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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,

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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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Open Versus Closed Treatment Of Subcondyle Mandible Fracture: An Evidence-Based Case Report Bangun, Kristaninta; Nangingtuari, Irinawati; Olivia, Andria; Maulana, Muhammad Iqbal
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Mandibular subcondyle fractures are accounted for 25%-35% of all mandible fractures. Closed treatment has been the preferred treatment for several years because it’s relatively easier and non invasive but the complications that may arise are varied. Open reduction was one of the options that is considered to reduce complications. This study examines whether open reduction was a better choice than closed reduction in the management of mandible subcondyle fracture with parameter outcomes are complications, facial nerve injury, pain, and mouth occlusion. Method: A literature study was conducted from two databases: PubMed and Journal of Cranio-Maxillo-Facial Surgery (JOMS) with predefined keywords and references from 23-28 January 2018. The search was conducted with mandible subcondyle fracture, open reduction, and closed reduction. The search has been limited only for the last 5 years and limited to meta-analysis and systematic review. From the search, there were three articles used based on inclusion criteria in this case review. Result: The reviewed articles showed that open reduction provides better results than closed reduction, although open reduction results in complications of facial injuries and facial nerve weakness, but the complications were transient and tolerable.Conclusion: Based on existing clinical evidence, open reduction was the preferred management rather than closed. reduction due to better outcome and fewer complication.

Speech Outcome Evaluation Of Cleft Palate Patients Underwent Palatoplasty In Plastic Surgery Division Cipto Mangunkusumo Hospital Indonesia Kreshanti, Prasetyanugraheni; Sari, Vania Aramita; Wangge, Grace; Wahyuni, Luh Karunia
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia.

Analgesia For Dressing Changes In Burns: A Systematic Review Ramadan, Mohamad Rachadian; Wardhana, Aditya; Sugiarto, Adhrie
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Intense and prolonged pain often caused by burn injuries. The greatest pain is mostly experienced during dressing changes to maintain healing and banish the infection. This review is conducted to assess the effectiveness and safety of different analgesia agents or methods for dressing changes in burn patients. Method: Searches of studies conducted from 4 electronic databases, using keywords “Analgesia”, “Dressing”, “Bandages”, “Changes” and “Burns”. We included randomized and quasi-randomized trials assessing and comparing the effects of different analgesia agents, analgesia methods for dressing changes in burns patients. We excluded trials reporting only pharmacokinetic and physiological outcomes, comparing drug dosages, with exception for those using different drugs in the same class. Result: Multiple databases search retrieved 144 studies. 17 trials are eligible involving 700 patients. Analgesia using pharmacological agents in 7 trials; 5 trials elaborating primary treatments and 2 trials as the adjunct treatment complementing the major analgesia. Two primary analgesia treatments were studying the role of patient-controlled analgesia (PCA), while 3 trials using caregiver delivered. Ten trials were observing the role of non-pharmacological analgesia. Conclusion: There was inadequate evidence from comparisons tested in randomized trials to confirm the dependent effectiveness of various techniques of analgesia, individual methods, or to assess the administration of different drug adjuncts for providing analgesia during dressing changes. Given the unresolved questions about the management of these conditions, we suggest that preference should be focused on the large scale, optionally, multi-center randomized observations of the primary methods.

Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction Atmodiwirjo, Parintosa; Anggrahita, Tasya
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.

Demographic Characteristic Of Burn Mortality And Its Relation To Tangential Excision At Burn Unit Of Cipto Mangunkusumo National General Hospital Wardhana, Aditya; Kurniasari, Dhita
Jurnal Plastik Rekonstruksi Vol. 5 No. 1 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: Burn injury is considered as major problem because of high mortality and morbidity. One of the several managements to decrease the mortality rate is wound excision. This study aimed to describe the characteristics of burn mortality in our burn unit and its association with timing of tangential excision. Method: We collect data of burn patients who died in 2016 at Burn Unit of Cipto Mangunkusumo Hospital. We investigate the association of mortality and timing of tangential excision. The data were compared with other studies from online databases. Result: Thirty-four burn patients died at RSCM Burn Unit from January - December 2016. 13 patients underwent early tangential excision, the rest had delayed or no tangential excision. Only length of stay (LOS) has statistically significant result. The early tangential excision group has significantly longer median LOS (p=0.003) compared to delayed tangential excision. From five relevant studies, three studies had higher mortality in early tangential excision group compared to delay group but fewer complications and shorter LOS. Two studies reported a significant reduction in mortality in early tangential excision group while culture positive wounds were more frequent in the delay group. Conclusion: Mortality in our patients in early tangential excision group is fewer than the delayed one. The early tangential excision group has longer length of stay compared to delay tangential excision. Although there are pros and cons from the literature review, we suggest that early tangential excision should be done in burn patients.

