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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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Aggresive Mass Excision Through Nasolabial Fold Areain the Treatment of Facial Neurofibromatosis : Case Report Handayani, Siti; Bangun, Kristaninta; Soetjipto Soepodo, Fernita Leo
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Neurofibromatosis type 1 is a rare disease which can manifest itself by the development of plexiform neurofibromatosis, with craniofacial deformities. In this paper, we propose special consideration in excision nasolabial fold mass to help lifting procedures in neurofibromatosis patients. We are reporting two case, both presented with von Recklinghausen’s disease, a 21 years old male patient with neurofibromatosis in his right hemifacial for which he had been operated on five times previously at other center, and a 24 years old male with neurofibromatosis in his left hemifacial. After several stages of reconstruction which started with nasolabial fold mass excision, the result was satisfactory, by using the multiple stage repair, it was done until the end result is similar to anatomical form. The mass debulking procedures for these patients, which started with Nasolabial Fold mass excisison are continued with durable lifting procedures. This method gives results a satisfactory lifting procedure.

Computer Aided Volume Measurement Using Osirix, A Free 3D-Rendering Software, In Preplanned Correction Of Enophthalmos With Diced Cartilage Graft Kreshanti, Prasetyanugraheni; Bangun, Kristaninta
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Autologous costal diced cartilage graft is an option for replenishment of the volume deficit in residual enophthalmos following orbito-zygomatic trauma. However, in published journals referring this treatment option, quantitative volume measurement of the graft needed has not been established. Two patients with orbito-zygomatic fractures resulted from motorcycle accidents, presented with dystopia, entrapment of the eyeball, diplopia, and depressed malar eminence on the affected side. CT scans demonstrated orbital-floor disruption and herniation of the intra-orbital content into the maxillary sinus. Using OsiriX®, a free and open source medical imaging software, we calculated the volume discrepancy of the affected orbit. On coronal slices, the segmentation of the bony orbital region of interest of each single slice was performed and grouped to compute the volume. At surgery, diced cartilage grafts were inserted to the orbital cavity according to the calculated volume, to promote forwards shift of the eye globe position after releasing the entrapment and replacing the orbital floor. In both patients, good position of the eye globe was achieved. The aesthetic appearance was perceived as quite acceptable to the patients and other viewers. Transient diplopia settled within 3 months. We considered OsiriX® as a reliable tool for accurate quantitative measurement of diced cartilage graft volume in enophthalmos correction.

Modified Two-Flap Palatoplasty With Leaving Lateral Periosteum and Application of Honey Pack : A Preliminary Study Bangun, Kristaninta; Sudjatmiko, Gentur; Mahandaru, Danu
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

According to our experience in Ciptomangunkusumo hospital, most cleft palate patients has wide gap. It makes the epithelialization of the lateral defect takes longer time ( 3- 4 weeks). In this study, the authors propose a modified technique to the two-flap palatoplasty by not elevating the lateral part of the periosteum with the flap, and then apply honey packs to cover the lateral defects. The technique modification and additional honey-soaked dressing are expected to hasten the epithelialization rate. Twelve consecutive patients with non-syndromic cleft palate (with or without cleft lip) are included in the study. They undergo the modified two-flap palatoplasty with the lateral periosteum left behind, covering the palatal bone and the utilization of Honey pack. The rate of epithelialization is then observed every 2 days after operation until full healing is achieved. Complete epithelialization was attained within 5 days in one patient ( 2,8 mm/day), within 7 days in 8 patients (2-2,5mm/day), and within 9 days in 3 patients (2,2-2,7mm/day). There were no surgical complications, such as hemorrhage or wound infection. The fistula of the palate was not found until the defect closed. Our technique hasten the rate of epithelialization. It may prevent the maxillary growth disturbances in the future because faster healing reduces scar formation and wound contraction.

