PIT XX PERAPI
6 1 0 2
The 20th Annual Scientific Meeting Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons (InaPRAS) 26 – 28 Mei 2016 Clarion Hotel, Makassar, South Sulawesi, Indonesia
Two Decades of InaPRAS Meeting: Bridging Scientif Scientific ic Advances and Reality in Daily Practice
Abstract Book
TABLE OF CONTENTS SCIENTIFIC SCHEDULE ......................................................................................... ..............................................................................................01 .....01 MOENADJAT MOENADJA T MEMORIAL LECTURE ......................................................... ...........................................................................09 ..................09 RHINOPLASTY:: AESTHETIC AND RECONSTRUCTION ASPECT .............................09 RHINOPLASTY MEDICAL ETHICS ................................................... ....................................................................................................... ....................................................10 10 PATIENT SAFETY .................................................... ........................................................................................................1 ....................................................11 1 STEPS TO GOOD RESEARCHER: A NOTE TO BEGINNER .....................................12 PLENARY LECTURE 2 ............................................................................................ .................................................................................................13 .....13 THE FUTURE OF ADIPOSE DERIVED STEM CELL IN PLASTIC SURGERY
13
PLENARY LECTURE 2 ............................................................................................ .................................................................................................14 .....14 VASCULAR STEM CELLS THERAPY FOR TISSUE REGENERATION .....................14 LUNCH SYMPOSIUM 1 (BSN) .....................................................................................15 .....................................................................................15 EFFICACY AND TOLERABILITY OF CUTICELL FOR BURN CASES .........................15 PLENARY LECTURE 3 ............................................................................................ .................................................................................................16 .....16 AESTHETIC FACIAL
CONTOURING ......................................................................16
AESTHETIC SURGERY OF THE FACIAL SKELETON SKELETON ............................................... ...............................................17 17 STEM CELL FACE FACELIF LIF ..................................................... ................................................................................................. ............................................18 18 SS 1: FA FACIAL CIAL AESTHETIC 1 ..................................................... ........................................................................................19 ...................................19 THE ART OF MINIF MINIFACE ACE LIFT ........................................................................ .......................................................................................19 ...............19 THREAD LIFT .................................................. ............................................................................................................ ............................................................20 ..20 THREAD LIFT FOR FACIAL CONTOURING ..................................................... ...............................................................21 ..........21 SS 2: FA FACIAL CIAL AESTHETIC 2 ..................................................... ........................................................................................23 ...................................23 SUTURE SUSPENSION BROWPEXY .........................................................................23 ABSTRACT ....................................................... ................................................................................................................. ............................................................09 ..09 SS 2: FA FACIAL CIAL AESTHETIC 2 ..................................................... ........................................................................................25 ...................................25 SUTURE SUSPENSION BROWPEXY .........................................................................25 BROWLIFT ENDOSCOPY ............................................................................................ ............................................................................................26 26 UPPER LID BLEPHAROPLASTY BLEPHAROPLASTY:: FAT TRANSPOSITION ..........................................27 SS 3: BREAST BREAST .......................................................... ............................................................................................................. ...................................................28 28 BREAST IMPLANT IMPLANT:: ROUND OR TEARDRO TEARDROP P SHAPE, WHICH ONE BETTER?
28
ENDOSCOPIC ASSISTED BREAST AUGMENT AUGMENTA ATION .............................................. ..............................................29 29 LARGE
GYNECOMASTIA
WITH
NIPPLE
REPOSITIONING
UTILIZING
THE
DERMATOGLANDULER DERMA TOGLANDULER FLAP ......................................................... ...................................................................................30 ..........................30 PLENARY LECTURE 4 ............................................................................................ .................................................................................................31 .....31
II
TABLE OF CONTENTS SCIENTIFIC SCHEDULE ......................................................................................... ..............................................................................................01 .....01 MOENADJAT MOENADJA T MEMORIAL LECTURE ......................................................... ...........................................................................09 ..................09 RHINOPLASTY:: AESTHETIC AND RECONSTRUCTION ASPECT .............................09 RHINOPLASTY MEDICAL ETHICS ................................................... ....................................................................................................... ....................................................10 10 PATIENT SAFETY .................................................... ........................................................................................................1 ....................................................11 1 STEPS TO GOOD RESEARCHER: A NOTE TO BEGINNER .....................................12 PLENARY LECTURE 2 ............................................................................................ .................................................................................................13 .....13 THE FUTURE OF ADIPOSE DERIVED STEM CELL IN PLASTIC SURGERY
13
PLENARY LECTURE 2 ............................................................................................ .................................................................................................14 .....14 VASCULAR STEM CELLS THERAPY FOR TISSUE REGENERATION .....................14 LUNCH SYMPOSIUM 1 (BSN) .....................................................................................15 .....................................................................................15 EFFICACY AND TOLERABILITY OF CUTICELL FOR BURN CASES .........................15 PLENARY LECTURE 3 ............................................................................................ .................................................................................................16 .....16 AESTHETIC FACIAL
CONTOURING ......................................................................16
AESTHETIC SURGERY OF THE FACIAL SKELETON SKELETON ............................................... ...............................................17 17 STEM CELL FACE FACELIF LIF ..................................................... ................................................................................................. ............................................18 18 SS 1: FA FACIAL CIAL AESTHETIC 1 ..................................................... ........................................................................................19 ...................................19 THE ART OF MINIF MINIFACE ACE LIFT ........................................................................ .......................................................................................19 ...............19 THREAD LIFT .................................................. ............................................................................................................ ............................................................20 ..20 THREAD LIFT FOR FACIAL CONTOURING ..................................................... ...............................................................21 ..........21 SS 2: FA FACIAL CIAL AESTHETIC 2 ..................................................... ........................................................................................23 ...................................23 SUTURE SUSPENSION BROWPEXY .........................................................................23 ABSTRACT ....................................................... ................................................................................................................. ............................................................09 ..09 SS 2: FA FACIAL CIAL AESTHETIC 2 ..................................................... ........................................................................................25 ...................................25 SUTURE SUSPENSION BROWPEXY .........................................................................25 BROWLIFT ENDOSCOPY ............................................................................................ ............................................................................................26 26 UPPER LID BLEPHAROPLASTY BLEPHAROPLASTY:: FAT TRANSPOSITION ..........................................27 SS 3: BREAST BREAST .......................................................... ............................................................................................................. ...................................................28 28 BREAST IMPLANT IMPLANT:: ROUND OR TEARDRO TEARDROP P SHAPE, WHICH ONE BETTER?
28
ENDOSCOPIC ASSISTED BREAST AUGMENT AUGMENTA ATION .............................................. ..............................................29 29 LARGE
GYNECOMASTIA
WITH
NIPPLE
REPOSITIONING
UTILIZING
THE
DERMATOGLANDULER DERMA TOGLANDULER FLAP ......................................................... ...................................................................................30 ..........................30 PLENARY LECTURE 4 ............................................................................................ .................................................................................................31 .....31
II
TABLE OF CONTENTS REMOVING THE STIGMA OF THE CLEFT ......................................................... ..................................................................31 .........31 TRIANGULAR TECHNIQUE FOR BILATERAL CLEFT LIP .........................................32 MY EXPERIENCES IN CRANIAL VAUL VAULT T RECONSTRUCTION................................... RECONSTRUCTION...................................33 33 PLENARY LECTURE 5 ............................................................................................ .................................................................................................34 .....34 FREE PERFORATOR PERFORATOR FLAP IN LOWER LOWER LEG RECONSTRUCTION ..........................34 RECONSTRUCTION, LIP VERSATILITY VERSATILITY OF ABBE FLAP ..........................................35 CONDILUS MANDIBULA RECONSTR UCTION
WITH K WIRE AND SILICON
BLOCK ..................... ........................................... ............................................. ............................................. ................................... ............. 36 SPECIAL SYMPOSIUM (DERMOZONE INDONESIA) ................................................. .................................................37 37 LUNCH SYMPOSI UM 2 (PRO HEAL HEALTH TH INT) INNOVA INNOVATION TION FRO M BENCH T O B E D S I D E ..... ........... ........... ........... ........... ........... ........... ........... ............ ........... ........... ........... ........... ........... ........... ............ ........... ........... .......... ......39 ..39 MAKING PERFECTION OF THE ALVEOLAR BONE GRAFT IN CLEFT PATIENT: THE ROLE OF BTCP ........................................................ ........................................................................................................... ...................................................39 39 LUNCH
SYMPOSIUM
2
(PRO
HEALTH
INT)
INNOVA INNOV ATION FROM BENCH TO BED SIDE ..................................................... ...............................................................40 ..........40 EVOLUTION OF BIODEGRADABLE IMPLANT IN CMF: PERSONAL EXPERIENCE EXPERIENCE IN FOA PATIENT .................................................... .............................................................................................................. ............................................................40 ..40 SS 4: BURN AND AND WOUND ....................................................... ..........................................................................................41 ...................................41 HOW TO MANAGE ARDS PATIENTS WITHOUT VENTILATOR IN BURN UNIT?
41
HYPERBARIC OXYGEN THERAPY IN PLASTIC SURGERY CASES: A SYSTEMATIC REVIEW .................................................. ............................................................................................................. .....................................................................42 ..........42 ENDOCRINE AND METABOLIC METABOLIC CHANGES IN SEVERE BURN ................................43 SS5: A NEW CLINICAL OPTION IN WOUND MANAGEMENT (MUNDIPHARMA)
44
HOW “SMARTPORE TECHOLOG Y” CAN IMPROVE PATIENTS QUALITY OF LIVE ? ....................... ............................................. ............................................. ............................................. ...................................44 .............44 DAVID DA VID S. PERDANAKUSUMA (INDONESIA) ..................................................... ...............................................................44 ..........44 SHARING BET BETAPLAST APLAST EXPERIENCE ........................................................................45 PVP-I : MYTH AND FACTS IN WOUND MANAGEMENT ............................................ ............................................46 46 SS 6: FACIAL FACIAL RECONSTRUCTION RECONSTRUCTION ........................................................... ............................................................................47 .................47 BLEPHAROPTOSIS: ORBICULARIS PLICATION PLICATION MODIFIED TARSUS .....................47 CONSTRICTED EAR ........................................................ ................................................................................................... ...........................................48 48 ALAR NOSE RECONSTRUCTION WITH SEPTOCHONDRAL MUCOSAL FLAP, CARTILAGE GRAFT AND ISLAND FOREHEAD FLAP ............................................... ...............................................49 49
III
SS 7: CRANIOFACIAL ..................................................................................................50 FACIAL TRAUMA OLD FRACTURE MANAGEMENT ..................................................50 TETRAPOD FRACTURE, SURGICAL ANATOMY REVISITED AS A GUIDE FOR 3D REDUCTION USING CAROLL GIRARD SCREW ........................................................51 TURRICEPHALY RECONSTRUCTION IN SANGLAH GENERAL HOSPITAL
52
SS 8: CLEFT (SMILE TRAIN) .......................................................................................53 THE USAGE OF EAR CARTILAGE GRAFT TO IMPROVE AESTHETIC PERFORMANCE OF THE NOSE IN CLEFT CHILDREN ..........................................................................53 OUR EXPERIENCE WITH NASOALVCOLAR MOLDING (NAM) IN MORE THAN 80 CLEFT PATIENTS ........................................................................................................54 NOSE REVISION AFTER LABIOPLASTY ...................................................................55 SS 9: MICROSURGERY ...............................................................................................56 MICROVASCULAR RADIAL FOREARM FASCIOCUTANEOUS FREE FLAP FOR DEFECT RECONSTRUCTION ON HEAD AND NECK ................................................56 RECONSTRUCTIVE MICROSURGERY IN CRANIOFACIAL TUMOR .......................57 SS 9: MICROSURGERY ...............................................................................................58 FINGER REPLANTATION : REPORTED OF TWELVE CASES IN SANGLAH GENERAL HOSPITAL, BALI-INDONESIA ......................................................................................58 10: HYPOSPADIA TIPS AND TRICKS ..........................................................................59 SURGICAL MANAGEMENT OF SHORT URETHRA ....................................................59 MY
EXPERIENCE
USING
STANDOLI’S
TECHNIQUE
TO
REPAIR
PENILE
HYPOSPADIA ...............................................................................................................60 SS 11: MISCELLANEOUS 1 .........................................................................................61 GAMBARAN MORBIDITAS OUTCOME PASIEN BEDAH PLASTIK YANG DIKERJAKAN DOKTER NON BEDAH PLASTIK DI SUMATERA BARAT 2007- 2015 .......................61 PROFILE SNAKE BITE DIAGNOSTIC AND TREATMENT DR. MUWARDI HOSPITAL .................................................................................................... 62 THE ROLE OF BLEOMYCIN IN HAEMANGIOMAS ....................................................63 SS 12: MISCELLANEOUS 2 .........................................................................................64 CHALLENGE IN GIANT HEMIFACIAL NEUROFIBROME’S REDUCTION : A CASE REPORT AND LITERATURE REVIEW .........................................................................64 ROLE OF EPITHEL GROWTH FACTOR IN TREATING SCAR / KELOID
65
DIABETES MELLITUS TYPE II IMPAIRS ADIPOSE – DERIVED STEM CELLS
66
