Jurnal Plastik Rekonstruksi
ISSN / EISSN : 20896492 / 20899734
Current Publisher: Jurnal Plastik Rekonstruksi (10.14228)
Total articles ≅ 39
Latest articles in this journal
Jurnal Plastik Rekonstruksi, Volume 6, pp 270-275; doi:10.14228/jpr.v6i2.284
Background : Good formation of granulation tissue in the ulcer bed is regarded as one of the indicators of pressure ulcer healing. Granulation red index (GRI) had been published as an objective parameter to assess the quality of granulation tissue. Honey stimulates granulation of tissue and creates a moist healing environment. However, the assessment of granulation tissue quality of pressure ulcers treated by honey has yet to be proven in clinical settings. In this study, we evaluate the granulation tissue quality of pressure ulcers treated by honey using granulation red index by digital image analyses. Method: There were 12 subjects who fulfill inclusion criteria treated by honey gauze dressing and were evaluated every week for three times measurements of %GRI and DESIGN-‐score. Parameters of this study were the delta %GRI80 and DESIGN-‐R score. Correlations were evaluated by Spearman’s correlation coefficient. Result : The correlation of delta GRI80% and DESIGN-‐R score was statistically significant from baseline measurement to first week of treatment and to second week of treatment (r1=0.65, p1=0.02 and r3=0.832, p2=0.001). The correlation of delta GRI80% and DESIGN-‐R score from first to second week therapy was not statistically significant (r=0.23, p=0.47), but the GRI80% from first week therapy to second week of therapy was increasing and DESIGN R score was decreasing. Conclusion:This study shows the correlation of %GRI80 and DESIGN-‐R score of pressure ulcer after the treatment of honey gauze dressing. This study hopefully assists further study for wound bed preparation assessment and treatment of pressure ulcer for surgical intervention.
Jurnal Plastik Rekonstruksi, Volume 6, pp 291-294; doi:10.14228/jpr.v6i2.289
Background: Dermal filler injections have been associated with several complications, including migration to other areas and forming nodules due to the presence of foreign bodies or granulomatous reactions may develop, which encapsulates the filler. Fillers might also be associated with malignancy. The presence of such complications must be removed with reconstructive surgery. Methods: We present a case of breast cancer patient with a history of dermal filler injection to the lower eyelid. The nodules in the lower eyelid was surgically removed, and the lower eyelid, particularly the muscle, was reconstructed to provide a good cosmetic result. The nodules were also pathologically examined to confirm the diagnosis. Reconstruction of the lower eyelid was conducted with care by noting the aesthetic aspects. Results: A local muscle flap was easy to harvest and handle, and provided good results. It is also important to consider malignancy to treat the patient thoroughly. The pathology examination confirmed the diagnosis of metastasis. This case is unique because the nodules developed in the patient may be associated with metastasis of the cancer or the dermal filler injection. Conclusion: Our reconstruction technique leads to a good cosmetic result. There are no sign of complications and recurrence at 3 months following the procedure.
Jurnal Plastik Rekonstruksi, Volume 6, pp 276-280; doi:10.14228/jpr.v6i2.287
Background: Polydactyly is the most common hand congenital abnormality found, next after syndactyly. The presence of these extra fingers is not merely duplication but is accompanied by abnormal hypoplastic structures, abnormal joints, tendon anomalies, and anomly of the insertion of ligaments. There are many tehniques proposed to reconstruct polydactyly, from simple excision of bones, ligaments, and tendons to complex reconstructions. We report a case of polydactily, the patient had bone exicision of the duplicates when the patient was four-month-old, but that extra metacarpal with no phalanges resulted in a greater space of finger 1 and 2. Patient and Method: A 21-year-old woman complaining of difficulty in grasping because the space between first and second fingers is too far away, and the extra metacarpal bone is protruding that causes snagging and stumbling on other objects. She had a history of surgical removal of polydactyl when she was 4-month-old. The patient has a limitation in hand activities. Result: Six months after surgery, the patient was satisfied with the results. The fingers has better mobility, good appearance. No more prominent bone, and neuropathic problems, or other disorders were found. Conclusion: Polydactyly is a common congenital hand occurrence. Understanding the anatomy to guide the reconstructive actions is important. It is not only about which digit would be preserved, but we have to concern about what our patient need, improving the quality, patient's hand function, and the aesthetic aspect.
