Faster epithelialization of the lateral palatal defects post two-flap palatoplasty was significantly in!uenced by intraoral honey application on the wound as oral drops (RR 2.1, 95% CI 1.314 - 3.391, p < 0.001).Conclusion: Honey given as oral drops significantly precipitates the epithelialization process of the lateral palatal defects post two flap palatoplasty 2.1 times faster.

Keypoints in Wound Contractures Sudjatmiko, Gentur; Tania, Vika
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Wound contracture is a challenging problem to deal with. By understanding the phases of wound healing, attempts can be performed to prevent abnormal wound healing that can lead to scar contracture. This article will attempt to provide a simple summary of wound contracture and how to prevent it.Although most wounds can be expected to heal uneventfully, infection, dehiscence, and delayed healing continue to be problems, associated with signi!cant morbidity, mortality, and economic cost. Wound contracture is one of morbidities that caused by delayed healing and incorrect management of wound.

Standardization of Honey Application on Acute Partial Thickness Wound Raymond, Benni; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Backgrounds: : Inthe past few years, clinicians worldwide have been using honey for wound treatment. But until now, there was no such standard on method of honey application on wound. In our center, honey was applied on wound by once a day application and the result was observationally satisfactory. What if application of honey were done once every two days? Would the result become more satisfactory? This study aims to search honey application method, which gives the best result on wound treatment. Methods: This is single-blinded non-randomize clinical trial, which was conduscted in Cipto Mangunkusumo Hospital Jakarta from July until September 2012. 14 Patients with acute partial thickness wound resulted from STSG harvesting were involved in this study. Patients were devided into 2 groups: control (once every two days application of honey) and the rate of wound healing were evaluated. Rate of wound healing will be assessed as number of percentage of reduced non-epithelialized areas on the seventh day of application. Results: The mean percentage of non-epithelialized area reduction on treatment gruop was 86,76% and 97,97% on control group. There was significant difference on percentage of reduced area between control and treatment group (p<0,00). Conclusion: There was statistically signi!cant difference between once a day and once every two days application of honey. However, changing of honey dressing once a day is still a preferable method in wound treatment.

Is The ‘Rule of Tens’ a Necessary Screening Criteria in Cleft Lip Surgeries Ibadurahman, Ibadurahman; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 6 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The “rule of tens” (ROT) is still widely applied nowadays in many cleft centers worldwide for cleft lip surgery, although many surgeons do not implement it as a standard ru Recent advances in the field of anesthesiology have enhanced the safety of surgery for neonates. In Indonesia, ROT is still applied but is still flexible, due to some pertaining social confiicts. The relevance of ROT to the rate of mortality and morbidity is still unknown. This study aims to assess the need of using ROT in cleft lip surgeries.Methods: A retrospective study was conducted. Data was obtained from the medical records of patients who had undergone cleft lip repair between January 2004 to December 2005 in one day care setting. All data related to ROT parameters was categorized in two groups, either fit or unfit according to ROT criterias. The relationship of ROT to rate of associated morbidity and mortality was evaluated.Results: There were 204 cases of cleft lip repair with age range of 6-week to 12-year old. More than half (52.9%) was unfit for ROT. There were twelve cases of wound dehiscence and one total breakdown of the sutures, and no mortality. There were no statistically significant correlation ce between ROT and the rate of dehiscence. Conclusion: ROT is not a definitive criterion that could predict the success of cleft lip repair surgery.

The Incidence of Palatal Fistula Postpalatoplasty in Children with Dental Caries: A Multi Centre Study Utama, Defry; Buchari, Frank; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Cleft lip and/or palate (CL&/P) is the most common congenital craniofacial abnormality, affecting approximately 1 in every 700 newborns. Patients with cleft lip and/or palate (CL&/P) generally display poor oral hygiene and a higher prevalence of caries. This may be due to the difficulty in achieving adequate plaque control associated with dental anomalies and defects from the lips and/or palate. Palatal fistula is a significant complication following cleft palate repair. It is the aim of this research to find correlation between palatal fistula and dental caries. Patient and Method: Patients with unilateral complete cleft palates admitted to the Cipto Mangunkusumo hospital, Adam Malik hospital within the period July 2012 till March 2013 were included in this study. All cases underwent modified two flap palatoplasty leaving lateral periosteum technique and follow-up were done in two weeks to see if there are any palatal fistula. Result: Thirty eight patients with unilateral cleft palate were enrolled in the study. Fifteen (39.5%) of them are boys and 23 (60.5%) are girls. Fifteen of the patients (41.7%) had dental caries, with six patients (40%) had palatal fistula in the follow up after palatoplasty, while there was none (0%) of the 21 (58.3%) patients that were found negative for dental caries developed a fistula. Conclusion: Dental caries is one of the important predisposing factors of palatal fistula in patients who undergo palatoplasty.