FREE PAPER 1 - 2 ........................................................................................................67 FREE PAPER SCHEDULE ...........................................................................................67 IV
FP 006 ..........................................................................................................................73 INTRALESIONAL INJECTION WITH 5-FLOUROURACIL VERSUS TRIAMCINOLONE ACETONIDE FOR KELOID TREATMENT ....................................................................73 ABSTRACT FREE PAPER ............................................................................................73 FP 014 ...........................................................................................................................74 COMPARISON OF THE NUMER OF ANGIOGENESIS OF ACUTE WOUND HEALING BETWEEN ALOE VERA AND TULLE ON ACUTE WOUNDS OF WISTAR RATS
74
FP 018 ...........................................................................................................................75 MANDIBULOMAXILLARY FIXATION (MMF) TRAINING PROGRAM EVALUATION AMONG PLASTIC SURGERY RESIDENT: A QUASI-EXPERIMENTAL STUDY
75
FP 019 ...........................................................................................................................76 EVALUATION OF MAXILLARY GROWTH OF PATIENTS WITH UNILATERAL COMPLETE CLEFT LIP AND PALATE AFTER TWO FLAP PALATOPLASTY WITH HONEY ORAL DROPS ................................................................................................76 FP 020 ...........................................................................................................................77 PERFORATOR BASED FLAPS IN BURN RECONSTRUCTION: A 2 YEARS EXPERIENCE ...............................................................................................................77 FP 022 ...........................................................................................................................79 THROMBOPROPHYLAXIS STRATEGY AND THE RISK OF FREE FLAP THROMBOSIS IN PATIENTS WITH HYPERCOAGULABILITY: A SYSTEMATIC REVIEW
79
FP 030 ...........................................................................................................................80 FP 036 ...........................................................................................................................81 ANTHROPOMETRIC EVALUATION OF
GENTUR’S CHEILOPLASTY METHOD IN
UNILATERAL CLEFT LIP ..............................................................................................81 FP 038 ...........................................................................................................................82 COMPARISON OF TOPICAL TREATMENT RESULTS BETWEEN COMBINATION OF HERBAL EXTRACTS AND TULLE ON ACUTE WOUND MODEL ON WISTAR RATS 82 FP 049 ...........................................................................................................................83 THE SAFETY OF ONE-PER-MIL TUMESCENT INFILTRATION INTO SKIN FLAP THAT HAS SURVIVED FROM THE PRECEDING ISCHEMIC INSULT..................................83 FP 050 ...........................................................................................................................84 FLAP MODALITY FOR RESURFACING FOLLOWING AGGRESSIVE NECROTOMY DEBRIDEMENT IN SUBMANDIBULAR ABSCESS: CLINICAL EXPERIENCE IN 10 CASES ..........................................................................................................................84 FP 051 ...........................................................................................................................85 V
TABLE OF CONTENTS MORPHOMETRY OF INFANT NOSTRIL IN JAKARTA ................................................85 FP 040 ...........................................................................................................................86 EFFECTIVENESS OF EARLY EXCISIONAL DEBRIDEMENT IN BURN INJURIES TO SEPSIS INCIDENCE AND MORTALITY RATE AT BURN UNIT OF HASAN SADIKIN HOSPITAL .....................................................................................................................86 FP 042 ...........................................................................................................................87 NEW STRATEGY USING BETA BLOCKER AND NEGATIVE FLUID BALANCE THERAPY TO REDUCE MORTALITY RATE IN MANAGING PATIENT WITH SEVERE BURN INJURY: HASAN SADIKIN PROTOCOL............................................................87 FP 045 ...........................................................................................................................88 EFFICACY OF CHLORHEXIDINE-ALCOHOL VERSUS POVIDONE IODINE AS PREOPERATIVE SKIN PREPARATION TO PREVENT SURGICAL SITE INFECTION: A META-ANALYSIS ..........................................................................................................88 FP 046 ...........................................................................................................................89 RELATIVE BODY WEIGHT CHANGES POST PALATE REPAIR IN PATIENTS FED BY LONG NIPPLE NURSING BOTTLE VERSUS CONVENTIONAL FEEDING
89
FP 048 ...........................................................................................................................90 THE EFFECTIVENESS BOVINE AMNIOTIC MEMBRANE TO SUBSTITUTE HUMAN AMNIOTIC MEMBRANE IN PARTIAL THICKNESS WOUND CARE IN RATS
90
FP 044 ...........................................................................................................................91 EFFECTIVITY OF PLATELET RICH PLASMA IN WOUND HEALING OF DEEP SECOND DEGREE BURN INJURIES IN DR. SOETOMO GENERAL HOSPITAL ......................91 FP 001 ...........................................................................................................................92 FACIAL CLEFT OF TESSIER NO. 30: ENCOUNTERED IN ADULT.............................92 FP 010 ...........................................................................................................................93 DIFFERENT
APPROACH
ON
RECURRENT
TEMPOROMANDIBULAR
JOINT
ANKYLOSIS WITH INTERPOSITIONAL ARTHROPLASTY USING SILICONE BLOCK AND BILATERAL CORONOIDECTOMIES: A CASE REPORT.....................................93 FP 013 ...........................................................................................................................97 THE EFFECT OF HYPERBARIC OXYGEN THERAPY
FOR PREVENTING
THROMBOSIS IN FREE FLAP : AN ANIMAL STUDY .................................................97 FP 062 ...........................................................................................................................99 SUBJECTIVE ASSESSMENT OF THE SCAR FORMATION AT FACE AFTER
VI
TABLE OF CONTENTS MICROPOROUS PAPER TAPE APPLICATION............................................................99 FP 019 .........................................................................................................................100 THE
EFFECT
OF
PLATELET-RICH
PLASMA
(PRP)
FOR
PROMOTING
EPITHELIALIZATION SPEED IN RAT SKIN’S THIRD DEGREE BURN WOUND
100
FP 037 .........................................................................................................................101 CASE REPORT : HAND FINGER DEGLOVING INJURY, AMPUTATION IS NOT AN OPTION. ......................................................................................................................101 FP 031 .........................................................................................................................102 THE
EFFECT
PROCESS,
OF
TOPICAL
COLLAGEN
SIMVASTATIN
SYNTHESIS,
GEL
FIBROBLAST
ON
EPITHELIALIZATION
PROLIFERATION,
AND
NEOVASCULARIZATION OF FULL-THICKNESS WOUND ON WISTAR-STRAIN RAT (RATTUS NORVEGICUS) ...........................................................................................102 FP 032 .........................................................................................................................103 CARTILAGE REGENERATION ON DONOR SITE DEFECT WITH ONE SIDED PERICHONDRIAL AURICULAR CARTILAGE GRAFT : AN EXPERIMENTAL RABBIT MODEL .......................................................................................................................103 FP 041 .........................................................................................................................104 BACTERIAL PATHOGENS AND ANTIBIOTIC SENSITIVITY PATTERN IN BURN UNIT OF HASAN SADIKIN HOSPITAL (RSHS) FROM JANUARY 2012 - DECEMBER 2015 ........................................................................................................ 104 PO 001 ........................................................................................................................105 TOTAL NASAL RECONSTRUCTION ..........................................................................105 PO 004 ........................................................................................................................106 COMPARATIVE AESTHETICS POST LABIOPLASTY UNILATERAL WITH MILLARD TECHNIQUE AND RANDALL - TENNISON TRIANGULAR........................................106 E-POSTER SCHEDULE..............................................................................................107 PO 001 ........................................................................................................................113 TOTAL NASAL RECONSTRUCTION ..........................................................................113 PO 004 ........................................................................................................................114 COMPARATIVE AESTHETICS POST LABIOPLASTY UNILATERAL WITH MILLARD TECHNIQUE AND RANDALL - TENNISON TRIANGULAR........................................114 PO 005 ........................................................................................................................115 HEMOSTATIC PERFORMANCE OF HONEY SOAKED OXYDIZED REGENERATED
VII
TABLE OF CONTENTS CELLULOSE (SURGICEL MADU); AN ANIMAL STUDY ............................................115 FP 007 .........................................................................................................................116 AN ALTERNATIVE TREATMENT AFTER TUMOR ABLATION AT MAXILLOFACIAL REGION FOR GERIATRIC PATIENT : CASE SERIES ..............................................116 PO 008 ........................................................................................................................117 SUCCESFUL SURGICAL MANAGEMENT OF GIANT CONDYLOMA ACUMINATUM, AN AIDS PATIENT : A CASE REPORT ......................................................................117 FP 009 .........................................................................................................................118 FACIAL ATROPHY LESION TREATMENT WITH MODIFIED DERMAL-FAT GRAFT: A TECHNIQUE TO IMPROVE GRAFT SURVIVAL (CASE REPORT) ...........................118 PO 010 ........................................................................................................................119 NON-SURGICAL MANAGEMENT OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS PRESSURE ULCERS: A CASE REPORT ..................................................119 PO 011.........................................................................................................................120 INTRA-LESIONAL ALCOHOL INJECTION FOR FACIAL VASCULAR MALFORMATION; TREATMENT AND CHALLENGES .............................................................................120 PO 012 ........................................................................................................................121 MESENCHYMAL
STEM
CELLS
THE
NEXT
GENERATION
OF
BURN
TREATMENT ............................................................................................ 121 PO 013 ........................................................................................................................122 LONG TERM MAXILLARY GROWTH EVALUATION AFTER THE NON DENUDED MUCOPERIOSTEAL PALATOPLASTY TECHNIQUE ................................................122 PO 014 ........................................................................................................................123 BUNIONPLASTY IN PLASTIC SURGERY POINT OF VIEW .....................................123 PO 016 ........................................................................................................................124 DEGLOVING HAND INJURY : IS “SANDWICH FLAP” STILL AN OPTION?
124
PO 017 ........................................................................................................................125 THE EFFECT OF TOPICAL SIMVASTATIN GEL TO EPITHELIALIZATION PROCESS, COLLAGEN SYNTHESIS, AND FIBROBLAST PROLIFERATION, OF FULL THICKNESS WOUND ON WISTAR STRAIN RAT (RATTUS NORVEGICUS).................................125 PO 019 ........................................................................................................................126 THE OBJECTIVE MEASUREMENT OF MARGINAL EPITHELIAL CREEPING OF SPLIT-THICKNESS SKIN GRAFT USING TRANSPARENT PLASTIC PAPER: AN IDEA
VIII
TABLE OF CONTENTS AND INNOVATION METHOD .....................................................................................126 PO 022 ........................................................................................................................128 SURVIVAL OF COSTOCHONDRAL VERSUS CALVARIAL BONE GRAFT AS BIOMATERIALS FOR ORBITAL VOLUME RESTORATION SURGERY : A SYSTEMATIC REVIEW ......................................................................................................................128 PO 023 ........................................................................................................................129 CLEFT CRANIOFACIAL CENTER JAKARTA: PROFILE OF PALATAL INDEX AND FISTULA FORMATION ...............................................................................................129 PO 024 ........................................................................................................................130 EMBOLIZATION AND REDUCTION IN GIANT HAEMANGIOMA GLOSSUS ET LABIALIS INFERIOR : A CASE REPORT ..................................................................130 PO 025 ........................................................................................................................131 MACROPHAGES BEHAVIOR; AMNION AND MNICROBIAL CELLULOSE IN RAT’S FULL THICKNESS WOUND .......................................................................................131 PO 026 ........................................................................................................................132 CORRELATION BETWEEN BLOOD GLUCOSE VARIABILITY AND MORTALITY AMONG SEVERE BURN INJURY PATIENTS AT RUMAH SAKIT HASAN SADIKIN BURN UNIT ................................................................................................................132 PO 027 ........................................................................................................................133 EVALUATION OF PRE-REFERRAL MANAGEMENT OF ACUTE BURN PATIENTS IN RUMAH SAKIT HASAN SADIKIN ...............................................................................133 PO 028 ........................................................................................................................134 EXPERIENCE WITH NEOVAGINAL CONSTRUCTION IN MALE TO FEMALE RECONSTRUCTION IN HASAN SADIKIN HOSPITAL...............................................134 PO 029 ........................................................................................................................135 SUCCESSFUL SURGICAL REPAIR OF PENILE SILICONE GRANULOMA WITH SPLIT-THICKNESS SKIN GRAFT AND SKIN FLAP: REPORT OF TWO CASES
135
IX
SCIENTIFIC SCHEDULE SYMPOSIUM (Aesthetic) Thursday, 26 May 2016 07.00 – 08.00
Re – registration
08.00 – 08.40
OPENING CEREMONY Sandeq B Room
08.40 – 09.00
Moenadjat Memorial Lecture Moderator: A.J. Rieuwpassa (Indonesia) Sandeq B Room Rhinoplasty: Aesthetic and Reconstruction Aspect Sidik Setiamihardja (Indonesia)
09.00 – 10.00 09.00 – 09.20 09.20 – 09.40 09.40 – 10.00
Plenary Lecture 1 Moderator: Moch. Sjaifuddin Noer (Indonesia) Medical Ethics – Djohansyah Marzoeki (Indonesia) Patient Safety – Idrus Paturusi (Indonesia) Steps to Good Researcher: A Note to Beginner Din Syafruddin (Indonesia)
10.00 – 10.30
Exhibition Opening and Coffee Break
10.30 – 11.30
Plenary Lecture 2 Moderator: Fonny Josh (Indonesia) Sandeq B Room The Future of Adipose Derived Stem Cell in Plastic Surgery Hiroshi Mizuno (Japan) Vascular Stem Cells Therapy for Tissue Regeneration – Rica Tanaka (Japan) Discussion
10.30 – 10.50 10.50 – 11.10 11.10 – 11.30 11.30 – 12.30
Lunch Symposium 1 (BSN) Moderator: Ishandono Dachlan (Indonesia) Sandeq B Room Efcacy and Tolerability of Cuticell for Burn Cases Iswinarno Doso Saputro (Indonesia)
12.30 – 13.30
LUNCH
01
SCIENTIFIC SCHEDULE 13.30 – 14.30 13.30 – 13.45 13.45 – 14.15 14.15 – 14.30 14.30 – 15.45 14.30 – 14.45 14.45 – 15.00 15.00 – 15.15 15.15 – 15.30 15.30 -15.45 14.30 – 15.45
14.30 – 14.45 14.45 – 15.00 15.00 – 15.15 15.15 – 15.45
Plenary Lecture 3 Moderator: Djohan Wirawan (Indonesia) Sandeq B Room Esthetic Face Contouring – David J. David (Australia) Aesthetic Surgery of the Facial Skeleton Rong-Min Baek (South Korea) Stemcell Facelif – Natalie Brenner (Germany) SS 1: Facial Aesthetic 1 Moderator: Donna Savitry (Indonesia) Sandeq A Room Face Lift – Irena Sakura Rini (Indonesia) Thread Lift – Enrina Diah Nurmeirini (Indonesia) Thread Lift for Facial Contouring Bambang Wicaksono (Indonesia) Nose Contouring – Sumantri Sarimin (Indonesia) Discussion SS 3: Breast Moderator: Mendy Juniaty Hatibie (Indonesia) Sandeq B Room Breast Implant: Round or Teardrop Shape, Which one Better? Hendri Andreas (Indonesia) Endoscopic Assisted Breast Augmentation Dharma P. T. R. Maluegha (Indonesia) Large Gynecomastia with Nipple Repositioning Utilizing the Dermatoglanduler Flap - Hardisiswo Soedjana (Indonesia) Discussion
14.30 – 16.30
Free Paper 1 – 2 Moderator: Elida Sari Siburian (Indonesia) Azalea Room
15.45 – 16.45
SS 2: Facial Aesthetic 2 Moderator: Sachraswaty (Indonesia) Sandeq A Room Brow Lift – Tomie Hermawan Soekamto (Indonesia) Endoscopic Forehead Lift – Hendri Andreas (Indonesia) Upper Lid Blepharoplasty: Fat Transposition Ferdinand (Indonesia) Discussion
15.45 – 16.00 16.00 – 16.15 16.15 – 16.30 16.30 – 16.45
02
SCIENTIFIC SCHEDULE WORKSHOP MEDICAL WRITING Thursday, 26 May 2016 Sandeq B Room 16.30 – 18.10 16.30 – 17. 00
Session 1 Moderator: Magda Rosalina Hutagalung (Indonesia) Hiroshi Mizuno (Japan) The title: Says It All The Abstract: A Tale of Two Summaries Set the Scene with a Good Introduction Who, What, When, Where, How, and Why: The Ingredients in the Recipe for a Successful Methods Section
17.00 – 17.30
Rica Tanaka (Japan) The Results Section What Journal You Choose, Then Sequential Results Are What You Use Put Your Best Figure Forward: Line Graphs, Scatter Grams, Bars and Pies Bring Your Best to the Table
17.30 - 18.00
Din Syafruddin (Indonesia) The Discussion Section: Your Closing Argument, Conclusion Giving Credit: Citations and References Top 10 Tips for Responding to Reviewer and Editor Comment
18.00 – 18.10
Discussion
18.10 – 19.10