Jurnal Plastik Rekonstruksi, Volume 6, pp 261-265; doi:10.14228/jpr.v6i2.283
Background: Cleft is a common congenital abnormality in the lip and palate. Cleft palate or palatoschisis is a congenital abnormality occured during pregnancy, resulting in cleft of the palate that does not coalesce into the nasal cavity area, so there is a relationship between the nasal cavity and mouth. Various surgical techniques for cleft palate correction can be used and each method has advantages and disadvantages. Patient and Method: Here, we report a case of palatoschisis reconstruction using Von Langenbeck technique and hemostatic absorbable gelatin that was carried out at Aliyah 3 Hospital, Kendari. Result: After initial diagnosis, the patient underwent surgery about two weeks later. Von Langenback palatoplasty was performed to close the palate defect. The defect then closed primarily with 4/0 optime and 6/0 corolene. Conclusion: Optimal surgical planning, good patient orientation and surgical techniques that are carefully considered are essential for optimal results. Herein, we report a case of palatoschisis and reconstructive surgery using von Langenback technique performed to restore the cleft of palate.
Jurnal Plastik Rekonstruksi, Volume 6, pp 266-269; doi:10.14228/jpr.v6i2.282
Background : Polydactyly of the foot is the most common anomaly in congenital diseases. This abnormality is characterized by the presence of additional digits outside the normal complement of the foot. Polydactyly has reported about 1 in 1,000 births. The Watanabe classification is used in assessing polydactyly in the feet as a fifth ray duplication. Various operating techniques can sometimes be an option. Each method has advantages and disadvantages that can be considered in the selection of surgical in the correction polydactyly. Patient and Method: we report a case of polydactyly of the foot reconstruction using circumferential racquet-shaped incision, osteotomy and collateral ligament reconstruction that was carried out at Bahteramas Hospital, Kendari. Result : A circumferential racquet-shaped incision design was performed over the sixth MTP joint. Complete excision of the lateral sixth toe was performed, followed by osteotomy of the fifth metatarsal lateral head with a micro-sagittal oscillating saw. The collateral ligament was reconstructed using ligamentoperiosteal flap and fixed using syringe needle to replace K-Wire. Conclusion: Optimal surgical planning, good patient orientation and surgical techniques that are carefully considered are essential for optimal results. Herein, we report a case of polydactyly and racquet shaped incision technique performed to reconstruct the polydactyly.
Jurnal Plastik Rekonstruksi, Volume 6, pp 254-257; doi:10.14228/jpr.v6i1.274
Background : Arterio-venous malformations (AVMs) defined as high-flow vascular malformations of dysmorphic arterial and venous vessels. And connected directly to one another without an intervening capillary bed. The incidence is higher in females than male (3-5:1). Globally, there are only 5 cases of genital hemangiomas reported. Various treatment has been investigated, a recent topical treatment is the application of timolol. It has minimal adverse effects, easy administration, and good cosmetic outcomes. However, the effectiveness of timolol in vulvar cases remains unclear. Case Report : A one-year-old girl was brought by her mother with complaint of a lump in her child's genitals. The lump was appeared during the early days of her life and it was getting bigger gradually. A plastic surgeon performed excision and reconstruction procedure using the island abdominal flap technique. Discussion : Preserving vaginal function and perineal integrity is quite challenging, and cosmesis correspondingly less important. The patient underwent surgical excision and primary closure procedure in the labia majora region, followed with abdominal flap tunneled through the mons pubis. Conclusion: Surgical excision and primary closure are the most recommended procedure for overcoming genital lesion. A reconstruction using flap following the procedure resulted in a normal contour and well functioned genital.
Jurnal Plastik Rekonstruksi, Volume 6, pp 258-260; doi:10.14228/jpr.v6i1.275
Background : A Surgeon should have good leadership. Leadership plays an important role in improving health services. Leadership can shape a better future. Method : A literature search was conducted in November 2019. Related keywords were applied to Pubmed, Medline, and SCOPUS for studies published in the last five years. Relevant research is taken to be used as the discussion material. Result : The key to surgical leadership is collaboration and cooperation, humanism and mentorship, and operational efficiency. Conclusion: Effective leadership in a surgical team has the following characteristics: (1) Defines the role of a leader clearly, especially in critical situations; (2) Leadership style that suits the clinical situation; (3) Clear directions to team members; (4) Consistently seeking input from team members; (5) Involving members in decision making.