How I Do It : Bilateral Cleft Lip Repair Sudjatmiko, Gentur; Pribadi, Sweety
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Several techniques have evolved to achieve better outcomes in bilateral cleft lip repair. The techniques performed should overcome the challenge presented in bilateral cleft lip, such as protrusion of premaxilla, the short columella, the wide gap, minimal dry mucosa in prolabium also the low socioeconomic level that typically presented in cleft patient. Considering the challenges mentioned above, a proper design and precise technique should be defined. We proposed a design and technique with promising results, which involves: 1) The precision of the design, the adjustable point of the design to modify lateral flap will provide adequate thickness of vermillion to create tubercle as well as to provide adequate tissue for nasal floor. 2) The possibility to approximate the orbicularis oris muscle although the premaxilla is protruded. It is beneficial and cost-effective for the patients who cannot afford preoperative orthodontic treatment. 3) The suggestion to not worry about the immediate postoperative result as it will evolve to a satisfactory result. 4) The use of non-absorbable nylon 5.0 and 6.0 for the whole layers will overcome tension and reduce cost.

Random Perforator Flap : Some Experiences with Keystone Flap Sudjatmiko, Gentur; Pribadi, Sweety; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 2 No. 2 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: In reconstructing challenging defects, surgeons are considered fairly fortunate when they are able to obtain a similar donor tissue quality to that of the missing tissue; in regards to their color, texture, size, and the ease of donor transfer to the defect. Several methods may be used, which frequently include the free tissue transfers using microvascular anastomoses bearing their specific consequences. We report a select of challenging cases which were successfully reconstructed using the Keystone flaps and avoid microvascular anastomoses, where otherwise the free tissue transfers would be the typical option for closure in such defects. Patient and Method: Nine cases of relatively large defect in various locations were reconstructed using the Keystone flaps supplied by either non-identified perforators or identified reliable perforators. Result: Out of the 9 defects located on various region of the body (lumbar, thorax, dorsum of the foot, plantar of the foot, posterior leg, sacrum, and cervicofacial) only the first 2 cases had identifiable perforators. All flaps survived completely without problem of vascularization. Summary: The Keystone flap is a useful and reliable random perforator-based flap even when the perforator vessels are not identified.

Efficacy of Intralesional Alcohol Injection as Preoperative Treatment of Upper Lip Arteriovenous Malformation Kreshanti, Prasetyanugraheni; Sudjatmiko, Gentur; Anindhawati, Nur
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Management of vascular malformation remains a major challenge because treatment carries a substantial risk of morbidity and recurrence of the fundamental problem. Intra-lesional 96% alcohol injection as a combination with other treatment modalities has good-to-excellent results. Six-year old female with a 5-year history of arteriovenous malformation on her upper lip underwent intralesional alcohol injection under general anesthesia. Afterward we performed excision of the lesion. During the surgery we used Satinsky intestinal clamp to control the bleeding by compressing the artery. The follow up period was 9 months; there were no complications and no signs of relapse. Aesthetically, the result perceived as acceptable to the parents and other viewers. In cases of arteriovenous malformation involving the lip the technique of injecting alcohol 96% intralesional in conjuct with reducing blood loss by using Satinsky intestinal clamps had an acceptable result aesthetically.

Co-Authors A., Nur A., Teuku Anggrahita, Tasya Anindhawati, Nur Atmadja, Tessa Miranda Bangun, Kristaninta Buchari, Frank D., Ishandono Djaprie, Shelly M Djoenaedi, Intania eko heryadi, eko Hakim, Intan Frischilla Hakim, Intan Friscilla Harsono, Anastasia Dessy Ibadurahman, Ibadurahman Irwansyah, Denny K. P., Ayu Diah K., Nadia Kreshanti, Prasetyanugraheni Kusumastuti, Nadia Laureen Supit Lestari, Puri Ambar Mahandaru, Danu Marita, Adinda Mukarramah, Dewi A. Mukarramah, Dewi Aisyah P., Nandita Melati Pribadi, Sweety Rani Septrina Raymond, Benni Raymond, Benny S., Asrofi Sandhi, Afriyanti Sari, Tessa Puspita Simamora, Huntal Sundoro, Ali Tania, Vika Tedjo, A. Tiza, Melina Utama, Defry Yundari, Yundari

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