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Jurnal Plastik Rekonstruksi

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Published by Yayasan Lingkar Studi Bedah Plastik

ISSN : 20896492 EISSN : 20899734 DOI : -

Core Subject : Education, Engineering,

Civil Engineering, Building, Construction & Architecture Other

Jurnal Plastik Rekonstruksi is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery. JPR publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types.

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Articles 250 Documents

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Giant Abscess On Serve Leprosy Reaction With Prolong Used Of Steroid Narmada, Steven; Hasibuan, Lisa Y
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Abstract: Leprosy patients during the course of their illness may experience the leprosy reactions, the body's immune response against Mycobacterium leprae. Long-term use of steroids for treatment may decrease the body's immune system against Mycobacterium leprae. As severe leprosy reactions, giant abscess incidence is rare and has a high morbidity and motality. Therefore, it needs a comprehensive multidisciplinary management such multiple incision and drainage, proper pharmacologic treatment for leprosy reactions as underlying disease that involves the patient's systemic condition. Patient and Method: We report one case of giant abscess in bucal, left upper and lower extremities in leprosy patients who had been taking steroids for 1.5 years due to neuritis (Paucibacillary leprosy reaction type) but the leprosy reactions became more severe and the patient's condition deteriorated. We performed multiple incision through subcutaneus and fascia to expose each compartmens of muscle and drainage to remove pus. Result: There were 2,500 cc of pus in the left femoral region and 200 cc in the left antebrachial region. The culture was negative, showing that the giant abscess was not caused by bacterial infection, but a severe leprosy reactions. Systemic complications due to leprosy reactions, the longterm use of steroids and hypoalbuminemia prevent wound healing and patient’s recovery. Summary: Long-term use of steroids in leprosy may weaken the immune system and cause a giant abscess. Therefore we need a comprehensive management of multiple surgical incision and drainage as well as medical treatment and proper nutritional support.

Perigenital Defect Reconstruction Post Giant Condyloma Acuminata Resection: Experience With The Double Keystone Flap Suhartadi, Bayu; Supit, Laureen; Sukasah, Chaula
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Abstract: Due to its high recurrence, genital condyloma acuminata should be widely excised to include the full dermal thickness. Currettage is not advisable, as the rate of recurrence is high. The bigger the lession, the bigger donor area needed to close the defect. The reconstructive options do not merely depend on the defect area, but also on selecting a tissue donor of similar color, thickness, sensation and durability. The ease of donor transfer is equally important. Not many case of giant genital condyloma acuminata wide excision and reconstruction has been reported. For coverage of larger soft tissue defect, skin graft is the most common option; however durability is of concern and the perigenital area is a challenging area to graft. Two cases of perigenital reconstruction after giant genital condyloma excision is reported in this paper, using random perforator based flaps, the double keystone flap. Patient and Method: Both cases of giant genital condyloma underwent wide excision by the urologist and referred to our division for reconstruction. Both patients are male, and the defects were reconstructed using the double keystone flap. One patient needed a split thickness skin graft to cover remaining defect on the penile shaft. Result: In both cases, the double keystone flap successfully covered for the defects on the perigenital with tissue quality similar to its original characteristics. No complication ensued. All flaps were vital, no dehisence nor local infection occurred. Summary: The double keystone flap is a reliable option for the reconstruction of large defects on the perigenital region.

Incidence of Palatal Fistula after One-Stage Palatoplasty and Factors Influencing the Fistula Occurrence Vityadewi, Nurardhilah; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas are related to an increased rate of hypernasal speech, articulation problems, and food or liquid regurgitation from the nose. Fistulas also tend to recur after a secondary repair to address the fistulas. This study reviews the rate of fistula in our craniofacial center after a onestage cleft palate repair; and to determine whether, cleft type, age at repair, type of cleft repair, hemoglobin level presurgery, and patients nutritional state influence the risk of fistula occurence. Patient and Method: A retrospective analysis was performed on medical records of 93 patients who underwent palate repair between January 2012 to October 2013. All consecutive cleft (lip and) palate patients are included. Bivariate analysis was performed to identify the predictors of fistula formation. Result: Ninety-three patients (50 male and 43 female) underwent one-stage palatoplasty. Cleft palate fistulas occured in 19 of 93 patients (20,4%). The age of the patients at the time of repair ranged from 9 to 144 months (mode 18 months). All palate repairs were done in one stage, using either the two flap (N=66), Wardill-Kilner (N=24), Furlow (N=2), and Langenback (N=1) techniques. No significant influence was found related between age at the time of repair (p 0.789), body weight (p 0.725), Hemoglobin value (p 0.295), and type of cleft (p 0.249) to the rate of fistula occurrence. Summary: This study found no association between , body weight, preoperative hemoglobin value, and the type of cleft to the rate of fistula following cleft palate surgery.