Microsurgery Recontruction in Plastic Surgery Division FKUI-RSCM, From 2009 - 2010 Atmodiwirjo, Parintosa; Adhistana, Prasasta
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Microvascular surgery is the ability to repair very small blood vessels. Once the technique is mastered it becomes possible to revascularize and replant incomplete or complete digital amputations, and to design free tissue transfer procedures for the reconstruction of a large variety of damaged parts. This study included 17 cases of microsurgery in the last 1 years admitted to Division of Plastic and Reconstructive Surgery RSCM between February 2009 to February 2010. All patient were subjected to through clinical examination and appropriate laboratory and radiological investigations. Trauma is the most common etiology of soft tissue defect (10 cases, 58,8%), followed by tumor and infection (5 and 2 cases respectively). Defect is located 35,3% on the head/neck, 23,6% on the knee/lower leg, 23,6% on ankle/foot, and 17,6% on upper extremity. In this study we performed 9 anterolateral thigh (ALT), 6 radial forearm, 1 chimera flap, and 1 fibula flap. Flaps were vital in 13 cases, compromised in 4 cases, with 2 of them salvaged and survived. Vitality rate of ALT flap was 88,9% (7 vital, 1 non vital, 1 salvaged), 83,8% in RFFF (4 vital, 1 non vital, 1 salvaged) and 100% in fibular flap. The use of microvascular techniques has revolutionized reconstruction method and expanded the range of options for reconstructing a large anatomic defects in patients. If compare with advance center, the success of micro-surgery in our division is still under them. Expected to be approached with increasing operator experience and number of cases was undertaken.

A Simple Method to Measure Serum Lactate Concentration as A Reliable Parameter to Detect Flaps Blood-flow Patency Handayani, Siti
Jurnal Plastik Rekonstruksi Vol. 1 No. 4 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background: The change in !ap blood flow patency can be monitored by measures. Subjective clinical observation through flap examinations is greatly biased depending on examiner’s experience. Standardised equipments of assessment are more reliable. This study propose the use of a device to provide an objective, safe,reproducible, simple, portable, and cost-effective method of monitoring flaps vitality by measuring serum concentration of lactic acid. Methods: An experimental lab-based study was conducted utilising Sprague-Dawley rats. Twenty rats were randomly assigned into two groups. In all subjects, bilateral groin-flaps were elevated. In rats of Group A, the vein pedicle of one-side of the flap was occluded while in Group B both the artery and vein on one-side of the flap were occluded. The other side of flaps in each rat were left unoccluded to serve as controls. Baseline serum lactate was measured in all flaps, then remeasured 60 and 120 minutes in all flaps after pedicle manipulations. Results: The mean lactate concentration of Group A rats with vein-occluded !aps was 2.5 ± 0.17 mmol/L at 0-min initially, and increased to 7.9 ± 0.16 mmol/L 120-min after occlusion (p<0.0005). The mean lactate concentration of Group B rats with arterial and venous flap occlusion was 2.55 ± 0.21 at baseline, which increased four-fold at 120-min to 9.86 ± 0.28 mmol/L (p<0.0005). Among the two groups, the lactate difference was also found to be significant. Conclusion: This study demonstrates that the proposed method detects serum lactate changes in flaps with vein and arteriovenous occlusions. This thus can be used as an objective parameter to evaluate compromised blood flow on cutaneous flaps.