Jurnal Plastik Rekonstruksi, Volume 6, pp 248-253; doi:10.14228/jpr.v6i1.272
Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.
Jurnal Plastik Rekonstruksi, Volume 6, pp 234-242; doi:10.14228/jpr.v6i1.270
Background : Burns is a significant cause of morbidity and mortality worldwide. Particularly in low- and middle-income countries (LMICs), burns account for an estimated 180.000 deaths every year. Burn-related mortality rates are exceptionally high in South-East Asia (11.6 deaths per 100 000 population per year) compare with much lower rates of 1.0 deaths per 100.000 people per year in high-income countries. This study aims to investigate the demographic data, etiology, and outcome of the patients treated in burn unit Ciptomangunkusumo Hospital, Jakarta, Indonesia. Method: This is a retrospective cross-sectional study, collecting epidemiologic data from the medical record through Electronic Health Record. A total of 709 patients admitted to burn unit between 2013-2017 were reviewed based on age, sex, total burn surface area (TBSA), burn grade, inhalation injury, etiology, length of stay, outcome, and payment method. Inclusion criteria are patients that were admitted to burn unit of Ciptomangunkusumo Hospital between 2013-2017, while there are no exclusion criteria in this study. Result : Admission of patients between 2013-2017 has inclined throughout the year, from 97 in 2013 to 166 in 2017. Average patient admission per year, reaching 141,8±26,761. Jakarta, and its suburb Bogor, Depok, Tangerang, and Bekasi, has dominated the proportion of referring hospital with 538(75.9%) The most amount of payment method is NHI (JKN/BPJS) with 534(75.3%) population. A total of 465 were male, and 244 were female, with a ratio of 1.9:1. The highest incidence in terms of age group is 16-35 years old (269, with the average age of patients, is 29±19. The highest incidence of burn injury is caused by a stove gas explosion with 253(35.7%), followed by flame 189(26.7%). There are 63 out of 709 patients with inhalation injury, where the incidence rate is 8.9%. Patients admitted to the Ciptomangunkusumo burn unit has an average length of stay of 15 days hospitalization. The most frequent population of extent, staying >14 days is 21-30% TBSA (88). The mortality rate in the Ciptomangunkusumo burn unit is 25.8% (183), with the highest number of death came from TBSA >40% (136). Conclusion: A total of 709 patients were admitted to the Ciptomangunkusumo burn unit in Jakarta, Indonesia, over 5 years, with an average of 141 patients per year and an increase of 171% from 2013 to 2017. Most patients were diagnosed with >40% TBSA and 2nd-3rd grade burn injury. An average of 15 days of hospitalization for patients leading up to 25.8% mortality rate, they are with septic shock as the most common condition causing death in the burn unit.
Jurnal Plastik Rekonstruksi, Volume 6, pp 243-247; doi:10.14228/jpr.v6i1.271
Background : Hypospadias is a genital congenital abnormality with a variable prevalence. There are risk factors associated with hypospadias. This study analyse the characteristics of hypospadias patients, hypospadias with other genital anomalies, and family history of hypospadias. Method : We used the National Hospital Cipto Mangunkusumo Medical Record Database, which contains all the patient's data from 2013 to 2017. All the information of the diagnosis, type of hypospadias, and the family history are provided. After collecting all the data, we analysed the total cases of hypospadias and the characteristic of hypospadias patients. Result : Based on the data, 6,254 patient that registered in the Plastic Surgery Division, forty-nine patients were diagnosed with hypospadias. Among them, 16% are penoscrotal type hypospadias. Furthermore, there is only 3% of the patients who has a history of hypospadias running in the family. Approximately 29.4% of the patients associated with other genital anomalies. However, only 35% of the sample population underwent surgical repair at the age of 0-5 years. Conclusion: The number of hypospadias cases treated by Plastic Surgery Division at The National Hospital Cipto Mangunkusumo is parallel with the global prevalence of hypospadias. The most common hypospadias type treated in Cipto Mangunkusumo Hospital is penoscrotal, which is similar to the previous study in Europe. The prevalence of hypospadias in Indonesia remains unknown therefore, the data management of hypospadias patients ought to be improved.