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Median Nerve Repair Using Sural Nerve Grafting: A Case Report Prasetyo, Eko; Oley, Maximillian C.; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.; Sitorus, Edwin H.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46200

Peripheral nerve injuries (PNIs) have increased to nearly 2.8% of all trauma cases. It often occurs in the upper extremities, such as the median nerve. EMG can be used to confirm a PNI diagnosis. When continuity defects are present in the injured nerve, a nerve graft procedure may be indicated. The most common donor nerve for repair is the sural nerve. Different surgical options are available for the repair of PNI. We presented a 39-year-old woman whose left hand was cramping and did not fully clench. On physical examination, there was an irregular scar on the left arm 1/3 upper region. Sensory deficits were found in the distribution areas of the median nerve, from digiti 1 to 3 of the manus sinistra. EMG showed the lesion of the left median nerve, an axonetmesis was suspected. The patient was then treated with sural nerve grafting to the median nerve using fibrin glue. The postoperative result revealed improvement in hand function. Grafting sural nerve to median nerve using fibrin glue was rarely performed. According to several studies, nerve grafts usually used 6-0 sized synthetic, monofilament, non-absorbable polypropylene sutures. however, there was no difference in the results between fibrin glue and sutures, both have good outcomes. In conclusion, repairing of the median nerve injury using autograft (sural nerve) and fibrin glue can be an option to restore the function of the hand. Keywords: peripheral nerve injury; median nerve; sural nerve; nerve grafting

Pattern of Skull and Facial Bone Fracture in Craniomaxillofacial Trauma Associated with Traumatic Brain Injury: A Retrospective Analysis at Tertiary Hospital Prasetyo, Eko; Oley, Maximillian C.; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.; Sonbay, Antonius E.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46477

Abstract: Trauma is one of the primary causes of death during the first four decade. Craniomaxillo-facial (CMF) trauma has become a common presentation in emergency departments of hospitals. The most presentation of CMF trauma includes skull and facial bone fracture and traumatic brain injury (TBI). This study aimed to obtain the pattern of skull and facial bone fracture in craniomaxillofacial trauma associated with traumatic brain injury. This was a retrospective study conducted on 501 patients from January 2020 to December 2021. Demographic data included age, sex, length of stay (LOS), and Glasgow coma scale (GCS). The results showed that from the total 501 patients with skull and facial bone fracture with or without traumatic brain injury, 406 (81%) were males and 95 (19%) were females. The age range of the patients was between 2 years and 86 years (mean±SD 33.9±18.2). The most common patient affected age ranged from 21 to 30 years. The average of LOS was 7.2±5.7 days (0-33) and the mean of GCS was 10.2±4.2. Based on types of cases, there were 232 cases (60%) of skull and facial bone fractures accompanied by TBI; 154 cases (40%) of only skull and facial bone fracture; and 339 (59.5%) cases of only TBI. In conclusion, the distribution of TBI increases in those with skull and facial bone fractures. On the other hand, the distribution of TBI is more common without fracture. Hence every skull and facial bone fracture must be carefully evaluated clinically and radiologically to rule out any underlying TBI. Keywords: skull and facial bone fracture; craniomaxillofacial trauma; traumatic brain injury

Median and Ulnar Nerve Repair Using Sural Nerve Graft: A Case Report Prasetyo, Eko; Oley, Maximillian C.; Manuhutu, Yovanka N.; Panduwinata, Dicky
e-CliniC Vol. 12 No. 1 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i1.46482