Break & Dinner
19.10 – 21.00 19.10 – 20.00
Session 2 Moderator: Irra Rubianti Widarda (Indonesia) Irawan Yusuf (Indonesia) How to Write a Case Report Ferry Sandra (Indonesia) Preparation of Manuscript for Publication: A short Message for Indonesian Authors Discussion
20.00 – 20.50
20.50 – 21.00
03
SCIENTIFIC SCHEDULE SYMPOSIUM (Reconstructive) Friday, 27 May 2016 07.00 – 08.00
Re – Registration
07.30 – 08.30
Plenary Lecture 4 Moderator: Magda Rosalina Hutagalung (Indonesia) Sandeq B Room Removing the Stigma of the Cleft – David J. David (Australia) Triangular Technique for Bilateral Cleft Lip A.J Rieuwpassa (Indonesia) My Experiences in Cranial Vault Reconstruction Andi Asadul Islam (Indonesia)
07.30 – 07.50 07.50 – 08.10 08.10 – 08.30
08.30 -09.30 08.30 – 08.50 08.50 – 09.10 09.10 – 09.30
Plenary Lecture 5 Moderator: David S. Perdanakusuma (Indonesia) Sandeq B Room Free Perforator Flap in Lower Leg Reconstruction Baek-Kyu Kim ( South Korea) Reconstruction, Lip Versatility of Abbe Flap – Bisono (Indonesia) Condilus Mandibula Reconstruction with K wire and Silicon Block Djohan Wirawan (Indonesia)
09.30 – 10.00
Coffee Break
10.00 – 11.00
Special Symposium (DERMOZONE INDONESIA) Moderator: Sigit Wahyu Jatmiko (Indonesia) The Revolution in Wound Care Sandeq B Room Introduction To Revolution In Wound Care: Several Case Reports Donna Savitry (Indonesia) TBA - Ratna Javita SRG (Indonesia)
10.00 – 10.30 10.30 – 11.00 11.00 – 12.00
11.00 – 11.20
04
Lunch Symposium 2 (PRO HEALTH INT) Innovation from Bench to Bed Side Moderator: Donna Savitry (Indonesia) Sandeq B Room Making Perfection of the Alveolar Bone Graft in Cleft Patient: The Role of BTCP Herman Yosef Limpat (Indonesia)
SCIENTIFIC SCHEDULE 11.20 – 11.40 11.40 – 12.00 12.00 – 13.30 13.30 – 14.30
13.30 – 13.45 13.45 – 14.00 14.00 – 14.15 14.15 – 14.30 13.30 – 14.30 13.30 – 13.45 13.45 – 14.00 14.00 – 14.15 14.15 – 14.30 13.30 – 14.30
13.30 – 13.45 13.45 – 14.00 14.00 – 14.15
14.15 – 14.30
Evolution of Biodegradable Implant in CMF: Personal Experience in FOA Patient Magda Rosalina Hutagalung (Indonesia) Discussion Friday Pray & Lunch SS 4: Burn and Wound Moderator: A. A. G. N. Asmarajaya (Indonesia) Sandeq A Room How to Manage ARDS patients without Ventilator in Burn Unit? Lisa Hasibuan (Indonesia) Hyperbaric Oxygen Therapy in Plastic Surgery Cases: A Systematic Review - Afriyanti Sandhi (Indonesia) Endocrine and Metabolic Changes in Severe Burn I Nyoman P. Riasa (Indonesia) Discussion SS5: A New Clinical Option in Wound Management (MUNDIPHARMA) Moderator: Hardisiswo Soedjana (Indonesia) Sandeq B Room How “Smartpore Techology” can improve Patients Quality of Live ? David S. Perdanakusuma (Indonesia) Sharing Betaplast Experience Brevitra Janesa Bismedi (Indonesia) PVP-I : Myth and Facts in Wound Management Iswinarno Doso Saputro (Indonesia) Discussion SS 6: Facial Reconstruction Moderator: Najatulah (Indonesia) Acacia Room Blepharoptosis: Orbicularis Plication Modied Tarsus Ferdinand (Indonesia) Constricted Ear – Kristaninta Bangun (Indonesia) Alar Nose Reconstruction with Septochondral Mucosal Flap, Cartilage Graft and Island Forehead Flap Djohan Wirawan (Indonesia) Discussion
05
SCIENTIFIC SCHEDULE 13.30 – 15.30
Free Paper 3 – 4 Moderator: Erythrina Permata Sari (Indonesia) Azalea Room
14.30 – 15.45
SS 7: Craniofacial Moderator: Magda Rosalina Hutagalung (Indonesia) Sandeq A Room Facial Trauma Old Fracture Management Siti Handayani (Indonesia) Tetrapod Fracture, Surgical Anatomy Revisited as a Guide for 3D Reduction using Caroll Girard Screw RR. Prasetyanugraheni Kreshanti (Indonesia) Turricephaly Reconstruction in Sanglah General Hospital Made Suka Adnyana (Indonesia) Discussion SS 8: Cleft (SMILE TRAIN) Moderator: Asro S. Surachman (Indonesia) Sandeq B Room The Usage of Ear Cartilage Graft to Improve Aesthetic Performance of the Nose in Cleft Children – Donna Savitry (Indonesia) Our Experience with Nasoalvcolar Molding (NAM) in More Than 80 Cleft Patients - Karina F. Moegni (Indonesia) Nose Revision after Labioplasty – Muhammad Jailani (Indonesia) Discussion
14.30 – 14.45 14.45 – 15.00
15.00 – 15.15 15.15 – 15.45 14.30 – 15.45 14.30 – 14.45 14.45 – 15.00 15.00 – 15.15 15.15 – 15.45 14.30 – 15.45 14.30 – 14.45
14.45 – 15.00 15.00 – 15.15 15.15 – 15.45 15.30 – 16.20
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SS 9: Microsurgery Moderator: Irena Sakura Rini ( Indonesia) Acacia Room Microvascular Radial Forearm Fasciocutaneous Free Flap for Defect Reconstruction on Head and Neck Agus Roy Rusli Hamid (Indonesia) Reconstructive Microsurgery in Craniofacial Tumor Hendra Sanjaya (Indonesia) Finger Replantation : Reported of Twelve Cases in Sanglah General Hospital, Bali-Indonesia - Agus Roy Rusli Hamid (Indonesia) Discussion Free Paper 5 Moderator: Irra Rubianti Widarda (Indonesia) Azalea Room
SCIENTIFIC SCHEDULE 15.45 – 17.00 15.45 – 16.15 16.15 – 16.45 16.45 – 17.00 15.45 – 17.00
SS 10: Hypospadia Tips and Tricks Moderator: Sachraswaty (Indonesia) Sandeq A Room Surgical Management of Short Urethra Chaula L. Sukasah (Indonesia) My Experience Using Standoli’s Technique to Repair Penile Hypospadia - Sumantri Sarimin (Indonesia) Discussion
16.30 – 17.00
SS 11: Miscellaneous 1 Moderator: Parintosa Atmodiwirjo (Indonesia) Sandeq B Room Gambaran Morbiditas Outcome Pasien Bedah Plastik yang Dikerjakan Dokter Non Bedah Plastik di Sumatera Barat 2007-2015 Deddy Saputra (Indonesia) Prole Snake bite Diagnostic and Treatment dr. Muwardi Hospital Amru Sungkar (Indonesia) The Role of Bleomycin in Haemangiomas Herman Yosef Limpat (Indonesia) Discussion SS 12: Miscellaneous 2 Moderator: Dharma P.T.R Maluegha (Indonesia) Acacia Room Challenge in Giant Hemifacial Neurobrome’s Reduction Ruby Riana Asparini (Indonesia) Role of Epithel Growth Factor in Treating Scar / Keloid Poengki Dwi Poerwantoro (Indonesia) Diabetes Mellitus type II Impairs Adipose – Derived Stem Cells Karina F. Moegni (Indonesia) Discussion
18.30 – 21.30
PERAPI NIGHT (Phinisi 1 Room)
15.45 – 16.00
16.00 – 16.15 16.15 – 16.30 16.30 – 17.00 15.45 – 17.00 15.45 – 16.00 16.00 – 16.15 16.15 – 16.30
Instructional Course on Stem-Cell Saturday, 28 May 2016 Sandeq B Room 07.00 – 08.00
Re-Registration
08.00 – 10.00
Session 1 Moderator: Elida Sari Siburian (Indonesia) 07
SCIENTIFIC SCHEDULE 08.00 – 08.20 08.20 – 08.40
09.40 – 10.00
What’s Stem Cell? - Hiroshi Mizuno (Japan) Introduction to Bone Marrow Derived Stem Cells Rica Tanaka (Japan) Introduction to ASCs - Fonny Josh (Indonesia) Harvesting and isolation of adipose derived stem cells Fonny Josh (Indonesia) Introduction to Hematopoietic Stem Cells Ferry Sandra (Indonesia) Discussion
10.00 – 10.30
Coffee Break
10.30 – 12.30 10.30 – 10.50
11.30 – 11.50 11.50 – 12.10 12.10 – 12.30
Session 2 Moderator: Irena Sakura Rini (Indonesia) Adipose Derived Stem Cells in Regenerative Medicine Hiroshi Mizuno (Japan) Clinical application of Adipose derived stem cells in Plastic surgery Hiroshi Mizuno (Japan) Harvesting and Isolation of Bone Marrow Stem Cells Rica Tanaka (Japan) An overview of PRP – Natalie Brenner (Germany) Harvesting PRP – Natalie Brenner (Germany) Discussion
12.30 – 13.00
LUNCH
13.00 – 14.40 13.00 – 13.20
14.20 – 14.40
Session 3 Moderator: Donna Savitry (Indonesia) Harvesting and isolation of hematopoietic stem cells Ferry Sandra (Indonesia) Clinical Application of Bone Derived Marrow Stem Cells Rica Tanaka (Japan) Skin Rejuvenation and Associated Application of PRP Natalie Brenner (Germany) Discussion
14.40 – 15.00
Coffee Break and Closing
15.00 – 21.00
KONKER PERAPI
08.40 – 09.00 09.00 – 09.20 09.20 – 09.40
10.50 – 11.10 11.10 – 11.30
13.20 – 13.40 13.40 – 14.20
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ABSTRACT Moenadjat Memorial Lecture RHINOPLASTY: AESTHETIC AND RECONSTRUCTION ASPECT Sidik Setiamihardja (Indonesia)
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ABSTRACT Plenary Lecture 1 MEDICAL ETHICS Djohansyah Marzoeki (Indonesia)
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ABSTRACT Plenary Lecture 1 PATIENT SAFETY Idrus Paturusi (Indonesia)
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ABSTRACT Plenary Lecture 1 STEPS TO GOOD RESEARCHER: A NOTE TO BEGINNER Din Syafruddin (Indonesia) Senior Research Fellow and Professor Malaria and Vector resistance Laboratory, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430 Department of Parasitology, Faculty of Medicine, Hasanuddin University, Jalan Perintis Kemerdekaan Km 10, Tamalanrea 90245, Makassar, Indonesia
Research in basic human biology and the biomedical sciences is entering the most exciting phase of its development within the last few two decades. However, it is difcult to anticipate when the gains of this explosion in scientic knowledge will become available for the prevention and treatment of the major killers of mankind. Therefore, efforts are now focused to translate the major discoveries in basic science into tool (s) that may facilitate diagnosis, treatment and prevention of diseases, particularly in developing countries where infectious diseases are still dominant - thus underlines the importance of clinical research at hospital and community levels. Clinical research pertains research conducted on humans or human tissues that makes use of patient data. This Includes study of disease mechanisms, therapeutic interventions, epidemiology, and clinical trials, aimed at understanding human disease and improving human health. Interaction between researchers and patient data is a key feature. This talk focuses on how to create a good clinical researcher among the Indonesian medical professionals. The basic qualities of a good researcher including clinical researcher in general are intelligence, honesty, curiosity and initiative, enough knowledge, and good in oral and written communication. Steps in clinical research includes: pre-investigation step: identify the problem, collect and evaluate existing information ( state-of-the-art ), formulate research objective and hypotheses, identify the study subjects, think of the study design, write the study protocol, and develop the tool. Investigation step includes: pretest and pilot study, collect the data, handle the non-response and ethical issues, scrutinize the data. Post-investigation step includes: analyse the data, interprets the results, write and disseminate the reports and monitor the reaction. The detail of each step will be discussed during presentation.
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ABSTRACT Plenary Lecture 2 THE FUTURE OF ADIPOSE DERIVED STEM CELL IN PLASTIC SURGERY Hiroshi Mizuno (Japan)
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ABSTRACT Plenary Lecture 2 VASCULAR STEM CELLS THERAPY FOR TISSUE REGENERATION Rica Tanaka (Japan)
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ABSTRACT Lunch Symposium 1 (BSN) EFFICACY AND TOLERABILITY OF CUTICELL FOR BURN CASES Iswinarno Doso Saputro (Indonesia)
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ABSTRACT Plenary Lecture 3 AESTHETIC FACIAL
CONTOURING
David J. David (Australia) The relationship between aesthetic surgery of the head and neck and craniomaxillofacial surgery is a close one. Many of the mainstream aesthetic manoeuvres have taken their inspiration from repair of severe craniofacial defonnities. Conversely the need for craniofacial surgeons to remove the ultimate stigmata of the diseases that they treat relies heavily on their ability in and knowledge of aesthetic surgical techniques. The basis of facial contouring is the rule outlined by Pichler “rst the bone then the soft tissue”. This presentation deals with the techniques, of reshaping the face in patients with “deformity” and in purely aesthetic cases. Such surgery presupposes knowledge of the aesthetic norms for the society and the wishes of the patient. Understanding of anthropon1etrics and cephalometries becomes essential for the surgeon. The treatment 1nodalities consist of osteotomies, onlay procedures, soft tissue sculpturing and soft tissue augmentation. Somme common complications are addressed.
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ABSTRACT Plenary Lecture 3 AESTHETIC SURGERY OF THE FACIAL SKELETON Rong-Min Baek (South Korea) Department of Plastic Surgery Seoul National University College of Medicine Seoul, Korea The standard of beauty is a matter of individual or cultural opinion. The Asians have their own view of beauty and it is fairly different from that of other ethnic populations. Also, most Asians do not want to lose their ethnic identity after aesthetic surgery. However, there are certain facial skeletal features that, although frequently seen among the Asian population, are regarded as poor facial aesthetics: a narrow and at forehead, prominent malar eminences, a convex lower facial prole, hypoplastic paranasal areas, and prominent mandibular angles. With advancement of the knowledge and technique of the craniomaxillofacial surgery, forehead plasty, malaplasty, aesthetic orthognathic surgery, and mandibular contouring surgery added important armory to correct these aesthetic weakness. With one or combination of these aesthetic surgeries of the facial skeleton, the plastic surgeon gives harmony, balance, and proportion to the facial prole to make aesthetically pleasing appearance of the face.
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ABSTRACT Plenary Lecture 3 STEM CELL FACELIF Dr.Brenner, Natalia, Bonn, (Germany) The stem cell facelift is a complete facial rejuvenation procedure. The main function is to restore both the youthful contour and shape of the face. Another goal is to improve the skin quality and color irregularities caused by both the aging process and exposure to the sun and environment. Adipose tissue has been considerred an organ of energy storage and the lagest endocrine organ . It was found that the adipose cell population contains not only monopotent progenitor cells but also multipotent mesenchymal Stem Cells (Adipose Derived StemCells – ADSCs). ADSCs are regarded as a potent tool for cell-‐base therapies, comparable to bone marrow-‐derived mesenchymal SC, because they can be obtained in a large amount throught a less invasive approach, liposuction. Liposuction aspirates are composed of two parts-‐ fat tissue and SVF. Mesnchymal Stem Cells can be separated from SVF. Our study identired freshly isolated ASCs as CD31-‐CD34+CD45-‐CD90+ cells. The Stem Cell Facelift is different from a conventional Fat Grafting and Lipo transfer. Fat grafting or Lipo Transfer is the process of transferring the fat to an area, but the stem cells are “locked” inside the tissue stroma. Real Stem Cell Facelifts isolate the stem cells from the fat itself and then reintroduce the stem cells into the desired area. Applications of ADSCs in plastic and reconstructive surgery shows a great promise in repair of skin lesions. In summary is to determine that the StemCell Facelift is a good Complement to conventional Facelift operations. It Must be performed more than once to achieve good results . Must be done by experienced stem cell doctors with the use of certied laboratory. Technologies for Fat Processing, Harvesting and Application must be standardized to achieve better results in ASC-‐Usage
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ABSTRACT SS 1: Facial Aesthetic 1 THE ART of MINIFACE LIFT Irena Sakura Rini (Indonesia)
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ABSTRACT SS 1: Facial Aesthetic 1 THREAD LIFT Enrina Diah Nurmeirini (Indonesia)
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ABSTRACT SS 1: Facial Aesthetic 1 THREAD LIFT FOR FACIAL CONTOURING Bambang Wicaksono (Indonesia)
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ABSTRACT SS 1: Facial Aesthetic 1 NOSE CONTOURING Sumantri Sarimin (Indonesia)
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ABSTRACT SS 2: Facial Aesthetic 2 SUTURE SUSPENSION BROWPEXY Tomie Hermawan Soekamto (Indonesia) Current aesthetic literature reects a renewed interest in the subcutaneous brow lift. Management of eyebrow ptosis remains a most challenging problem. No single superior solution for brow ptosis currently available. The closed transcutaneous thread brow lift is not a new approach, encompass the principle concept of stable suturing and xation of mobile fascias to immobile periosteum resulting in suture suspension and/or repositioning. This technique has not had widespread acceptance. The surgical result of brow rejuvenation depends on the type of deformity, the procedure done and the quality of its execution. Lesser procedures generally produce lesser results but for patient’s appropriate expectations may be adequate. Keyword: brow rejuvenation, suture suspension, lesser procedures
SS 2: Facial Aesthetic 2 23
ABSTRACT SS 1: Facial Aesthetic 1 NOSE CONTOURING Sumantri Sarimin (Indonesia)
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ABSTRACT SS 2: Facial Aesthetic 2 SUTURE SUSPENSION BROWPEXY Tomie Hermawan Soekamto (Indonesia) Current aesthetic literature reects a renewed interest in the subcutaneous brow lift. Management of eyebrow ptosis remains a most challenging problem. No single superior solution for brow ptosis currently available. The closed transcutaneous thread brow lift is not a new approach, encompass the principle concept of stable suturing and xation of mobile fascias to immobile periosteum resulting in suture suspension and/or repositioning. This technique has not had widespread acceptance. The surgical result of brow rejuvenation depends on the type of deformity, the procedure done and the quality of its execution. Lesser procedures generally produce lesser results but for patient’s appropriate expectations may be adequate. Keyword: brow rejuvenation, suture suspension, lesser procedures
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ABSTRACT SS 2: Facial Aesthetic 2 BROWLIFT ENDOSCOPY Hendri Andreas (Indonesia) Eyelid sagging with aging. Sometimes it is not the real sagging of eyelids, but eyelids look sag because of eyebrow sagging. In that case, eyelid surgery must be prohibited. if middle age woman have upper blepharoplasty because they think their eyelids sag, facial image will turn strong and rough. Doing so without any examination could lead to strong appearance. And the thickening eyelid will give unnatural look. Sometimes Patients tend to ask doctor about their thick eyelid. They remove any excessfat from the upper lid that leads to sunken eyelid. Especially on older patients.Therefore they must have forehead eyebrow lift. If young people with have no sagging brow, can do double eyelid surgery only. If it is necessary, endobrowlift can do with double eyelid surgery simultaneously. So, if people want to do the eyelid surgery, the problem should be diagnosed rst. The problem is brow, eyelid or both. Lots of patients thought that the problem is the sagging of eyelid(s), but to determine the problem we have to thoroughly do the physical examination of the patient’s periorbital area. Brow lift surgery is curicial before the upper lid procedure. Endoscopic browlift have advantages, could hide scars and heals faster than open procedure.