Sidik-Chaula Urethroplasty and the Manset Flap for Non-Glanular Hypospadias Repair Sukasah, Chaula L; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Hypospadias present with a wide array of meatal position and curvature. Choosing an operative technique for the different types of hypospadias has been challenging and controversial among the plastic, urologic, and pediatric surgeons. Regardless of the selected techniques, primary hypospadias repair still frequently results in complications requiring further surgery, such as fistula, residual chordee, and stricture. Owing to its practicality, the single stage urethroplasties are more-popular and widely used at present. However, our experience found higher rates of postoperative complications with the one-stage procedure compared to the two-stage for repair of non-glanular hypospadia. This article details the operative techniques of the two-stage Sidik-Chaula urethroplasty, a technique that we have implemented in our institution over two decades. It is applicable for the primary repair of any distal, middle, and proximal hypospadias. We also introduce the Manset Flap, a simple modification to the first stage of urethroplasty, which ease neourethra creation in the second stage. However, due to prior insufficient medical recordkeeping, we are yet unable to produce a quantified rate of success and complications by utilizing this technique. A study is currently being done to produce the numbers.

Squamous Cell Carcinoma Arising From Marjolin’s Ulcer Due To Post Burn Scar: A Case Report Atmowirdjo, Parintosa; Laidding, Sachraswaty
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Marjolin’s ulcers are a rare squamour cell carcinomas which develops in non-healing scar tissue. The most frequent predisposing lesion is in a post burn wound, especially after flame burns. Incidence appears to be on the rise and outcome of treatment remains poor. A 51-years old male with burn scar at the posterior left calf since 43 years ago. After burnt, the wound was left to heal spontaneously with minimal treatment. Three years later an unhealing wound emerged on the scar. This wound got bigger, spreaded further, turned into a mass 15 x 8 x 5 cm in size. The tumor was mobile, ulcerative with unprovoked bleeding, malodorous, and painful. Biopsy and imaging concluded a diagnosis of Squamous Cell Carcinoma from Marjolin’s Ulcer, Stage III (T4N0M0). Wide excision was performed 1-2 cm from hiperemis area, neighboring muscles sacri"ced. Frozen section revealed a free-tumor margin and wound covered by split thicknes skin graft. On folllow up, STSG’s “take” was 100%. Four months postoperation, a wound the size of 1 x 1 x 0,5 cm appeared at the distal left posterior calf. Biopsy was performed, result showed granulating tissues with no sign of malignancy. The wound was treated in the outpatient, and healed well. Marjolin Ulcer’s prognosis is not very favorable so it best to prevent at the best first place.

The Effect Of Aloe Vera On Healing Process Of Incision Wound Mahandaru, Danu; Dachlan, Ishandono
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Considering the advantages of wound treatment in moist-state, many practitioners always keep the wound in the moist condition. One of the alternatives is by using aloe vera. It has moisturizing effect, anti inflammatory and can stimulate growth factor and fibroblast. In this study, the authors aim to compare the effect of the wound dressing with the dry gauze, moist gauze and aloe vera toward the tensile strength. Thirty Rattus Novergicus were divided into two experimental groups and 1 control group. We performed full thickness skin incision on the back of the rats, and then we sutured and nursed them by using moist gauze and Aloe Vera while the dry gauze group treated as the control. On the 10th day, we decapitated the rats and we took the trace of incisional skin for the tensile strength test. At last, the samples were measured by Zwick universal tensile strength testing machine. This research show that the group treated by dry gauze had tensile strength (35 ± 7 N/cm2) , with moist gauze (41 ± 7 N/cm2), and with Aloe Vera (68 ±17 N/cm2). There was a significant difference between the three groups regarding the tensile strength (p<0.001). Treatment of wound by using Aloe Vera is proven to be more effective than the dry gauze and moist gauze to increase the tensile strength.

Early Burn Resuscitation Done By Referring Facilities And Burn Patient’s Survival: A Retrospective Study Wardhana, Aditya; Handini, Nurliati Sari
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

An acute burn wound is a complex injury, which ideally needs to be handled in a special burn unit. Problems arise when a burn patient come to a facility with no burn unit available. The patient needs to be referred and transferred to the nearest burn unit. The adequacy of burn resuscitation done by the referring facility during the transfer process is important to the patient’s survival. To evaluate this matter, a review of mortality during one-year interval of 2010 is being done in Cipto Mangunkusumo Hospital’s burn unit. We are conducting a retrospective review of all 143 patients with acute burn injuries admitted in 2010 to Cipto Mangunkusumo Hospital’s burn unit, analyzed with bivariate analysis using SPSS. Out of the 143 patients being evaluated, we predict there is a significant level of burn resuscitation inadequacy done by the referring facility which influences the patient’s survival. Survival rates can be improved by providing adequate burn resuscitation during transfer process to the nearest burn unit. It is recommended that efforts on updating the knowledge and awareness of treating burn injury patients is given to nurses and physicians in referring facilities.