Factors Associated with Occurrence of Amputation in Electrical Burns Narmada, Steven; Hasibuan, Lisa Y
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Electrical burns can cause damage to blood vessels in the burning extremities . This damage can lead to amputation that significantly impacts both physically and psychologically that affects the quality of life. This study aimed to determine the incidence and factors associated with the occurrence of amputation in electrical burns. Method: A retrospective cohort study was done to patients with electrical burns that came to RSHS from 2011 to 2013. Mulativariate analysis, logistic regression, was performed on the factors associated with the occurrence of amputation in electrical burns. Result: Most of the electrical burns were suffered by men (93.5%) at reproductive age (mean 34.1 years; range 10-60 years of age). The incidence of amputation in electrical burns is 54.8% from 31 patients. There is a significant relationship between the causes of high-voltage electrical burns> 1000V with the occurrence of amputation (p = 0.008; Relative risk ratio 8,125 ; 95% CI= 1,62-40,752) and there is a significant relationship between the presence of third degree of burns with amputation (p = 0,011; Relative risk ratio 16; 95 % CI=1,643-155,76). There is no significant relationship between the extent of burns and lactate levels with the amputation on electrical burns. Conclusion: Amputation in electrical burns have a fairly high incidence. High electrical voltage> 1000V and presence of third degree of burns are associated with the occurrence of amputation.

The Application of Moist Exposed Burn Ointment (MEBO) and Binahong Leaves in Treating Partial Thickness Burn : A Case Report Prasetyo, Arif Tri; Heridadi, Eko
Jurnal Plastik Rekonstruksi Vol. 2 No. 4 (2013): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Burn healing is dependent on good wound care management. Infection is one of the cause of wound healing failure. Infectious wound should be treated immediately. Binahong’s leaves is trusted as traditional herbal medicine which is considered capable to help wound healing process. Patient and Method: A 35 years old women suffer from scald and got 3% surface partial thickness burn at her right hand. The patient was initialy treated by application of MEBO. After a week patient came and felt uncomforted with the gauze. So, binahong’s leaves was patched on her wound to help the wound healing process. Result: After a week with binahong’s leaves therapy, the epithelialization is good and there was no infection. The result is satisfactory. Conclusion: This study shows that binahong’s leaves can be used to help wound healing process.

Large Abdominal Defect Closure: Case Series Handini, Nurliati Sari; Tiza, Melina; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 3 No. 1 (2016): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: We will report some experiences in managing challenging malignant cases on the abdominal wall, including a case of large, irradiated defect. All of those cases were consulted intraoperative immediately following tumor removal. The keystone random perforator flap was chosen among the option of solutions in large abdominal defect closure. This region has natural elasticity, which combines well with the multi-axial tissue recruitment of the flap Methods: Three cases of complicated abdominal defect were reconstructed using the keystone flaps supplied by non-identified (random) perforators. Results: All flaps survived without problem of vascularization, despite of its large defect, sequence of radiotherapy following reconstruction, infection, and with its margin unable to be freed from tumor. One out of three cases suffered from contaminated wound from stomal leakage, leading to dehiscence. Conclusion: The keystone flap is a useful and reliable random perforator-based flap, even in complex and challenging malignant cases of abdominal wall.

Simple Metric Measurement To Choose A keystone Flap Design On Extremities: A Cadaveric Study Hariwangsa, Narottama Tunjung; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 3 No. 1 (2016): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Closing defect on extremities can be challenging because of limited donor area in order to obtain similar quality, color, texture, and adequate size with the defect. The keystone flap has gained popularity as a tool for local reconstruction because of its simple design, short operative time, good aesthetic outcome, and cost-effective wound closure. The aim of this study is to introduce a method in choosing a keystone flap design based on simple metric measurement resulting in lower tension.. Methods: Four circular defects were created on 4 different regions of a fresh cadaver’s upper limbs. Diameters were 5 cm for upper arms and 3 cm for lower arms. Two options of keystone flaps designs were introduced. The keystone could be advanced in longitudinal manner or in transversal manner according to limb’s axis. We then calculated the percentage of the skin required to stretch, in order to close the defects. The less percentage of skin required to stretch between the two manners indicated the lower tension of the keystone flap. Results: Measurements in all of 4 regions of upper limbs showed that the percentage of skin stretch in closing the defects was lower in longitudinal advancement keystone flap compared to transversal advancement (19.88% versus 27.8% for upper arms and 15.71% versus 21.67% for lower arms) Conclusion: Simple metric measurements in choosing a keystone flap can be applied to defects on extremities. With less tension when raising the keystone flap, acceptable scar is expected and the occurrence of contracture and flap necrosis can be reduced.