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ABSTRACT SS 2: Facial Aesthetic 2 UPPER LID BLEPHAROPLASTY: FAT TRANSPOSITION Ferdinand (Indonesia)
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ABSTRACT SS 3: Breast BREAST IMPLANT: ROUND OR TEARDROP SHAPE, WHICH ONE BETTER? Hendri Andreas (Indonesia) Choosing a right breast implant is very important before breast augmentation operation. The breast implant is chosen by based on size and customer’s needs/taste. Every breast implant is unique in itself with their own pros and cons that makes it customizable to patients’ condition. The right breast implant should improve the condition of the breast. There are several types of breasts implant. Based on their looks, there are round and teardrop shape. Two different textures: textured or smooth. Lastly, Polyurethane-based implant that could prevent the risk of Capsular Contracture There are 2 types of lling, saline-lled implant and silicone-lled implant. Saline would feel rmer compared to softer silicone. In choosing the right breast implant, we have to nd one which is suitable. Base on the measurements, width of the breasts, height of the breasts and ratio between width and height, to gure out whether they have higher breasts, normal breasts or lower breasts. For high and normal breast position, we can use round shape, while for low breast is teardrop shape, because it can give volume to upper part of breast to make the appearance less hollow. Incision area to facilitate implant is also important to discuss. These areas are inframammary fold, auxiliary and infra-areola, in connection with the post-surgical scars. To prevent the forming of keloid, we have to be careful on the place of the scars so it can be hidden scars on infraareola could fade along the changes of skin and areola’s colour. Scars on inframammary could be closed if glandular ptosis present, there is a risk of visible if the breasts are exposed. Scars on these areas have to be extremely thought because Asian skins tend to have darker shades, especially on at-chested that make it more difcult to hide. The thickness of breasts is also something to consider, because thin breasts tend to show rippling especially when using round cohesive 1 or saline.
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ABSTRACT SS 3: Breast ENDOSCOPIC ASSISTED BREAST AUGMENTATION Dharma P. T. R. Maluegha (Indonesia)
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ABSTRACT SS 3: Breast LARGE GYNECOMASTIA WITH NIPPLE REPOSITIONING UTILIZING THE DERMATOGLANDULER FLAP Hardisiswo Soedjana (Indonesia)
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ABSTRACT Plenary Lecture 4 REMOVING THE STIGMA OF THE CLEFT David J. David (Australia) The outcome of treatn1ent for deft lip and palate was once conned to repairing the lip rst and later the palate. Greater understanding of the condition, a more afuent society and the introduction of protocol management from birth to maturity has opened the way to a more demanding patient body . The stigmata are not only the facial shape , lip and nose deformities but dental malalignment and deft speech Each of these is dealt with as part of the modern protocol, however there are additional subtle deformities that need to be addressed to get as good a result as possible and these draw on the techniques shares with general plastic surgery and aesthetic surgery of the face.
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ABSTRACT Plenary Lecture 4 TRIANGULAR TECHNIQUE FOR BILATERAL CLEFT LIP A.J Rieuwpassa (Indonesia)
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ABSTRACT Plenary Lecture 4 MY EXPERIENCES IN CRANIAL VAULT RECONSTRUCTION Andi Asadul Islam (Indonesia)
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ABSTRACT Plenary Lecture 5 FREE PERFORATOR PERFORATOR FLAP IN LOWER LEG RECONSTRUCTION Baek-Kyu Kim ( South Korea) Free perforator aps are very useful options in lower extremity reconstruction. The relatively constant anatomical structures of lower leg vessels make it possible to apply to all the different location. But the approach to reconstructions of lower extremity should be cautious in the aspects of the difference in the features of lower leg vessels. ASO, calcication, traumatic injury are more common in lower extremity and the selection of the recipient vessel is a hard task because of the relationship between the soft tissue and skeletal framework. The reconstruction site and the operating position of patients are important factors in the selection of the recipient vessel. All of the main vessels in lower extremity can be used as a recipient vessel, but also the pedicle of common donor ap site could be used as a recipient vessel. The most important thing is to avoid injury zone. Lateral circumex femoral a (especially descending branch) can be useful in anterior portion defect of thigh and on knee level, geniculate artery can be a candidate. At posterior thigh, we can choose the perforating branch from supercial or deep femoral artery. Popliteal artery can be used on knee level. In anterior lower leg, the anterior tibia artery can be selected with knee extension, and the posterior tibia artery with knee exion. The peroneal artery is difcult to use because it is hidden by bular bone. After selecting the recipient vessel, the anastomosis area should be considerately chosen. If the patients have peripheral arterial diseases like diabetes, surgeons must evaluate the status of recipient vessels. Percutaneous transluminal angioplasty or bypass surgery is the mandatory step for overcoming the hurdle of diseased vessels. In the cases of traumatic defect, the zone of injury is not recommended for anastomosis because the thrombosis rate is very high in there.
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ABSTRACT Plenary Lecture 5 RECONSTRUCTION, LIP VERSATILITY OF ABBE FLAP Bisono (Indonesia) Due to its very unique characters, the best donor to reconstruct lip deffect is the still existing lip tissue; rearrange and re unite using ap technique if necessary. Abbe found a technique of sharing, closing the deffect using opposite lip tissue as a ap, based on labial artery on the rich vascularization of lip tissue as pedide To reconstruct lip, we have to familiarize with normal lip look and shape which also depends on the position of alveolus and teeth behind the lip that support lip position. Many special techniques have been found to reconstruct Congenital Deffect. Understanding of ap construction technique should be have in adult cases,so that we can try to do Total Reconstruction, where as in babies we should remember / be warned by the principle of Functional Matrix. Minute structures could catch up growth in time to normal affer being united with the surrounding structure. Abbe ap is very versatile to reconstruct congenital deffect, deect due to trauma / infection / tumor removal / or imperfect result of previous reconstruction. It can close almost 80% loss of lip beautifully.
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ABSTRACT Plenary Lecture 5 CONDILUS MANDIBULA RECONSTRUCTION WITH K WIRE AND SILICON BLOCK Djohan Wirawan (Indonesia)
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ABSTRACT Special Symposium (DERMOZONE INDONESIA) Donna Savitry (Indonesia) Introduction To Revolution In Wound Care: Several Case Reports Background: In Indonesia those who suffered from diabetes mellitus type II or other chronic wounds is like an iceberg phenomenon, only a few that can be detected on the surface. Some reason are the lack of money and knowledge about the wound, the expensiveness of the cost of the medicine, the long period of time to heal the wound, etc. Medcare dermozone has already used in United Kingdom for 6 years as an alternative choice to heal the chronic wound. Method: We reported several cases with various wound, observed and noted to see the efcacy of the ointment. Result/Conclusion: In the average the wounds healed quickly, the prominent thing is the bad odor reduce very quick that indicate the aseptic environment and also the rapid growth of granulation tissue that can even cover the exposed bone or plate.
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ABSTRACT Special Symposium (DERMOZONE INDONESIA) Javita SRG (Indonesia)
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ABSTRACT Lunch Symposium 2 (PRO HEALTH INT) Innovation from Bench to Bed Side MAKING PERFECTION OF THE ALVEOLAR BONE GRAFT IN CLEFT PATIENT: THE ROLE OF BTCP Herman Yosef Limpat (Indonesia)
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ABSTRACT Lunch Symposium 2 (PRO HEALTH INT) Innovation from Bench to Bed Side EVOLUTION OF BIODEGRADABLE IMPLANT IN CMF: PERSONAL EXPERIENCE IN FOA PATIENT Magda Rosalina Hutagalung (Indonesia)
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ABSTRACT SS 4: Burn and Wound HOW TO MANAGE ARDS PATIENTS WITHOUT VENTILATOR IN BURN UNIT? Lisa Hasibuan Hasan Sadikin General Hospital - University of Padjadjaran, Bandung, Indonesia Lesson learned by the author for more than 15 years treating burn patients, there is a pattern occuring in most burn patients, but particularly in more severe presentations, such as in sepsis and inhalation injury cases. In acute phases, uid resuscitation is administered to all burn patients. Reaching third to fth day, tachycardia and dyspnea begin to present, and without proper interventions, in fth to seventh day postburn, culminated in death. In our facility, the burn unit is not equipped with ventilator. Furthermore, we always had difculties in admitting patients with inhalation injury to intensive care unit due to the limited number of ventilators. Other setback, if burn patients are admitted to the General ICU, the wound management for patients with larger burn areas is challenging for the ICU personnels, unlike in our burn unit and its trained personnels. The question in my mind: can we do something to help ARDS patients survive without ventilator? To date, we have learned from our inhalation injury cases to develop a detailed protocol in our burn unit. Patients with conrmed inhalation injury will be intubated and admitted to Burn Unit. The endotracheal tube is connected to T-piece and the patient breathes spontaneously. Fluid resuscitation is continued until reaching adequate urine output in the rst two days, while maintaining low central venous pressure. In the third day, spontaneous uid back ow from interstitial to circulation occurs, increasing cardiac preload profoundly. We administer either colloid, fresh frozen plasma, or albumin to augment the back ow process then administer furosemide drip to make it relatively “dry” and hence reducing cardiac preload and preventing pulmonary edema. In the third to fth day, we attempt to control hypermetabolic response using beta-blocker and dobutamine when necessary. Now we have nine survivors out of eighteen
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ABSTRACT SS 4: Burn and Wound HYPERBARIC OXYGEN THERAPY IN PLASTIC SURGERY CASES: A SYSTEMATIC REVIEW Afriyanti Sandhi (Indonesia) Plastic Reconstructive and Aesthetic Surgeon Dr. Suyoto Pusrehab Kemhan Hospital, Jakarta, Indonesia BACKGROUNDS: Diabetic Wounds, Venous Ulcers and Chronic Burn Wounds are the most challenging chronic wound cases in Plastic Surgery; and has been accepted by Hyperbaric Oxygen Therapy Committee of The Undersea and Hyperbaric Medical Society as the appropriate indication for Hyperbaric Oxygen Therapy (HBOT). Various pathologies may cause tissue breakdown, including poor blood supply resulting in inadequate oxygenation of the wound bed. HBOT has been suggested to improve oxygen supply to wounds and therefore improve the healing process. METHODS: This paper provides a systematic review of the literature reporting the results of HBOT in the treatment and prophylaxis. Evidence Based Medicine (EBM) is designed to discover the best evidence available and apply it in daily practice for treatment of individual patient. The preferred level of evidence is the randomized controlled trial, however, other evidence has merit as well. RESULTS: We included eleven trials in this study. Eight trials for diabetic foot ulcer (total 452 subjects); pooled data of three trials (140 subjects) revealed an increase in the rate of ulcer healing with HBOT at six weeks (RR 5.20; 95% CI 1.25 – 21.66; p 0.02), but there was no evident for long term follow up at one year and pooled data of ve trials (312 subjects) showed no statistically signicant difference in major amputation rate (RR 0.36; 95%CI 0.11 – 1.18). One trial (16 subjects) considered for venous ulcers suggested a signicant benet of HBOT in terms of wound size reduction at six week (MD 33%; 95% CI 18.97 – 47.03; p<0.00001). Two trials (141 subjects) for burns, but those two trials were poor of methodological quality and it was difcult to have condence in the individual results and was not appropriate to pool the data. CONCLUSIONS: This review found that HBOT seems to improve the chance of healing in diabetic foot ulcer and may reduce the major amputation. And as adjunctive therapy, HBOT may reduce the size of the wounds in venous ulcer. In terms of burns therapy, we found no sufcient evidence to support or refuse HBOT for the management of burns injury. Further research is needed to better dene the role of HBOT in the treatment of chronic wounds and burns. Keywords: Hyperbaric oxygen therapy, chronic wounds, burns, systematic review.
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ABSTRACT SS 4: Burn and Wound ENDOCRINE AND METABOLIC CHANGES IN SEVERE BURN I Nyoman P. Riasa (Indonesia), Hendra Sanjaya (Indonesia). Despite advances in major burn resuscitation, and its surgical treatment, endocrine and metabolic dysfunction still remains a signicant cause of morbidity and mortality in burn patients. Severe burn injury is characterized by hypermetabolism and catabolism proportional to burn surface area. Severe burns have the most intense and prolonged catabolic response of all ‘surgical’ ICU patients. This metabolic prole includes changes in glucose homeostasis and muscle protein metabolism that persist from the rst few days following injury to as long as three years later. The hypermetabolic response is associated with high REE and release of substrate from protein and fat stores. Increase Rate of protein catabolism lead to loss of LBM and protein wasting. Muscles proteolysis continues until 6 months, and resulted in increasing delay in rehabilitation, other complication and death. Insulin resistance is a critical part of the etiology of hyperglycemia after burn and its etiology is poorly understood. Hyperglycemia and loss of muscle mass that are attendant with catabolism have a central role in determining the prognosis of burn patients. Healing of burn wounds is an anabolic process which consumes massive amounts of amino acids, supplied by breakdown of skeletal muscle. Simple and effective anabolic strategies are early burn wound excision and skin grafting, sepsis elimination, prompt environment temperature (30 32° C), continuous high carbohydrate and protein diet (enteral route) and early institution of vigorous excercise program. Further anabolic strategies aimed on reducing erosion of LBM at minimum level, administration of anabolic agents such as recombinant human growth hormone, Insulin, Metformin, Oxandrolone and anti-catabolic drugs (propanolol).
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ABSTRACT SS5: A New Clinical Option in Wound Management (MUNDIPHARMA) HOW “SMARTPORE TECHOLOGY” CAN IMPROVE PATIENTS QUALITY OF LIVE ? David S. Perdanakusuma (Indonesia)
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ABSTRACT SS5: A New Clinical Option in Wound Management (MUNDIPHARMA) SHARING BETAPLAST EXPERIENCE Brevitra Janesa Bismedi (Indonesia)
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ABSTRACT SS5: A New Clinical Option in Wound Management (MUNDIPHARMA) PVP-I : MYTH AND FACTS IN WOUND MANAGEMENT Iswinarno Doso Saputro (Indonesia)
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ABSTRACT SS 6: Facial Reconstruction BLEPHAROPTOSIS: ORBICULARIS PLICATION MODIFIED TARSUS Ferdinand (Indonesia)
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ABSTRACT SS 6: Facial Reconstruction CONSTRICTED EAR Kristaninta Bangun (Indonesia)
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ABSTRACT SS 6: Facial Reconstruction ALAR NOSE RECONSTRUCTION WITH SEPTOCHONDRAL MUCOSAL FLAP, CARTILAGE GRAFT AND ISLAND FOREHEAD FLAP Djohan Wirawan (Indonesia)
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ABSTRACT SS 7: Craniofacial FACIAL TRAUMA OLD FRACTURE MANAGEMENT Siti Handayani (Indonesia)
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ABSTRACT SS 7: Craniofacial TETRAPOD FRACTURE, SURGICAL ANATOMY REVISITED AS A GUIDE FOR 3D REDUCTION USING CAROLL GIRARD SCREW RR. Prasetyanugraheni Kreshanti (Indonesia)
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ABSTRACT SS 7: Craniofacial TURRICEPHALY RECONSTRUCTION IN SANGLAH GENERAL HOSPITAL I Made Suka Adnyana (Indonesia) Division of Plastic Reconstruction and Aesthetic Surgery, Department of Surgery, Udayana University-Sanglah Hospital, Denpasar- Bali Turrycephaly characterized by abnormal tall head caused by premature fusion of both coronal suture, though others suture may also be involved. This abnormality commonly related to craniofacial syndromes such as Crauzon, Apert, and Pfeiffer. This article describes a case of 5 year old boy present with tall head, forehead slopes backward, proptosis,normal maxilla and occlusion, papill athropy, delay speaking. The head CT shows bicoronal synostosis. A fronto orbita advacemen and anterior cranial vault reshaping was performed to correct the deformity. Signicant cosmetic improvement was achieved after surgery.