Abstract: Most peripheral nerve injuries (PNI) are caused by trauma. Upper extrimities are most likely to get injured, and the radial nerve is the most common part in upper extrimites to be affected. There are different surgical options available to repair PNI. We reported a 48-years-old male consulted to the Neurosurgery Department for right upper limb weakness and numbness. He had history of laceration due to iron sheeting in the right arm. There was an irregular scar, weakness on right lower arm with hypesthesia, but no neurovascular distal (NVD) abnormalities were found. Further examination showed claw hand. EMG examination revealed total lesion of the right median and ulnar nerve, partial lesion of the right radial nerve with the lesion at wrist level, possibly neurotmesis according to Seddon Classification. Initial debridement, suturing, and repairing of radial artery and flexor carpi ulnar tendon were performed. The patient was then diagnosed as total lesion of the right median and ulnar nerve, partial lesion of the right radial nerve, post repair right ulnar and radial artery and flexor carpi ulnar tendon repair with the planning of nerve graft with no complication under monitoring. The patient was scheduled for sural nerve graft procedure. Early nerve repair or reconstruction is needed even though it only results in incomplete recovery for months to years. The sural nerve is great either in diameter or length which can be a huge source for the grafting of nerve and revealed good outcomes. Recent study showed incomplete recovery especially seen when the patient could not fully clench his hand and his thumb did not move properly during the movement. In conclusion, sural nerve graft is an appropriate choice for peripheral nerve injuries with more benefits included. Prognosis depends on how early the treatment performed and how severe the lesion is. Keywords: median nerve; sural nerve; peripheral nerve injury; nerve repair; nerve grafting

Management of Crush Injury’s Complications Using Hyperbaric Oxygen Therapy: Case Series Arikalang, Patrick S.; Hatibie, Mendy J.; Oley, Maximillian C.; Noersasongko, Albertus D.; Suharso, Tommy
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.46847

Abstract: Crush injury occurs due to an external trauma mechanism that directly affects the skin, muscle, and bone tissue. Crush injuries can involve several parts of the body at the same time. When accompanied by handling, wound healing in crush injury can be long-term, so that it can affect the function of the patient. Various complications that can occur ranging from secondary infection, necrosis, recurrent bleeding, to compartment syndrome. We reported serial cases of crush injury with various clinical presentations and complications, varying in the age range of 16-65 years. All four patients were given multiple managements, such as open reduction external fixation and extensive debridement. There were complications such as secondary infection and delay in the wound healing process in patients who did not on time for follow-up. The four patients received additional treatment in the form of wound dressings hyperbaric oxygen therapy (HBOT) with 5-10 90-minute sessions under 2.4 ATA pressure for 10 consecutive days. Follow-up was carried out again within a period of one month to compare the wound condition before and after HBOT. The clinical condition was getting better, marked by the formation of granulation tissue. The state of hyperoxia in HBOT accelerated the inflammatory process and angiogenesis during the wound healing process characterized by the eradication of bacteria in the wound tissue and accelerated neovascularization formation. In conclusion, adequate therapy, wound dressing, and patient compliance affect patient outcome. Moreover, the addition of hyperbaric oxygen therapy has shown to accelerate the wound healing process and restore the patient's limb function. Keywords: crush injury; hyperbaric oxygen therapy; oxygen; wound healing

Hubungan Kadar Fibronektin Serum dengan Tingkat Kesadaran Menurut Klasifikasi CT-Marshall pada Cedera Otak Sedang dan Berat Akibat Trauma Mogi, Diornald J.; Prasetyo, Eko; Oley, Maximillian C.; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.
e-CliniC Vol. 12 No. 2 (2024): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v12i2.52956

Abstract: Traumatic brain injury (TBI) is the main cause of brain damage in the adolescent and productive age generations, and its incidence is increasing every year. To date, there is still no accurate biological marker for detection of traumatic brain damage or prognosis related to the brain damage. One of the promising biological markers for detection of brain damage is fibronectin. This study aimed to evaluate the relationship between level of serum fibronectin and level of consciousness based on CT-Marshall in TBI patients. This was an observational and analytical study with a cross-sectional design. Samples that met the study criteria were taken sequentially from the study hospital without differentiating exposure status (serum fibronectin levels) or outcome (CT-Marshall category). The regression test on level of serum fibronectin and level of consciousness based on the CT-Marshall category obtained significant result indicating that the higher the serum fibronectin level, the higher the patient's CT-Marshall category which meant the patient had a higher degree of severity and poor consciousness. In conclusion, there is a significant relationship between level of serum fibronectin and level of consciousness based on the CT-Marshall category in moderate and sever traumatic brain injury patients. Keywords: traumatic brain injury; biological marker; serum fibronectin; CT-Marshall category Abstrak: Cedera otak akibat trauma (COT) merupakan penyebab utama kerusakan otak pada generasi muda dan usia produktif dengan angka kejadian meningkat setiap tahunnya. Saat ini, belum terdapat penanda biologis yang akurat untuk mendeteksi kerusakan otak traumatik ataupun menilai prognosis terkait kerusakan otak traumatik. Salah satu penanda biologis yang cukup menarik perhatian ialah fibronektin. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar fibronektin serum dengan tingkat kesadaran menurut klasifikasi CT-Marshall pada COT. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Sampel yang memenuhi kriteria penelitian diambil berurutan dari rumah sakit tempat penelitian tanpa membedakan status paparan (kadar fibronektin serum) atau luaran (kategori CT-Marshall). Hasil uji regresi pada variabel utama kadar fibronektin serum dengan kesadaran menggunakan kategori CT-Marshall mendapatkan hasil bermakna yaitu semakin tinggi kadar fibronektin serum, semakin tinggi pula kategori CT-Marshall pasien yang berarti pasien memiliki derajat keparahan dan kondisi kesadaran yang buruk. Simpulan penelitian ini ialah terdapat hubungan bermakna antara kadar fibronektin serum dan tingkat kesadaran menggunakan kategori CT-Marshall pada pasien cedera otak traumatic sedang dan berat. Kata kunci: cedera otak akibat trauma; penanda biologis; fibronektin serum; kategori CT-Marshall