Long Term Evaluation Of Maxillary Growth After ‘The Non Denuded Palatoplasty’ Technique Kreshanti, Prasetyanugraheni; Handayani, Siti; Rachmasari, Maulina; Pancawati, Julieta; Susanto, Amila Jeni; Wangge, Grace; Indania, Alita
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Conventional Two Flap Palatoplasty technique will produce lateral defects without any periosteal coverage. These denuded lateral defects are prone to contamination and infection. These will result in wound contraction, scar formation and maxillary growth impairment. In 2011, we studied “The Non Denuded Palatoplasty” technique. This technique precipitated the epithelialization process of the lateral defects. Faster epithelialization is expected to decrease wound contraction and good maxillary growth. Method : This is a case control study to compare the maxillary growth of 2 groups consists of unilateral cleft lip and palate patients repaired with “The Non Denuded Palatoplasty” technique and Conventional Two Flap Palatoplasty. The outcome will be evaluated from cephalometry and the dental cast for each patient is evaluated using GOSLON YARDSTICK method. Data will be analyzed using SPSS version 20. Result : A total of 4 patients in The Non Denuded Palatoplasty group and 10 in the Conventional Two Flap Palatoplasty. The cephalometric SNA, SNB and ANB point showed Class III skeletal jaw relationship or deficient maxilla. Meanwhile the GOSLON yardstick type III are the most common GOSLON on both group with good inter-ratter reliability (p=0.839) based on Mann Whitney test. In these study, there was no correlation between cephalometric variables with GOSLON score. Conclusion: Our results showed that modification (The Non Denuded Palatoplasty) technique made no statistically significant difference to the maxillary growth. However this study has several limitations, one of which being the small sample size due to family, social and other factors that are beyond the control of the investigating team. Also the evaluation was conducted in patients aged 7-9 years, hence the result of this study is not the final outcome. Keywords: maxillary growth evaluation, cephalometry, Goslon Yardstick, two flap palatoplasty

Maxillary Growth Evaluation Of Patients With Unilateral Complete Cleft Lip And Palate After Two Flap Palatoplasty With Honey Oral Drops Kreshanti, Prasetyanugraheni; Handayani, Siti; Fortuna, Forry; Pancawati, Julieta; Susanto, Amila Jeni; Wangge, Grace; Indania, Alita
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Honey given as oral drops significantly precipitate epithelialization of the lateral palatal defects post two-flap palatoplasty by 2.1 times. Honey is believed to reduce wound contraction, scar formation, and would contribute as an important factor that will result in a satisfactory maxillary growth. The aim of this study is to evaluate maxillary growth as the long-term effect of rapid epithelialization of the palates treated by honey oral drops. Method : This is a case control study consisting of 2 groups; comparing maxillary growth of the UCCLP patients that were and were not given honey as oral drops following their two-flap palatoplasty in 2011-2012. The cephalometric measurements were recorded and the dental cast are evaluated using GOSLON Yardstick method.Result : This study included a total of 20 patients. Goslon Yardstick type IV are the most frequent GOSLON on both groups (40%) with moderate inter-rater reliability between examiner 1-2 and 2-3 (kappa; 0.583 and 0.512) and substantial between examiner 1-3 (kappa 0.716). Forty-percent of SNA angle in the honey group were considered as normal, while only 20% normal SNA angle were found in the control group.Conclusion: Honey oral drops following two-flap palatoplasty resulted in satisfactory SNA angle. As the completion of maxillary growth occurs at the age of 20, the results of this study would only serve as a preliminary report. Other measures to support maxillary growth should also be taken into account. Further studies are warranted to discover innovations in surgical technique that may be a major contributing factor in maxillary growth. Keywords: Maxillary growth, Two Flap Palatoplasty, honey

Reconstruction Of Noe Fracture With Immediate Diced Costal Cartilage Grafting: A Case Series Bangun, Kristaninta; Maulana, Muhammad Iqbal; Putra, Teuku Nanda
Jurnal Plastik Rekonstruksi Vol. 5 No. 2 (2018): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Background : Naso-orbital-ethmoid (NOE) fracture is one of the common injury and the management remains difficult and controversial due to the anatomic complexity. Severe facial deformity and dysfunction are the results from the untreated injury. Moreover, the results from many procedures are not aesthetically satisfying. Meanwhile diced cartilage graft popularity is increasing in order to correct nasal deformity whether post trauma, revision (secondary) rhinoplasty or cleft nose. The procedure is less time consuming, easy to perform and also highly malleable. Methods : This study presents our experience in managing four patients with NOE fracture using costal cartilage graft technique immediately after injury. A columellar V-shaped incision was made, the finely diced cartilage harvested from the eight rib was injected to the glabella, dorsum and nasal tip using one cc syringe needle with cut tip. Demographic data were obtained from the patients’ medical record. Post-operative results were observed. Result: The four surgeries were done, with average 5.75 (range, 2-9) days after injury. During the observation, nasal tip misalignment was observed in only one patient. Diced cartilage were not visible through the skin, although it could be palpable. No cartilage extrusion were occurred. After averange follow up 10.25 mo (range 8-12 mo) All patients were satisfied with their facial appearance. Conclusion: The fracture of NOE can be manage with immediate diced costal cartilage graft, since this treatment can achieve a normal facial function and appearance. The complications are low and manageable, making it as serious contender technique of choice in managing NOE fracture to other techniques. Keywords: NOE fracture, diced costal cartilage graft, facial fracture

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