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ABSTRACT SS 8: Cleft (SMILE TRAIN) THE USAGE OF EAR CARTILAGE GRAFT TO IMPROVE AESTHETIC PERFORMANCE OF THE NOSE IN CLEFT CHILDREN Donna Savitry (Indonesia) Background: As a plastic surgeon I know that nose repair in cleft patients is not easy, usually takes some surgeries to make it good. And in school age the pateints usually have low self condence in thei school because of the nose. The sun-shield method of using ear cartilage graft works really well in adult for aesthetic result, so why not using this method to improve the aesthetic performance of the nose in cleft children? Method: Twelve cleft patients age 4-12 years old had rhinoplasty using ear cartilage graft in the sun-shield method. The results were observed by comparing the photographs before and after surgeries in 1-2 weeks post op. Result/Conclusion: The aesthetic performance of the repaired nose looks better and both parents and children are happy with the result.
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ABSTRACT SS 8: Cleft (SMILE TRAIN) OUR EXPERIENCE WITH NASOALVCOLAR MOLDING (NAM) IN MORE THAN 80 CLEFT PATIENTS Karina F. Moegni (Indonesia)
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ABSTRACT SS 8: Cleft (SMILE TRAIN) NOSE REVISION AFTER LABIOPLASTY Muhammad Jailani (Indonesia)
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ABSTRACT SS 9: Microsurgery MICROVASCULAR RADIAL FOREARM FASCIOCUTANEOUS FREE FLAP FOR DEFECT RECONSTRUCTION ON HEAD AND NECK Agus Roy Rusli Hamid (Indonesia) Sub Division of Hand Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, School of Medicine Udayana University Sanglah General Hospital, Denpasar-Bali Indonesia Purpose: The aim of this study is to report 3 cases facial defects reconstruction by microvascular radial forearm fasciocutaneous free ap (RFFF). Material and Methods: Reported 3 patients who had facial defects, 1 patient with post NOMA Infection, 1 patient with large haemangiomas on upper eyelid and 1 patient with defect of palatal after palatoplasty. All the patients were immediately reconstructed using RFFF after resection and excision. Patient with large haemangioma, following palmaris longus tendon for ptosis correction immediately. Vascular anastomoses were done with the facial vessels in the neck. All the patients underwent a lateral thigh splitthickness skin graft for closure of the donor site. Outcome measurements included postoperative assessment of ap survival and healing. Results: Flap survival was successful in all cases. Complication include, haematoma occure in patient with NOMA and perfomed hematoma evacuation. All donor site were healing good, no hand functional loss. Conclusion: RFFF for soft tissue reconstruction for facial defect is a reliable technique. It is thin, pliable skin ap and Acceptable functional morbidity at donor site. Key Words : Facial Defect- radial forearm fasciocutaneous free ap (RFFF).
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ABSTRACT SS 9: Microsurgery RECONSTRUCTIVE MICROSURGERY IN CRANIOFACIAL TUMOR Hendra Sanjaya (Indonesia)
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ABSTRACT SS 9: Microsurgery FINGER REPLANTATION : REPORTED OF TWELVE CASES IN SANGLAH GENERAL HOSPITAL, BALI-INDONESIA Agus Roy Rusli Hamid (Indonesia) Sub Division of Hand & Microsurgery Division of Plastic, Reconstructive and Aesthetic Surgery Department of Surgery, School of Medicine, Udayana University/ Sanglah General Hospital, Denpasar-Bali, Indonesia Background: Replantation should be the prime indications for treatment of amputated hands and ngers, due to functional and aesthetic advantages. The absolute indications for replantation are thumb, multiple ngers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Type of injury, sharp amputation is a good indication, while blunt amputations are less likely to be regarded as indications for replantation. With proper management of the amputated nger, replantation can be attempted even after 24 hours. Case Report: This study reports twelve cases of nger replantation were received in hand and microsurgery sub division during the period of 2014-2015. Eleven patients were male and one was female. Three patients were child, who accidentally cut their nger while playing. Other nine patients with the age of 20-30 years old, the mechanism of amputation due to machine injury, cut by knife, and motorbike accident. 84% replant survivals were achieved, after a period of follow up with occupational therapy the patients regain good functional and cosmetic results. One patient got vein problem, and we using letches for remove the clot. Two patients were failed due to arterial problem. Conclusion: Functional outcome of replanted ngers will never equal that of the normal healthy counterpart, but replantation has major functional, cosmetic, and psychological benets. Our patients were very satised with their replanted ngers, which have helped them to return to a better quality of life. Keywords : Amputation, nger replantation
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ABSTRACT 10: Hypospadia Tips and Tricks SURGICAL MANAGEMENT OF SHORT URETHRA Chaula L. Sukasah (Indonesia)
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ABSTRACT 10: Hypospadia Tips and Tricks MY EXPERIENCE USING STANDOLI’S TECHNIQUE TO REPAIR PENILE HYPOSPADIA Sumantri Sarimin (Indonesia)
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ABSTRACT SS 11: Miscellaneous 1 GAMBARAN MORBIDITAS OUTCOME PASIEN BEDAH PLASTIK YANG DIKERJAKAN DOKTER NON BEDAH PLASTIK DI SUMATERA BARAT 2007- 2015 Deddy Saputra (Indonesia)
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ABSTRACT SS 11: Miscellaneous 1 PROFILE SNAKE BITE DIAGNOSTIC AND TREATMENT DR. MUWARDI HOSPITAL Amru Sungkar (Indonesia) Plastic and Reconstructive Surgery Division,Department of Surgery , Medical Faculty of 11 March University -Dr Moewardi General Hospital Surakarta Backgrounds: Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Snake venoms are rich in protein and peptide toxins that have specicity for a wide range of tissue receptors, making them clinically challenging and scientically fascinating, especially for drug design. Although the full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. There are view of complications that may arise from snake bite, one of them is compartment syndrome. We presented a descriptive retrospective study at Dr. Moewardi General Hospital Surakarta between January 2013 – Maret 2016, we found 91 patients and evalute including gender, age, time arrived at hospital, types of snakeclinical presentation, laboratory nding, amounts SABU injection, medical treatment, and length stay at hospital. Clinical presentation such as hematotoxin, neurotoxin, and swollen, bulla, trombositopenia, abnormal PT/APTT, fasciotomy, debridement , necrotomy and skingrafting Result: The most victim is male at age 21-50 , the majority without envenomiation, the clinical manifestation is haematotoxin, compartment syndrome, venom serum is given 1-2 vial according clinical examination, intervention treatment usually due to compartment syndrome with fasciotomies and delayed skingrafting . One patient died due to cardiac failure from neurotoxin venom. Keyword: snake bite, snake venoms, anti venoms ,compartment syndrome, skingrafting
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ABSTRACT SS 11: Miscellaneous 1 THE ROLE OF BLEOMYCIN IN HAEMANGIOMAS Herman Yosef Limpat (Indonesia) Latar Belakang: Anomali vaskuler adalah sekelompok kelainan kongenital pada pembuluh darah. Tahun 1982, Mulliken dan Glowacki mengklasikasikan anomali vaskuler dalam dua tipe yaitu tumor vaskuler dan malformasi vaskuler. Tumor vaskuler merupakan neoplasma endotel yang ditandai dengan hyperplasia sel vaskuler berselubung kapiler dengan sel endotel dan perisit yang meluas membentuk lobular. Hemangioma merupakan tipe tumor vaskuler yang paling sering muncul. Kategori kedua dari anomali vaskuler adalah malformasi vaskuler, yaitu jaringan ireguler pembuluh-pembuluh darah. Diagnosis: Diagnosis hemangioma didapat dari anamnesis, pemeriksaan sik dan pemeriksaan penunjang. Dari anamnesis dan pemeriksaan sik, hemangioma muncul pada pada masa neonatal, biasanya dalam 2 minggu pertama. Hemangioma viseral atau tumor subkutan dalam, mungkin tidak bermanifestasi sampai 2 hingga 3 bulan kehidupan. Sekitar 30% sampai 40% dari hemangioma baru terbentuk pada saat muncul sebagai tanda awal pada kulit yaitu daerah pucat nyaris tak terlihat, telangiektasi, atau bercak makula merah atau bercak ekimosis. Hemangioma kongenital adalah varian langka yang tumbuh sejak dalam kandungan dan telah terbentuk sepenuhnya pada saat lahir Penatalaksanaan: Hemangioma yang tumbuh biasanya diiringi penonjolan dan terdapat kulis ekstra. Ditentukan tindakan misalnya dengan eksisi sirkular dan purse-string closure sebagai prosedur primer yang menghasilkan bekas luka minimal. Tindakan bedah yang dilakukan disesuaikan dengan umur penderita dan fase dari hemangioma. Selain tindakan bedah, terdapat juga beberapa pilihan tindakan, seperti observasi, pemberian obat obatan atau injeksi bleomycin. Bleomycin A5 digunakan sebagai terapi hemangioma dan malformasi vaskuler dengan cara injeksi bleomycin intralesi. Bleomycin telah berhasil digunakan dalam pengobatan hemangioma dan semua jenis malformasi vaskuler kecuali port wine stain (malformasi kapiler), dimana terapi laser lebih baik karena sulit untuk menyuntikkan ke dalam pembuluh yang halus. Meskipun merupakan pengobatan yang cukup baru, namun efektivitas dan keamanan obat telah dipelajari secara luas dan pengobatan telah terbukti memiliki tingkat keberhasilan yang tinggi. Bleomycin A5 akan mempengaruhi sel lapisan pembuluh dan menyebabkan sel tersebut menghilang dan terkurangi jumlahnya, sehingga lesi akan mengecil ukurannya, warna lebih pudar, dan lesi berkurang penonjolannya Prognosis: Pada umumnya prognosis hemangioma dan malformasi vaskuler baik, bergantung pada letak lesi, komplikasi, serta penanganan yang baik. Kata kunci Bleomisin pada hemangioma, malformasi vaskular, non operatif terapi pada hemangioma 63
ABSTRACT SS 12: Miscellaneous 2 CHALLENGE IN GIANT HEMIFACIAL NEUROFIBROME’S REDUCTION : A CASE REPORT AND LITERATURE REVIEW Ruby Riana Asparini (Indonesia) Ruby Riana Asparini(1), Sitti Rizaliyana(2), Radias Dwi Padmani(3) (1)Surgery Department of Medical Faculty of Malang Muhammadiyah University, Malang, Indonesia (2) Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine/ Dr. Soetomo General Hospital, Surabaya, Indonesia (3)Bhakti Dharma Husada Hospital, Surabaya, Indonesia Neurobromatosis type 1 (NF-1), rst described by Von Recklinghausen (1882), is an autosomal dominant disease caused by a spectrum of mutations in the NF-1 gene. Prevalence in the general population is approximately 1/3000 births. A hallmark clinical feature of NF1 is multiple dermal neurobromas, benign tumours that typically appear in early adolescence and increase in numbers throughout life. The pathogenesis of these tumours is not known. Facial nerve neurobromas (FNN) are most commonly located in the parotid gland. We report a case of giant facial neurobroma in 26 years old male patient without family history of neurobromatosis type 1. Features typical of neurobroma, including an enlarged nerve fascicle composed of elongated nuclei and scant cytoplasmic cells, were identied. Excision was performed with preservation of parotid duct. The mass weight was about 4,9 kg. There were some challenges during the procedure, such as bleeding, hypovolemia, preservation of vital structure.
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ABSTRACT SS 12: Miscellaneous 2 ROLE OF EPITHEL GROWTH FACTOR IN TREATING SCAR / KELOID Poengki Dwi Poerwantoro (Indonesia)
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ABSTRACT SS 12: Miscellaneous 2 DIABETES MELLITUS TYPE II IMPAIRS ADIPOSE – DERIVED STEM CELLS Karina F. Moegni (Indonesia)
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FREE PAPER SCHEDULE g n i t n n a e : v e c i r p a r P a r l F b r f o e e r p y e y p F H a i f r n y o e s d u t h i t c T s o e b S f l f n a m E e g o m e y r i h x h n T O T A
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FREE PAPER SCHEDULE r o e y n g t i n r , ) o a i l b s r s D i k a i t b i u n d n u a c n d r a s n l r i d t l e a l i e a n e a R d t s i a u h o u t S J C l d s t , F g i n a n S r a 5 n n n n f W e I v t n o A a 1 P m o y r i o l l i o n o t e u n a i t o s S t y s r 0 a a a n o n a e t n n c i r c i a F 2 n r i i i z r d e o v r m e O i s n u i e f ) p l e H t t e n g r i f S b a g i u e h o l u l a t o e t s A t T i a i z o a g l p h n O H m e l l o f h r i r W e w i x t a e t o a o t i S e P a R t r E P S l c ( R t i n R C c d s u ( e t c p , t l s c s a e f e n n c U l D i e E s l a a a t e f r g e o : l i a f n s b s r i t o n n n l r a k a i h E o e D e t e i c f d t b u p 2 t c o i i r v c i o a r r c t e l i e a B o r t e r o a n s o 1 h e r b i e h t a i 0 n T G P F N T S C S P G M B A I H 2 e e v v o i i t t c c m c u u o i o o y t r t r t t t t t i e a e s o y p p s i s i h l n n t r a C t C l S b a a o o s e t v . i i , , c c y y i r a p i e y c e n D a e y a r r r r r i e e p s s i t A U u R e R e s g o e , g g o s s d e S , g r r e a r r a i H H n c c l n u u l n i i u S o o t u S o n a t P a g c t o i s s S f d g S f e n d i f d a a v a e p c o m c o m o t n l i n i u I u I s l t t t i l t t P P r M o f e n s s f e n s s n c i u a o h e u a u e t H o h r A f t e k t k t i n t o l s s n n i m y m m n s s l a t t t r e e r r u s r n e o r i o r u o r i e e g g A A a o g o e i a a s p n i s p n i v i v p c r h n d d v n e a n i v n e a n e e u c e i D R S S G D a D M U D a D M U
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ABSTRACT FREE PAPER FP 006 INTRALESIONAL INJECTION WITH 5-FLOUROURACIL VERSUS TRIAMCINOLONE ACETONIDE FOR KELOID TREATMENT Astrinita Lestari Suyata, A. Indra Dewa, Fonny Josh Div. of Plastic, Dept. of Surgery, Faculty of Medicine Hasanuddin University, Makassar, Indonesia
Background: Keloids are a burden for patients due to aesthetic, physical and social complaints and treatment remains a challenge since none of the them give satised result. Nowadays Triamcinolone Acetonide injection is the rst choice but gives side effect to body imunity if used for long time. Antimetabolite 5-Flourouracil also redeems broblast proliferation to reduce scar. This study compares efectivity of intralesional injection with 5-Flourouracil and Triamcinolone acetonide for keloid treatment. Methods This was an experimental study with 10 samples are treated with Triamcinolone Acetonide and 10 samples with 5-Flourouracil. Samples were being tested by Mann Whitney U-Test. Patients were taken from RS. Wahidin Sudirohusodo and other partnership hospital in Makassar, who passed inclusion criteria from April 2010 until fulllled the sample number. Injections were given for 12 times with 1 week interval. Vancouver Scar Scale Score was administered to measure changes in lession and the comparisons are being test with Chi Square Test. Result: Based on Chi Square Test, there were no differences in thickness (p=0.315), color (p=0.221) and consistency (p=0.291), but there was difference in pigmentation (p=0.001). Itchness was gone in the 4th week for 5-Flourouracil that 1 sample left for Triamcinolone Acetonide. Pain was gone in the 5th week for Triamcinolone Acetonide that 1 sample left for 5-Flourouracil. Conclusions: Based on Vancouver Scar Scale, there were no much difference between 5-Flourouracil and Triamcinolone Acetonide for keloid treatment except that Triamcinolone Acetonide gave better result in lession pigmentation.