Clinical Applications of Micro-Skin Grafting For Skin Defect Coverage Wardhana, Aditya; Samiadji, Muhammad
Jurnal Plastik Rekonstruksi Vol. 1 No. 1 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Microskin graft is a technique of skin defect closure using a minimum of STSG donors to cover the large defect. Some considerations were taken, which includes the general status of the patient, donor area morbidity, and patient refusal to act is one of the reasons for the use microskin graft. History STSG failure with previous defect closure and lack of donor area would to bene!t from microskin graft. Case of boy 12 years old with extensive defects in the forearm due to burns. Consideration of the lack of donor area made us deciding to use microskin graft as main option to close the defect. We did one-week post operative evaluation. Epithelialization occurs at day 7, while complete epithelialization occurred at 14th day. Three month during follow-up control, the scar are minimal. We conclude that microskin graft is one technic that can be used in skin defect closure with minimal donor.

Surgical Management of Giant Congenital Hairy Nevi Without Skin Graft or Other Methods of Closure Sukasah, Chaula L; Supit, Laureen
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Congenital hairy nevus refers to pigmented skin lesion presents at birth. Giant hairy nevus (GHN) is disfiguring and carries a great emotional distress on the patient and family. It also imposes a higher risk for developing malignant melanomas and other tumors. The management of GHN depends on the lesions’ size, location and its propensity to become malignant. When surgery is indicated, the simplest approach is a staged serial excisions. The longstanding challenge is in reconstructing the raw surface defect, especially if large. A case of congenital GHN on the trunk, abdomen and bilateral upper thighs was presented and the data was taken from the medical record from the Plastic and Reconstructive Surgery Division of Cipto Mangunkusumo Hospital. Patient was managed surgically with a technique similar to dermabrasion, by scalpel instead of dermabrator, to peel the skin in partial-thickness. In each surgery, not more than 10% of the total body surface area was excised and left to heal secondarily. Compression was used to reduce risk of hypertrophic scar formation. Subsequent operation was ideally 3 weeks apart, to allow for the excised surface to epithelialize and the body to return to homeostasis. Although visible, the patient’s family prefer the resulting scar than the initial lesion, because the skin is lighter, hairless, and less frightening. At two-years follow up, the patient still refuse further operation due to economical and social issues.

The Role of STSG and Delayed Midline Approximation In Abdominal Wall Reconstruction Irwansyah, Denny; Sudjatmiko, Gentur
Jurnal Plastik Rekonstruksi Vol. 1 No. 2 (2012): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Acquired abdominal wall defects can result from previous surgery, trauma, infection and tumor resection. Complex abdominal wall defects challenge both general and plastic reconstructive surgeons. Skin grafting of abdominal viscera was originally described by Horton in 1953, demonstrated in dogs that STSG placed on the parietal peritoneum of abdominal viscera and buried in the peritoneal cavity would take well and survive. In 1994, Baker and Millard Jr reported serial cases of abdominal midline wound dehiscence which was treated with two stage abdominal wall reconstruction.Data was taken from medical and surgical records of patients consulted to the plastic surgery division with and acquired abdominal defect. We are reporting, Male, 42 yo, previous history of Perforated appendicitis with general peritonitis. We performed 2 stage reconstruction of abdominal wall for this patient.Treatment for an abdominal defect is selected on the basis of several factors, including the medical status of the patient, wound bed preparedness, depth, size and location of the defect. The goals of abdominal reconstruction are restoration of function and integrity of the musculo-fascial abdominal wall, prevention of visceral eventeration and provision of dynamic muscle support.Skin grafting and delayed midline approximation are one of the reconstructive option available and deserve to be considered in the high risk, septic patient without compromising the patient final reconstructive result.

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