The Effect Of Erythropoietin Administration In Experimental Burns Wound Healing: An Animal Study Sandhi, Afriyanti; Wardhana, Aditya
Jurnal Plastik Rekonstruksi Vol. 3 No. 1 (2016): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The hematopoietic growth factor erythropoietin (EPO) attracts attention due to its all-tissue-protective pleiotropic properties. The purpose of this study is to investigate the effect of EPO in experimental burn wounds healing. Methods: Fifteen healthy Sprague-Dawley, strain of Rattus Novergicus weighing 300-350 grams, were prepared to achieve deep dermal burns. Animals were randomized to receive either low-dose EPO injection (600 IU/mL), high-dose EPO injection (3000 IU/mL) or nothing (control group). After 14 days of observations, quantitative and qualitative assessments of wound healing was determined. Results: The size of the wound area and re-epithelialization rate percentage was determined on Day-0, Day-5, Day-10, and Day-14. The average of raw surface areas measurement (p value: 0.012 in day-5; 0.009 in day-10 and 0.000 in day-14) and healing percentage of the lesions (p value: 0.011 in day-5; 0.016 in day-10 and 0.010 in day-14) were significantly best in the low-dose EPO grup compared to the control group and high-dose EPO grup. The histopathology evaluation revealed that the highest score for for re-epithelialization, granulation tissue and neo-angiogenesis were achieved by the low-dose EPO injection group than in both control and high-dose EPO injection groups. Conclusion: In this animal study using Sprague-Dawley rats, Recombinant Human EPO (rHuEPO) injection administration prompted the evidences of improved re-epithelialization and wound healing process of the skin caused by deep dermal burns. These findings may lead to a new therapeutic approach to improve the clinical outcomes for the management of burns wound healing.

Right Zygomaticomaxillary Complex Fracture With Rupture Of Internal Maxillary Artery: A Case Report Herlambang, Beni; Budiman, Budiman
Jurnal Plastik Rekonstruksi Vol. 3 No. 1 (2016): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: This case report gives prominence to the risk of delayed, possibly life - threatening bleeding following mid-facial fractures. Methods: A 42-year-old male was involved in an accident during which he suffered from right zygomaticomaxillary complex fractures with massive bleeding. The hemoglobin level was decreased from 11 to 5 g/dL, suspected caused by rupture of internal maxillary artery. Incidence of massive bleeding due to zygomaticomaxillary complex fracture is quite rare. Patient also felt right visual loss due to retrobulbar hematoma compression. He was given nasal tampon and transfusion in referral hospital. The patient had fracture reconstruction (reduction and fixation), ligation of right facial artery and temporary ligation of external carotid artery with Ethiloop for 5 days. Nevertheless, the bleeding still occurred. The patient then underwent Digital Subtraction Angiography (DSA) and coiling procedure from radiologic intervention. Twenty days after last procedure, we ligated the right external carotid artery due to recurrence of bleeding. Results: There are many modalities and procedure for the therapy of massive bleeding on midface fracture, ranging from conservative, minimal invasive to operative surgery. Patient that has gone through DSA procedure can still bleed. After ligation of external carotid artery, no more bleeding occurred. Conclusion: Patient suffering from extensive midfacial fracture, the internal maxillary artery and its branches are at special risk of injury due to their close anatomical relationship to bony structures. Its bleeding is possibly life threatening. Tampon and nasal packing are non-essential initial treatment, but digital pressure procedure can be performed to stop the bleeding temporarily. Ligation of external carotid artery is the best choice of treatment for permanent outcome.

Bacterial Pathogens And Antibiotic Sensitivity Pattern In Burn Unit Of Hasan Sadikin Hospital (RSHS) From January 2012 - December 2015 Bowo, Setiagung Ambari; Putri, Almahita Cintami
Jurnal Plastik Rekonstruksi Vol. 3 No. 2 (2016): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Infection is the common cause of death following burn injury. Antibiotic resistance is a major wide problem in burn unit. We evaluated the pattern of bacterial pathogens isolated from burn wound and sensitivity of antibiotics in burn unit of RSHS. Method : A retrospective descriptive study has been done in Burn Unit RSHS by collecting data from burn unit patient’s medical records over 4 years (2012-2015). Data of demography, characteristic of patients, wound isolates bacteria and sensitivity was collected. Result : A total of 205 patients were admitted to burn unit of RSHS and 164 patients fulfilled the requirements to be analyzed. 114 (69.5%) patients were male and the most commonly affected age groups were young adults 15-40 years old. The mortality rate in burn unit was 71 patients (43.3%) and Acute Respiratory Distress Syndrome (ARDS) was commonly the primary cause of death (53.5%) and followed by sepsis (42.3%). Microorganism from burn wound isolates were P. aeruginosa (30.1%), A. baumanii (19.9%), K. pneumonia (19.3%), E. cloacae (9.1%), E. coli (4%), P. stuartii (2.8%). Meropenem was the most sensitive antibiotic against to P. aeruginosa and K. pneumonia. Amikasin was shown to be sensitive to A. baumanii, E. cloacae and E. coli. P. stuartii was 100% sensitive to meropenem, amikasin, piperacillin-tazobactam and cotrimoxazole. Cefoperazon, ceftriaxone and ceftazidime showed very low sensitivity (0-14.3%). Conclusion : Dominant bacteria isolated was P. aeruginosa which was sensitive to meropenem and commonly resistant to the third generation of cephalosporin antibiotics, which becomes multi drug resistant bacteria.

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