Penetrating Head Injury by a Key: A Case Report Oley, Maximillian C.; Prasetyo, Eko; Tjungkagi, Ferdinan; Manuhutu, Yovanka N.; Sitorus, Edwin H.
Medical Scope Journal Vol. 7 No. 2 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i2.59224

Abstract: Penetrating head injury is defined as head trauma caused by an object that penetrates the skull and the underlying duramater. We reported a 22-year-old man who came to the hospital with a motorcycle key stuck into the back of his head after a fight with his friend approximately one hour before admission. The patient was fully conscious. History of projectile vomiting, and seizures were denied, and there were no other neurological deficits. Blindly removing the key can damage the neural tissue and can cause secondary injury to the brain and surrounding blood vessels. The primary goal of treatment for patients with suspected traumatic brain injury is to prevent secondary brain injury and infection. The removal of the object safely, debridement of the damaged parenchyma, removal of the hematoma, and closure of the injured dura and skin are the main goals of surgical treatment for penetrating head injuries. In this case, motor key evacuation was performed followed by craniotomy and debridement. The prognosis was good, and there was no neurological deficit. In conclusion, complete and adequate care is essential for patients with penetrating brain injuries. The strategy for treating these injuries is primarily surgery with the aim of preventing secondary brain injury and infection. According to existing research, antibiotics should be given for an indefinite period after surgery. Keywords: penetrating head injury; motorcycle key

Scalp Defect of Cranioplasty with Titanium Mesh: A Case Report Sonbay, Antonius E.; Prasetyo, Eko; Oley, Maximillian C.; Manuhutu, Yovanka; Tjungkagi, Ferdinan
Medical Scope Journal Vol. 7 No. 2 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i2.59703

Abstract: Several implant materials for cranioplasty have been studied, including autologous bone, titanium mesh, polyetheretherketone (PEEK), and polymethyl methacrylate (PMMA). Titanium mesh is believed to have excellent biocompatibility, low cost, and satisfactory cosmetic effects, especially in three-dimensional (3D) custom-made meshes. We reported a 54-year-old man complaining of open wound in his left temporoparietal region since a month. Blood tests showed leukocytosis. Patient was diagnosed as scalp infection with previous cranioplasty using bone cement on temporoparietal region. The patient underwent scalp reconstruction with skin flap, removing skin defect, and split thickness skin graft (STSG) from left thigh. Patient was provided with outpatient medication consisting of analgesics and broad-spectrum antibiotics. Follow-up assessment 14 days after surgery did not reveal any secondary infections on titanium mesh implant and skin flap. The main complications of cranioplasty, in addition to the studied aesthetic results, are represented by the risk of infection, postoperative hematoma, impaired wound healing, as well as prolonged failure due to transplant absorption or infection, as a result of which the prosthesis needs to be removed. In conclusion, titanium mesh is still a better choice of material for cranioplasty in many factors such as price, accessibility, infection rate, and biocompatibility Keywords: scalp; cranioplasty; head injury; prosthesis

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