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ABSTRACT FREE PAPER FP 014 COMPARISON OF THE NUMER OF ANGIOGENESIS OF ACUTE WOUND HEALING BETWEEN ALOE VERA AND TULLE ON ACUTE WOUNDS OF WISTAR RATS Edwin Ardiansyah, Djumadi Achmad, Arin Seweng, Sumantri Sarimin Div. of Plastic, Dept. of Surgery, Faculty of Medicine Hasanuddin University, Makassar, Indonesia Background: Wound is a partial loss of or damage to body tissues that can be caused by sharp objects or blunt trauma, changes in temperature, chemicals, explosion, electric shock or an animal bite. Many herbs are known to have an important role in the wound healing process. Aloe vera has been known to act as anti-inammatory, increases cell proliferation and collagen, as well as protecting the environment in a moist condition. Aim of study: Knowing the comparison of angiogenesis in acute wounds on Wistar mice between the use of aloe vera gel and tulle. Materials and Methods: 10 Male Wistar mice at the age of 2-3 months and weighing 100-200 grams in the laboratory with a single enclosure and fed a standard sufcient food for 7 days. After 7-day adaptation period is over, a stratied random grouping of mice, each of 5 mice for group 1 and labeled P1 and 5 mice for group 2, and then labeled P2. Then transferred into a single enclosure. All mice given intraperitoneal ketamine anesthesia treatment, made 1 piece of split thickness excision wound with a diameter of 1 cm on the back of Wistar mice, using a biopsy punch. The wound was cleaned and each wound on one group of mice was given tulle applications and each wound in mice group 2 by application of aloe vera gel. Made a parafn block and made preparations histochemical staining Haematoccylin-eosin (HE). Preparations were examined under a microscope. Did the tally of angiogenesis in each preparation using a counting chamber system per ten eld of view and compared between the two treatments. Results: After counting the number of angiogenesis four large eld of view on a microscope with Hematoxyline-eosin staining, the obtained data is: There is a signicant difference between the number angiogensis Aloe Vera with Tulle group (p <0.01), where the number of angiogenesis signicantly more in the group of Aloe Vera (12.4) compared with the group of Tulle (6.4). Conclusion: In this study, the average number of angiogenesis in the group of aloe extract were more visible than in group tulle. It was in line with the theory which states that aloe vera can stimulate angiogenesis. Keywords: Aloe vera, Wistar, angiogenesis, wound healing
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ABSTRACT FREE PAPER FP 018 MANDIBULOMAXILLARY FIXATION (MMF) TRAINING PROGRAM EVALUATION AMONG PLASTIC SURGERY RESIDENT: A QUASI-EXPERIMENTAL STUDY Fernita Leo Soetjipto Soepodo*, Kristaninta Bangun** Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Indonesia BACKGROUND: Mandibulomaxillary xation (MMF) is one of the surgery skill a plastic surgery resident have to master to become a plastic surgeon, as craniofacial cases increase rapidly. By doing training on a non-living model, one will be competent to do the skill prior to face the real patient. This study implement a training program using cranial model to evaluate the increasing learning curve in craniofacial cases among residents in training. METHODS: Twenty two plastic surgery residents were enrolled in this study, they were divided into two groups, the rst group consists of residents who never perform this skill before, and the second group were the ones who have performed this skill previously. They performed a set of training consisting of one knowledge-based session, followed by one skill-based session. Afterwards they were evaluated in terms of maxillomandibular xation skills ability using ABPAS and IMFscrew placement Global Rating Scale, which assessed by two senior craniofacial surgeons using video recording. RESULTS: The ABPAS and IMFscrew placement Global Rating Scale demonstrated an increase of performance score in the more experienced study population (group 2) in all aspect including the task-specic work list [16,5 (2,44) vs 18 (1,57); P = 0,19], global rating scale [17,5 (2,63) vs 19,4 (2,31); P = 0,43], total ABPAS score [33,9 (4,76) vs 37,4 (3,82); P = 0,34], and also for IMFscrew placement global rating scale [14,9 (1,53) vs 15,9 (0,95); P = 0,38], although the measurement did not show statistically signicant results. Time needed for arch bar completion [48 min 17 s vs 41 min 8 s; P = 0,23]. Time needed for IMFscrew placement completion [9 min 25 s vs 6 min 32 s; P = 0,23]. Total time to task completion was shorter in group 2, although the difference was not statistically signicant [57 min 24 s vs 47 min 17 s; P = 0,23]. CONCLUSION: The MandibulloMaxillary Fixation training program have proven to help plastic surgery residents in training to increase their craniofacial skills, give an increase in ABPAS and IMFscrew placement Global Rating Scale performance score and shorter time to task completion. KEYWORDS: mandibulomaxillary xation (MMF) training, plastic surgery testing, learning curve for craniofacial, arch bar
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ABSTRACT FREE PAPER FP 019 EVALUATION OF MAXILLARY GROWTH OF PATIENTS WITH UNILATERAL COMPLETE CLEFT LIP AND PALATE AFTER TWO FLAP PALATOPLASTY WITH HONEY ORAL DROPS Fory Fortuna*, Prasetyanugraheni Kreshanti*, Siti Handayani*, Julieata Pancawati**, Amilia Jeni Susanto**, Grace Wangge*** *Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Cipto Mangunkusumo Hospital - Faculty of Medicine, Universitas Indonesia ** Orthodontic Division, Department of Dentistry, Cipto Mangunkusumo Hospital Faculty of Medicine, Universitas Indonesia ***Department of Community Medicine, Faculty of Medicine, Universitas Indonesia Background: It is expected that faster epithelialization decrease wound contraction and then reducing scar formation. For long term, it will be an important factor that will results in good maxillary growth. Honey given as oral drops signicantly precipitates the epithelialization process of the lateral palatal defects post two ap palatoplasty 2.1 times faster. Long-term result has not yet evaluated. Aim of Study: To evaluate maxillary growth as long term effect of fast epithelialization of the palates those given honey as oral drops after two ap palatoplasty. Methods: This is a case control study consist of 2 groups. Comparing maxillary growth of the unilateral complete cleft lip and palate (UCCLP) patients who were given honey as oral drops and without oral drops after their two-ap palatoplasty in 2011-2012. The cephalometric measurement will be recorded and the dental cast for each patient will be made to be categorized using GOSLON YARDSTICK method. The data will be analysed using SPSS version 22.
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ABSTRACT FREE PAPER FP 020 PERFORATOR BASED FLAPS IN BURN RECONSTRUCTION: A 2 YEARS EXPERIENCE Hastika Saraswati*, Beta Subakti N** Dep/SMF of Plastic Reconstructive and Aesthetic Surgery Airlangga University School of Medicine / Dr.Soetomo General Hospital Surabaya Background: Burn trauma manifests in wide array of wound, and full thickness ones are the most challenging to manage. In early burn, these defects usually caused by third degree burns, and after healed and matured contracture will posses another major threat. Defects like these will excel in function and cosmesis with ap covarage. Local ap seldom be able to fulll this required task, so free tissue transfer, pedicled and perforator based ap will come in handy. Since its introduction by Koshima in 1989, perforator ap has been developed in variety, techniques, and applications. It has advantages in such for utilizing adjacent tissue that relatively have similar character, and also able to cover larger defect compared to local ap. Perforator based ap doesn’t need specialized instrument and can be learned through a atter learning curved compared to free tissue transfer. In this article we would like to report our 2 years experience in utilizing perforator based ap for burn reconstruction. Patient and method: We collect data from our medical record from 1 January 2014-15 March 2016. We always mapped perforator using handheld Doppler and marked them with permanent ink marker 1 day before operation. And not to forget preparing another secondary life boat ap in case of inadequate predicted perforator vessel or else. Result: e performed 21 operations. We did anterolateral thigh perforator ap, reversed anterolateral thigh perforator ap, lateral arm ap, reversed radial artery perforator ap, ulnar artery perforator ap, and medial thigh perforator ap once; supraclavicular artery perforator ap and thoracodorsalis artery perforator ap twice; radial artery peforator ap and lateral genu perforator ap three times; and dorsal metacarpal artery perforator ap four times. All operations were performed by the same operator. There were 4 cases with partial necrosis. Other cases were viable through healing process and perform well for resurfacing these defects. Conclusion: Perforator based aps are considered to be an appealing option for burn reconstruction due to its benets compared to other available modalities. Keywords: burn reconstruction, dorsal metacarpal, ulnar artery, radial artery, posterior interosseus, thoracodorsal, medial thigh perforator, lateral genu perforator, anterolateral thigh.
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ABSTRACT FREE PAPER Correspondence Hastika Saraswati, Resident Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Jl.Mayjend Moestopo 6-8 Surabaya, phone : 031-5501316.
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ABSTRACT FREE PAPER FP 022 THROMBOPROPHYLAXIS STRATEGY AND THE RISK OF FREE FLAP THROMBOSIS IN PATIENTS WITH HYPERCOAGULABILITY: A SYSTEMATIC REVIEW dr. Parintosa Atmodiwirjo, SpBP-RE(K) 1, dr. Johannes Albert Biben 1 1 Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital. Jakarta, Indonesia Background: Anastomosis technique and surgeon’s experience are two important factors contributing to the success of free ap procedures. Despite adequate anastomosis and surgical experience, ap loss due to thrombosis could still occur as a result of patient related factors. Patients with hypercoagulable state such as those with malignancy, hereditary, and acquired thrombophilia are among those who may need free tissue transfer procedure. This study reviewed the available evidence to evaluate whether these patients are more prone to thrombosis complication following a free ap procedure and the effective thromboprophylaxis regimen. Methods: We searched relevant studies in PubMed, Embase, and Cochrane Library databases using “free ap”, “microsurgery”, “hypercoagulable state”, and “thrombophilia” as the search terms. Title, abstract, and full text screening were applied to 56 articles found in the databases. Four articles, met the inclusion and exclusion criteria, were included in the review. Results: The etiologies of hypercoagulability in these 4 studies were varying from collagen vascular disorder, hereditary or acquired abnormality of coagulation mechanism, to malignancy related hypercoagulability. The overall incidence of thrombosis in hypercoagulable subjects was 14%, while the subsequent ap loss incidence in this group was 8%. Patients with hypercoagulable state were18.75 times more likely to experience thrombosis after free ap procedure. The most common thromboprophylaxis regimen used was heparin with various dose, interval, duration, and drug combination. Conclusion: Hypercoagulable state seems to increase the risk of thrombosis in free tissue transfer procedures. However, strong evidence to support this conclusion is lacking. The most effective thromboprophylaxis regimen to prevent the occurrence of thrombosis cannot be determine based on the current evidence due to the exceptionally varying regimen. Good quality studies needs to be conducted in the future to formulate a suitable perioperative strategy to prevent thrombosis complication in patients with hypercoagulable state.
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ABSTRACT FREE PAPER FP 030 Comparison of Total Fibroblast in Acute Wound Bed on Wistar Rats between The Applications of Aloe Vera Gel Extract and Tulle Muhammad Nawir, Sumantri Sarimin, A.J. Rieuwpassa Div. of Plastic, Dept. of Surgery, Faculty of Medicine Hasanuddin University, Makassar, Indonesia Aloe vera gel extract can be used as a new candidat for acute wound care which can accelerate the wound healing process. The aim of this study was to compare the effect of Aloe vera gel extract and tulle on the number of broblast in the wound bed acute. This study was an experimental research conducted on 10 wistar rats. This research was done at the University Teaching Hospital Hasanuddin Makassar in October 2015. Data were analyzed with SPSS version 22.0 with Mann-Whitney statistical test. The result indicated that the number of broblast in the application of aloe vera gel extract ranged between 828-992 with an average of 920 per 4 large eld of views. Number of broblast in the treatment group, tulle ranged between 788-884 per 4 large eld of views. Statistically there was a signicant correlation with p value of 0.032. Keywords: broblasts, aloe vera, tulle, wound healing.
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ABSTRACT FREE PAPER FP 036 ANTHROPOMETRIC EVALUATION OF GENTUR’S CHEILOPLASTY METHOD IN UNILATERAL CLEFT LIP Septrina R, Sujatmiko G Division of Plastic Surgery Reconstructive and Aesthetic, Departement of Surgery Cipto Mangunkusumo Hospital Faculty of Medicine University of Indonesia Background: Cheiloplasty is the earliest surgical procedure in cleft lip and palate patient. This procedure has impact on functional and aesthetical appearance 1. The Gentur’s technique is method of cleft lip surgery that has been developed by him and has been used in Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia. It uses the rotation-advancement, small triangular, preventing notching with some other details to overcome the wide cleft. Thus gives us hypothesis, does the Gentur’s technique give symmetrical result in anthropometric measurement. Methods: Cross sectional analytic study will be taken from medical record in 14 unilateral cleft lip patients undergo cheiloplasty procedure. Direct anthropometric data before and after procedure is analyzed using SPSS17. Datas were classied in cupid’s bow, vertical height, horizontal height, vermillion and nostril. Result: From 14 patients, we found that most patient whose undergone surgery in 3 month (64.3%) are mostly female (64,3%), complete defect (85,8%) and in left side (57,1%). This technique is able to produce signicant lip and nose symmetry (CI 95%, p value <0.005) in cupid’s bow, vertical height, horizontal height, thickness of vermillion and nose. By doing this technique, the author able to create good lip and nose symmetry (78.57%) even in wide defect (64.3%) and collapse palate (57.1%). Conclusion: The Gentur’s technique is able to use tissue deciency in creating ideal lip and nose in the repair of unilateral cleft lip even in patient with wide gap. Keywords: unilateral cleft lip, cheiloplasty, anthropometric measurement
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ABSTRACT FREE PAPER FP 038 COMPARISON OF TOPICAL TREATMENT RESULTS BETWEEN COMBINATION OF HERBAL EXTRACTS AND TULLE ON ACUTE WOUND MODEL ON WISTAR RATS Robin Kurnia Wijaya, Subchan Aga Bachtiar, Fonny Josh Plastic Surgery Subdivision, Medical Faculty of Hassanuddin University/ Dr. Wahidin Sudirohusodo Hospital Makassar, South Sulawesi INTRODUCTION: Recently, “back to nature” trend has affect many elds including wound healing process. A combination of herbal extracts (allium cepa, allantoin, asiaticoside aloe vera, kazinol F paper mulberry, tamarind, vitamin E) and silicone derivate (nano hydroxyprolisilane C) has been formulated to make a better scar. Theoritically, these herbal extracts can accelerate wound healing process as well as prevent hypertrophic scar formation. The purpose of this study was to prove the potential benet of topical herbal extracts combination on accelerating wound healing process. METHOD: Two rounds full thickness skin wound was made on the back of wistar rats. The samples were categorized into two groups, topical extract herbal group and tulle group. Clinical and Histopathological examination started at day 3, 7, 14, and 21. After examination, the rats was terminated. Angiogenesis, the presence of broblast and collagen formation to observed the histology changes during wound healing process was evaluated. All data was analized statistically. RESULT: The wounds that applied with an extract herbal showed faster healing than wounds that applied with tulle. KEYWORDS: erbal extract, allium cepa, allantoin, asiaticoside aloe vera, kazinol F paper mulberry, tamarind, vitamin E, hydroxyprolisilane C, wound healing, hypertrophic scar.
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ABSTRACT FREE PAPER FP 049 THE SAFETY OF ONE-PER-MIL TUMESCENT INFILTRATION INTO SKIN FLAP THAT HAS SURVIVED FROM THE PRECEDING ISCHEMIC INSULT E Nindita, Theddeus OH Prasetyono Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Cipto Mangunkusumo Hospital Universitas Indonesia INTRODUCTION: The study is aimed to observe the safety of one-per-mil tumescent injection into skin ap that has survived from the preceding acute ischemic insult. The outcome could be used for secondary procedures in replantation as well as free ap surgery. MATERIAL AND METHODS: An experimental study will be conducted on bilateral groin aps of 20 healthy Wistar strained-Rattus novergicus weighing 220-270 grams. Acute tissue ischemia is employed by 15 minutes clamping application to the pedicle (both artery and vein) to represent the clinical scenario of a primary ischemic insult. Following the clamp released, the aps are inset back to its wound bed and ap survival will be assessed with Analyzing Digital Images® on postoperative day (POD)-7. On this POD-7, the aps will be grouped randomly into 3 groups i.e. one-per-mil tumescent (A), normal saline (B), and control (C) groups. Re-harvesting the aps will be conducted on the same POD-7 following the injection group protocol. The ap survival is then re-assessed on the day-7 after the second surgery using the same method of photo analysis. TcpO2 is also measured pre and post injection. Statistical analysis will be conducted with ANOVA. Statistical signicance is stated as p<0.05. SUMMARY: Ascertaining the safety of one-per-mil tumescent injection into tissues that have survived from the preceding ischemic condition may weigh up its usage for assisting the needed secondary reconstructive procedures. Keywords: tumescent, skin ap, and ischemic
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ABSTRACT FREE PAPER FP 050 FLAP MODALITY FOR RESURFACING FOLLOWING AGGRESSIVE NECROTOMY DEBRIDEMENT IN SUBMANDIBULAR ABSCESS: CLINICAL EXPERIENCE IN 10 CASES Muda Muzakkie, Parintosa Atmodiwirjo Plastic Reconstructive and Aesthetic Surgery Division Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Background: Submandibular abscess is one of the most common case in our center due to dental radix gangrene, with prevalence 11 cases per year. Aggressive debridement was performed until open thoracotomy if the abscess spreading into the mediastinum. Neck has preferential contour and tissue, for instance: thin skin and soft tissue, important structure, cervicomental angel contour and range of movement, regarding to those importance, the choices of resurfacing should use the best modality. Material and Method: Patients referred from Cardiothoracic Surgery Division to Plastic Surgery Division at Cipto Mangunkusumo Hospital who diagnosed with submandibular abscess underwent aggressive necrotomy debridement. After aggressive necrotomy debridement, wound was managed with honey-packed gauze twice a day until the wound bed clear from necrotic tissue and ready to close. It took 14 days approximately before the denitive defect closure procedure. Results: 10 cases with submandibular defect due to abscess following aggressive debridement from Januari 2014 - Februari 2016, has been performed free ap and propeller supraclavicular ap for defect closure. The largest defect size was 33x12x2 cm, the smallest size was 8x4x1 cm. 9 patients perform anterolateral thigh free ap, 1 patient perform supraclavicular propeller ap. Conclusions: Submandibular defect is typically constitutes an indication for reconstruction using ap due to large defect and regarding neck has preferential contour and tissue, which give the best functional and aesthetic outcome. Keywords: Submandibular, abscess, ap
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ABSTRACT FREE PAPER FP 051 MORPHOMETRY OF INFANT NOSTRIL IN JAKARTA Melina Tiza, Siti Handayani, Grace Wangge Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Cipto Mangunkusumo Hospital - Universitas Indonesia Introduction: Indonesian normal nostril anatomy has received little attention in infants younger than 2 year. The notion of an ideal nose is critical to reconstruction, especially for cleft lip and nose repair. Methods: A cross sectional study was performed. Basal aspect images taken from screen capture of the video. Ten anthropometric measurements of the nostril were measured and analyzed with Image J software. Results were compared statistically using the two-tailed t test and correlation coefcients were calculated. Results: 156 infants were included (median age, 9,5 months; girls, n:72 and boys, n: 84; Deutero Malay race, n:127 and other race, n: 29). Measurements were similar (p>0.05) in Deutero Malay races and other races, included nasal tip protrusion, alar length, ala thickness, collumella width and length, sill width.Alar base width, sub alar width, anatomical width andmorphological width of nose were signicantly longer in Deutero Malay race than in other race (p<0.05). In under 9 months old Deutero Malay infant, everyage group (0-3, 4-6, 7-9) were increase their sill width value 0,77- 1,04 mm and nostril height value 0,4-0,54 mm. Measurements of Deutero Malay race were correlated positively with age and weight ( p < 0.05). Conclusion: Normal nostril morphology is described in a population of Indonesian infants. By providing reference data of normal nostril morphometric in Indonesian infants, it can guuide the cleft treatment or reconstruction of the Indonesian infant. Keywords: Infant; morphometry
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ABSTRACT FREE PAPER FP 040 EFFECTIVENESS OF EARLY EXCISIONAL DEBRIDEMENT IN BURN INJURIES TO SEPSIS INCIDENCE AND MORTALITY RATE AT BURN UNIT OF HASAN SADIKIN HOSPITAL Setiagung A Bowo*, Hardisiswo Soedjana** Division of Plastic, Reconstructive and Aesthetic Surgery *Department of Surgery University of Indonesia-Cipto Mangunkusumo Hospital **Department of Surgery Padjadjaran University-Hasan Sadikin Hospital Background: Sepsis is an important cause mortality in patients with burn, although many factors inuence it. Early excision debridement as source control treatment has been done routinely in our center. It was intended to prevent sepsis and improve mortality. Method: We performed a retrospective, cross sectional study over 4 years (2012-2014) among patients with ame burns in Burn Unit Dr. Hasan Sadikin Hospital who underwent early excisional debridement. The criteria of patients were adult, with full thickness burn, without inhalation injury and co morbid disease. The mortality and incidence of sepsis were analyzed by simple regression linier statistics using SPSS 16.0 for windows. Result: Mortality rateof all patients was 43,3% and 42,3% of it was directly caused by sepsis. Thirty nine patients matched with the criteria , 20 patients had early excision (< 3 days) and 19 patients had late excision (> 3 days). In early excision group, 75% got sepsis and 55% died. Mortality and incidence of sepsis wasn’t signicantly different in this group (p=0,252 and p=0,855). Sex as confounding factor wasn’t signicantly different (p=0,774). Both of groups have same length of stay (mean : 13,1 and p=0,236). The extent of TBSA and age were signicant factors causing mortality rate (p < 0,05). Conclusion: There are many factors that contribute to the success of treating burn patient. Excision debridement was proven by this study not a major factor and ineffective to decrease sepsis and mortality in burned patients.
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ABSTRACT FREE PAPER FP 042 NEW STRATEGY USING BETA BLOCKER AND NEGATIVE FLUID BALANCE THERAPY TO REDUCE MORTALITY RATE IN MANAGING PATIENT WITH SEVERE BURN INJURY: HASAN SADIKIN PROTOCOL Steven Narmada, Lisa Y. Hasibuan Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Padjajaran University Hasan Sadikin Hospital, Bandung
Background: he incidence of burns in Indonesia is still quite high, some of which are severe burns included patients with extensive burns 30 percent or more of body surface area, high-voltage electrical burns, inhalation injury, and burns with comorbid (trauma). Patients with severe burns are most likely to fall into severe sepsis and multiple organ failure complications, especially ARDS resulting in death. Methods: We present data of severe burn patients treated in Burn Unit Hasan Sadikin Hospital period 2013-2015. We started using Hasan Sadikin Protocol since January 2015. The strategy was negative uids balance therapy as using albumin or FFP to correct oncotic pressure and forced diuresis with furosemide to prevent pulmonary edema and ARDS complications on day three to ve days after the incident, betabloker was used to reduce complications of SIRS and sepsis. Dobutamine were given to the patients who already experienced ARDS to reduce extravascular lung water index and improvement of pulmonary ventilation function. Result: There were 26 patients with severe burn injury in 2013, the mortality rate were 53,8% and 78,6% of it was caused by ARDS. In 2014 there were 40 patients with severe burn, the mortality rate were 45 % and 66,7% of it was caused by ARDS. After using Hasan Sadikin Protokol since 2015, the mortality rate from 33 patients of severe burn was 33,3% and 66,3% of it caused by ARDS. Conclusion: Using new strategy, Hasan Sadikin protocols, on handling severe burn patients in our burn unit reduced the mortality rate. ARDS remains a major cause of death in cases of severe burns. Further research is needed to develop this strategy. Keywords: evere burn injury, betablockers, ARDS, negative uid balance, mortality rate
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ABSTRACT FREE PAPER FP 045 EFFICACY OF CHLORHEXIDINE-ALCOHOL VERSUS POVIDONE IODINE AS PREOPERATIVE SKIN PREPARATION TO PREVENT SURGICAL SITE INFECTION: A META-ANALYSIS Tasya Anggrahita, Aditya Wardhana, Gentur Sudjatmiko Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Indonesia - Cipto Mangunkusumo Hospital
Background: urgical site infections remain substantial problems to surgeons and patients as it increase the morbidity, mortality, length of stay, hospital cost, rate of readmission and rate of re-surgery. This study aim is to compare the use of chlorhexidinealcohol versus povidone-iodine for preoperative skin preparation to prevent surgical site infection. Method: The literature search was conducted through the Pubmed database in November 2015. Included studies were RCTs with the year of publication between 2005-2015 comparing the use of chlorhexidine-alcohol versus povidone-iodine in the effectiveness in reducing surgical site infection in adult patients. Quality of the study was assessed using Jadad Score. Meta-analysis was conducted in the included study to obtain a pooled estimate of effect size. Evidence of heterogeneity and publication bias was also assessed. Results: 6 RCTs with a total of 2,080 patients were included in meta-analysis. Metaanalysis showed the use of chlorhexidine-alcohol was associated with signicantly fewer SSIs (pooled risk ratio, 0.60 (95% CI, 0.45-0.79)) and fewer positive skin culture results (pooled risk ratio, RR 0.38(95% CI, 0.28-0.51)) compared with povidone iodine. Conclusion: Pre-operative skin antisepsis with chlorhexidine is more effective than povidone iodine in preventing surgical site infection. Keywords: chlorhexidine-alcohol, povidone-iodine, skin antisepsis, surgical site infection
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ABSTRACT FREE PAPER FP 046 RELATIVE BODY WEIGHT CHANGES POST PALATE REPAIR IN PATIENTS FED BY LONG NIPPLE NURSING BOTTLE VERSUS CONVENTIONAL FEEDING Tessa Puspita Sari, Prasetyanugraheni Kreshanti University of Indonesia, Jakarta, Indonesia Introduction: Until today the feeding regiment after palate repair is still debatable. While some craniofacial center worldwide already allow unrestricted feeding post palate repair and comes with no signicant adverse effects on operative outcomes or complications, our craniofacial center still forbid the immediate use of nipple feeding postoperative and allow only spoon or cup feeding. This randomized prospective study was aim to objectively compare the effect of immediate long nipple feeding with conventional feeding on patients’ body weight after post palate repair. Methods: This study randomized patients who will undergo cleft palate repair at Cleft and Craniofacial Center (CCC) into control and study group who will treated with different feeding method postoperatively. Control group was using conventional feeding method with spoon or cup feeding, while study grup was using bottle with long nipple. The body weight of each subjects was measured preoperative and rst week post operative. The amount of oral intake, insidences of complications and relative body weight changes was recorded and evaluated. Results: Relative weight changes after one week was signicantly different between two groups. The body weight of patients in group 1 was reduced 8,4% (mean 883 g) while patients in group 2 only reduced 2,3% (mean 201 g). There were no signicant betweengroup differences in the mean amount of daily oral intake for sixth days after surgery. At second week postoperative, the relative body weight changes from baseline weight was still signicantly difference between two groups. However, there is no signicant differences of relative body weight between two groups at third week postoperative. Calories of daily intake at week one, two and three did not differ signicantly between the two groups. There is also zero incidence of wound dehiscence or stula developed in either group. Conclusion: This preliminary study demonstrates that early unrestricted feeding using bottle with long nipple after cleft palate repair does not adversly affect nal outcome, does not increase risk of complications, and can be safely implemented. It also signicantly prevent greater weight loss after surgery that may disrupt the wound healing process Keywords: cleft palate, body weight, feeding management
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ABSTRACT FREE PAPER FP 048 THE EFFECTIVENESS BOVINE AMNIOTIC MEMBRANE TO SUBSTITUTE HUMAN AMNIOTIC MEMBRANE IN PARTIAL THICKNESS WOUND CARE IN RATS Y.J.Fitra; S. Rizaliyana;, M.S.Noer Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital Surabaya Background: The use of human amniotic membrane is widely known. Its use led to the imbalance of production and demand. On the other hand, bovine amniotic membrane is said to have similar efcacy in terms of wound closure but with the source of production far more plentiful and cheaper. Objective: This research to prove the use of bovine amniotic membrane as a substitute for human amniotic membrane in the case of partial-thickness wound care. Methods: A randomized clinical trial post-test control group design in male rats which harmed partial-thickness wound, the wound is closed with human and bovine amniotic membrane, then observed the local response in the wound bed and the speed of epithelialization in wound healing. Keywords: bovine amniotic membrane, partial-thickness wound Plastic Reconstructive and Correspondence: *Yugos Juli Fitra, Resident of Aesthetic Surgery Programme, Airlangga University School of Medicine, Dr. Soetomo General Hospital, Mayjen Moestopo 6-8 Surabaya, phone : 031- 5501316, email:
[email protected]. **Sitti Rizaliyana, Plastic Reconstructive and Aesthetic Surgeon, Staffs of Department Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital, Mayjen Moestopo 6-8 Surabaya, phone : 031- 5501316. **M. Sjaifuddin Noer, Plastic Reconstructive and Aesthetic Surgeon, Staffs of Department Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital, Mayjen Moestopo 6-8 Surabaya, phone : 031- 5501316
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ABSTRACT FREE PAPER FP 044 EFFECTIVITY OF PLATELET RICH PLASMA IN WOUND HEALING OF DEEP SECOND DEGREE BURN INJURIES IN DR. SOETOMO GENERAL HOSPITAL P. T. Utami*; S. Rizaliyana; M. S. Noer Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine Dr. Soetomo Teaching Hospital Surabaya Background: A wide damage of skin caused by burn injuries leads to high morbidity and mortality. Topical antibiotic such as silversulfadiazine was common used in burn care, but not so effective in promotes epithelial process. Amnion and platelet rich plasma (PRP) solely contain a lot of growth factor that promote epithelial process. Methods: randomized clinical trial post-test control group designs, was done from December 2015 until February 2016, to compare platelet rich plasma to amnion itself and topical silversulfadiazine, in deep 2 nd degree burn care in Dr. Soetomo General Hospital. Data was collected at the day 0, 7, 14, and 21, evaluated the wide of burn wound to get the percentage of epithelium and the rate of epithelial process among this three group. Data was analyzed statistically with one-way Annova’s multivariate. Results: PRP was superior signicantly to amnion itself and silversulfadiazine in percentage of epithelium (P = 0,001), and superior signicantly in the rate of epithelial process in rst 7 days (P = 0,009), but not signicantly different in 14 days and 21 days Conclusion: PRP itself may enhance the rate of epithelial process in deep 2 nd degree of burn wound, and can be considered for the burn wound dressing. Growth factors in PRP may works more effective in rst phase of wound healing. Keypoint: deep 2nd degree of burn, platelet rich plasma, amnion, silversulfadiazine
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ABSTRACT FREE PAPER FP 001 FACIAL CLEFT OF TESSIER NO. 30: ENCOUNTERED IN ADULT Hardisiswo Soedjana, MD.1 and Ade Sari N. Sitorus, MD. 1 Afliation: 1 Division of Plastic Surgery, Department of Surgery, Hasan Sadikin Hospital/ University of Padjadjaran Bandung Background: Facial cleft Tessier no. 30, also known as lower midline facial cleft, is an extremely rare case. To date, there were about 100 cases of median facial clefts reported since its rst encountered by Couronne in 1819. Since this deformity is rare and presents in widely variations, therefore presentation and management are valuable to our interest. Case presentation: A teenager female was present to our out-patient clinic hospital with chief complain of a cleft on her lower lip that appear since birth. She only wanted her lower lip to be repaired. There were no complain on feeding nor speech performance. On physical examination there were cleft on lower lip with scar that extend from chin to the neck, making appearance of web-like along the neck. The mandibular segments were mobile. We found ankyloglossia with small notch on the upper side of the tongue. Patient was not able to perform soundings of particular letter such as letter “K”. On the investigation of skull and panoramic x-ray examination both showed there were complete separations of mandibular symphisis. Patient were performed a tongue-tie release, rigid xation on separated mandibular segment continued with maxillo-mandibullar xation, and the last is lower lip reconstruction. Patient was discharged after maxillo-mandibular xation release and performed postoperative skull and panoramic x-ray examination. We consult the patient to speech therapist to optimize patient’s speech. Conclusion: Facial cleft Tessier no. 30 considered as a rare deformity. Management on this case is vary and valuable since there were lots of variant of presentation on each case. Keywords: Tessier cleft 30, facial cleft, midline mandible cleft
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ABSTRACT FREE PAPER FP 010 DIFFERENT APPROACH ON RECURRENT TEMPOROMANDIBULAR JOINT ANKYLOSIS WITH INTERPOSITIONAL ARTHROPLASTY USING SILICONE BLOCK AND BILATERAL CORONOIDECTOMIES: A CASE REPORT Betha E Riestiano1 dan Magda R Hutagalung 2 1 Resident of Department of Plastic Reconstructive and Estethic Surgery, Airlangga University, Dr. Soetomo Hospital 2 Senior Staff of Department of Plastic Reconstructive and Estethic Surgery, Airlangga University, Dr. Soetomo Hospital, Surabaya Ankylosis of temporomandibular joint (TMJ) is an intracapsular union of the disc-condyle complex to temporal articular surface that restricts mandibular movement, with brous adhesions or bony fusion between condyle, disc, glenoid fossa, and articular eminence (1). TMJ ankylosis is more commonly associated with trauma (13–100%), local or systemic infection (10–49%), or systemic diseases (100%), such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis. We report a debilitating recurrent case of left TMJ ankylosis in a 16-year-old male with history of trismus since 4 years old. We describe a step-wise procedure involving a patient at an early age which has not been previously described in Indonesian patients. In the rst surgery, an osteotomy of the ankylosis and interpositional temporofacial ap were performed. Recurring ankylosis was managed by osteotomy and interpositional silicone block with bilateral coronoidectomies. Postoperatively, patient followed aggressive regimen of physiotherapy. He healed uneventfully and showed favorable results in terms of function with mouth opening restored to 3,5 cm. Condylar fracture of mandible leading to TMJ ankylosis at an early age can be disastrous causing disturbances in facial growth, function and aesthetics. A vigorous and multidisciplinary approach should be executed to obtain an optimal outcome for TMJ ankylosis.
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ABSTRACT FREE PAPER FP 011 Free Flap Reconstruction of Scalp Defects Caused by High Voltage Electric Injury Doni Setiawan*, Sitti Rizaliyana** Department of Plastic Reconstructive and Aesthetic Surgery Airlangga University School of Medicine Dr. Soetomo General Hospital Surabaya Background Defects in the scalp may be partial or full thickness. Mostly, they result from burn injuries which have been managed using various methods including free ap surgery. Scalp has its own specicity. Therefore, extensive defect closure requires special attention due to its limited elasticity. Reconstruction of the scalp is determined by the size and depth of the defect. Free aps used in burn reconstructions can be divided into myocutaneous, muscular, cutaneous, and fasciocutaneous. Myocutaneous and muscular aps are mainly used to ll cavities and to provide better control of infection. They are also indicated in repairing areas which have undergone radical debridements, as in the case of electric trauma. Methods During the period of January 2010 to 2015, free ap reconstruction was performed on 5 male patients (6 surgeries) who had sustained electrical burn injuries, aged between 19 and 55 years old. Result Surgeries were successfully performed on 5 patients with scalp defects using free ap reconstruction. All patients underwent immediate debridement. After proper wound treatment, the scalp defects could be successfully reconstructed by a one-stage surgery with acceptable complications and good long-term outcomes. Conclusion We highlighted the indications for free ap technique in primary reconstructions, the preferred time frame within which free aps should be performed, and methods which may be employed to reduce complications and ensure aps success. Keywords Free ap, Scalp, High Voltage Electric Injury. Correspondence: *Doni Setiawan, resident of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316, email: setiawan.
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ABSTRACT FREE PAPER **Sitti Rizaliyana, Plastic surgeon, staffs of Departement Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316.
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ABSTRACT FREE PAPER FP 005 THE EFFECT OF ALLOGENIC FREEZE DRIED PLATELET RICH PLASMA ON EPHITHELIALIZATION OF FULL THICKNESS WOUND IN RABBIT A. M.Ardan, I.Dososaputro, M. Sjaifuddin Noer Plastic Surgery Department of Airlangga University School of Medicine Dr. Soetomo Hospital Surabaya Introduction: Wound care is constantly evolving with the advances in medicine. Search for the ideal dressing material which low cost but excellent outcome still continues especially in the developing country like in Indonesia. We need to improve outcomes while reducing the costs. The use of platelet-rich plasma (PRP) in tissue regeneration has developed as the more number of research and application in the clinical because it has a strong supply of low-cost raw material. Autologous platelet-rich plasma (PRP) has been extensively investigated for wound care, but its clinical application is harassed by controversial outcome, due to highly variable PRP quality among patients. Alternatively, allogeneic PRP from well-characterized donors cannot only generate more consistent and reliable therapeutic effect but also avoid harvesting large quantities of blood, an additional health burdens to patients. Here, we meticulously evaluated its healing efcacy for critical-sized defect treatment. Methods: Nine New Zealand white male rabbits were studied. Two 4 cm 2 full-thickness wounds were created using a template and treatments divided in two groups, rst group treated with tulle and second groups treated using allogenic freeze dried PRP. Wounds were bandaged, dressed intermittently, and a collection of samples at 7 days to evaluate epithelization using digital visitrac Hypothesis: Allogenic freeze dried PRP accelerate epithelialization in full thickness wound Keyword: Allogenic, freeze dried PRP, full thickness wound, ephitelialization
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ABSTRACT FREE PAPER FP 013 THE EFFECT OF HYPERBARIC OXYGEN THERAPY FOR PREVENTING THROMBOSIS IN FREE FLAP : AN ANIMAL STUDY Doni Setiawan*, Sitti Rizaliyana**, Iswinarno Doso Saputro** Department of Plastic Reconstructive and Aesthetic Surgery Airlangga University School of Medicine Dr. Soetomo General Hospital Surabaya
Background: The most common and feared complication of microvascular anastomosis is arterial or venous thrombosis. Thrombosis is the body’s natural defense mechanism to prevent blood loss. When a vascular insult occurs, the body employs platelets and brin to seal the defect. The physiologic process is initiated by the presence of tissue factor when injury to the vascular intima occurs. This results in the extrinsic pathway of the coagulation cascade to begin. Tissue factor activates factor X, which in turn activates thrombin, eventually leading to the activation of brinogen. When discussing free tissue transfer, the vascular intima has been injured as a result of the microsurgical anastomosis. It is imperative that the inherent process of coagulation be prevented. The use of pharmacologic anticoagulation has been shown to improve outcomes and patency rates free aps. Oxygen is the most critical of the nutritive needs of tissue being transferred. The amount of oxygen carried by reversible binding to each molecule of haemoglobin is xed. The amount of oxygen dissolved in plasma is proportional to the partial pressure of oxygen over the plasma. This can be increased many fold by the use of hyperbaric oxygen therapy (HBOT). Hyperbaric Oxygen Therapy can also increase the effectiveness of angiogenic factors, particularly vascular endotel growth factor (VEGF) in angiogenesis in the ap, so that the ap survival can be improved. Objectives: Effectiveness of Hyperbaric Oxygen Therapy for Preventing thrombosis in free ap was signicantly different in reducing thrombus size. Methods: A Tuck model anastomosis will be created in the 20 arteries. 24 hours before procedure, ten arteries receive Dextran, ten others receive Hyperbaric Oxygen Therapy (HBO). Sites of repair will be resected 3 hours after the procedure and prepared for histopathology assessment. The specimens will be stained with hematoxylin-eosin. The percentage of thrombus size to arterial size will be collected and data analysis used ANOVA method (Analysis of Variants ). Keywords: Free ap,Hyperbaric Oxygen Therapy, Thrombosis Correspondence: *Doni Setiawan, resident of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316, email: setiawan.ddr@ gmail.com.
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ABSTRACT FREE PAPER **Sitti Rizaliyana, Plastic surgeon, staffs of Departement Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316. **Iswinarno Doso saputro, Plastic surgeon, staffs of Departement Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316.
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ABSTRACT FREE PAPER FP 062 SUBJECTIVE ASSESSMENT OF THE SCAR FORMATION AT FACE AFTER MICROPOROUS PAPER TAPE APPLICATION Beni Herlambang, Chaula L Sukasah, Nandita Melati Putri, Grace Wangge Plastic surgeon division, Surgery Department, Faculty of Medicine University of Indonesia Jl. Diponegoro No. 71, central Jakarta,Indonesia. Background: Management of scar after surgical procedure is important to make good mature scar for long-term results. After suture removal, skin tension between the edges of the wound will promote hypertrophic scar. Microporous paper tape mechanism could support the scar with reduce tension force from edges of the skin, occlusive dressing , continuous pressure effect, cheap and can be used easily by the patient themselves. After application of microporous could make better quality of mature scar. Material and Methods: Experimental study to compare the differences Visual Analog Score (VAS) subjective scar scoring between the intervention group (“Chaula method“ microporous paper tape application) and control group. The sample will be taken from patient in emergency room,Cipto Mangunkusumo Hospital from April to Mei 2016. Patients with the lacerated wound site at face (60 sample) who achieve primary suture procedure and will be follow up after six months microporous paper tape application. Data primary source obtained directly from subjects which meet the inclusion and exclusion criteria. Sampling technique will be done with consecutive technique. Evaluation scar method using clinical pictures by simple blinded and simple randomized technique. The result of this study are mean, mean difference standard deviation and P-value in VAS score that analyzed by one evaluator between intervention and control group. The results of this study will help clinicians to choose therapy after a surgical procedure to make good mature scar. Key Word: hypertrophic scar, microporous paper tape, Visual Analog Score(VAS).
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ABSTRACT FREE PAPER FP 019 THE EFFECT OF PLATELET-RICH PLASMA (PRP) FOR PROMOTING EPITHELIALIZATION SPEED IN RAT SKIN’S THIRD DEGREE BURN WOUND Devina S., Rizaliyana S., Hutagalung M.R. Department of Plastic Reconstruction and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital Surabaya Background: In third degree burn wound, the main problem facing burn surgeon is defect closure itself. The defect including full thickness skin loss, or other vital structure, ie. tendons, nerves, vaskulars, and bones, will require skin graft or ap. This method could be achieved in stable and non septic-prone patient. Platelet-rich plasma (PRP) as a new, adjunctive therapy, is proven for promoting speed of epithelialization of seconddegree burn in recent researchs, since the growth factor is contained in PRP. PRP also stimulates broblast proliferation and angiogenesis. In our research, the main aim is to proof that PRP could reduce the defect size by promoting the speed of epithelialization of third-degree burn. Research Hypothesis: The use of Platelet-rich Plasma can promote the speed of epithelialization on third-degree burn wound, compared with the use of silver sulfadiazine. Material and Method: This research is a clinical trial post test control group design, simple randomized dan single blind experiment. A total 48 male Wistar rat will divided into 2 groups as follows ; wound treated with silver sulfadiazine, and those treated with PRP. The animals will subdivided in 4 groups for the study of epithelialization in day 7, 14, and 21. Keyword: Third-degree burn wound, full-thickness burn wound, Platelet-rich plasma, Growth factor. Correspondence : Santi Devina, Department of Plastic Reconstruction and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital, Address : Prof. dr. Moestopo 6-8, Surabaya.
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ABSTRACT FREE PAPER FP 037 CASE REPORT : HAND FINGER DEGLOVING INJURY, AMPUTATION IS NOT AN OPTION. Ribka Theodora, MD Gatot Soebroto Central Army Hospital Hand injuries send more than one million workers to the emergency room each year, in Hong Kong 66% of the treated hand injuries are crush type injuries. Replantation of the skin in a degloving injury of the hand can be considered as the rst reconstructive choice. Nevertheless, after arterial revascularization, insufcient perfusion of more than half of the avulsed tissue was observed. All distal phalanges are usually amputated to avoid avascular necrosis of the bone and facilitate wound coverage. Our case is a fore-nger degloving injury caused by a roller machine. A direct vascular anastomosis or arteriovenous shunting was impossible due to the extension vascular damage. One of the oldest consistently safe practical technique of providing soft tissue coverage is the use of a groin ap. The groin ap, being an axial ap, has a length-to-base ratio that is about three times greater than the classic abdominal ap makes it more mobile. Unused portion of the ap can be tubed to create a closed wound, reduces the chance of infection. Rather than deltopectoral ap, there is no unfavorable scars on upper anterior chest wall as the donor site. Also, the reliability of blood supply allows the surgeon to take a longer ap than usual without fear of vascular embarrassment. For the result in our patient, there is not much of unsightly bulk that is often associated with the fat thickness from abdominal aps, and because of the excellent venous drainage at its base there is no sign of edema. The length of injured digit completely preserved. And the patient can do his work and daily activities normal again. So, in hand ngers degloving injury, amputation is not an option.
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ABSTRACT FREE PAPER FP 031 THE EFFECT OF TOPICAL SIMVASTATIN GEL ON EPITHELIALIZATION PROCESS, COLLAGEN SYNTHESIS, FIBROBLAST PROLIFERATION, AND AND NEOVASCULARIZATION OF FULL-THICKNESS WOUND ON WISTAR-STRAIN RAT (RATTUS NORVEGICUS) N. Febry*, A. Santoso Budi**, M. R. Hutagalung** Department of Plastic Reconstructive Reconstruc tive and Aesthetic Surgery Airlangga University School of Medicine Dr.Soetomo General Hospital Surabaya Wounds and wound healing have always been one of the most important subjects that experimental researches were dedicated to. Simvastatin has been used for long as a common lipid lowering agent which was reported to have some pleiotropic effects such as antioxidation, anti-inammation and immunomodulation. In this study we aimed to determine the effect of simvastatin on wound healing process in laboratory rats by means of stereological and histopathological analyses. 18 male Rattus novergicus rats rats each with a 2 cm2 full thickness wound on their backs were divided into two groups, rst group that received 2% concentration of simvastatin, second group treated with only gel base. Duration of the study was 5 days. Wound closure rate, epithelialization, broblast proliferation, collagen bundles synthesis and vascularization were determined. Keywords: Simvastatin, Wound healing, Epithelialization, Fibroblast proliferation, Collagen bundles Correspondence: Nanda Febry, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Mayjen Moestopo rd. 6-8 Surabaya, phone : 031-5501316. * Plastic surgery resident at Medical School of Airlangga University / Dr.Soetomo Hospital Surabaya Indonesia. ** Plastic surgeons, staff at Medical School of Airlangga University / Dr.Soetomo Dr.Soetomo Hospital Surabaya Indonesia
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ABSTRACT FREE PAPER FP 032 CARTILAGE REGENERATION REGENERATION ON DONOR SITE DEFECT WITH ONE SIDED PERICHONDRIAL AURICULAR CARTILAGE GRAFT : AN EXPERIMENTAL RABBIT MODEL Nurardhilah Vityadewi*, Kristaninta Bangun*, Budiman**, Ahmad Aulia Jusuf*** *Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia ** Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery Gatot Soebroto Army Central Hospital, Jakarta, Indonesia ***Department of Histology, Histology, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia Background: Auricular cartilage considered a source for cartilage graft with favorable aesthetic result and most frequently used in augmented rhinoplasty. Rhinoplasty becomes an increasingly popular procedure and also the number of revision increases. Most revision procedures require grafting and auricular cartilage is typically precious site for secondary rhinoplasty. Since the donor site is limited, search for the source and optimization of the donor site of graft material is necessary. The availability of the cartilage amount after harvesting very limited to be a structural support of the ear. It is our goal to investigate the possibility poss ibility of reharvesting cartilage from the utilized donor site without any risk of distorting the ear morphology. The aim of this study was to evaluate the healing process of the donor site, include the cartilage regeneration of the donor site in experimental animal model. Material and Methods: We conducted an experimental study in 32 white, healthy, healthy, New Zealand rabbits for the investigation of the cartilage regeneration from donor defect with one side perichondrium. Cartilage defects size 0,5 x 3 cm2 were created on the elastic ear cartilage of rabbits. Two experimental groups with 16 ears in each group were created: Group 1 (with one side perichondrium) and group 2 (without perichondrium). Macroscopic and microscopic evaluations were done on the 4th and 10th weeks. Statistical analysis will be conducted with Kruskall Wall Wallis is test. Summary: The regeneration of cartilage after harvesting at the donor site defect with one side perichondrium will give the possibility poss ibility of reharvesting the limited donor cartilage. The result of this study would enrich data to be used in clinical setting in cartilage regeneration for reconstructive and aesthetic surgery. Key word: auricular cartilage graft, rhinoplasty, donor defect, cartilage regeneration, cartilage healing
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ABSTRACT FREE PAPER FP 041 BACTERIAL PATHOGENS AND ANTIBIOTIC SENSITIVITY PATTERN IN BURN UNIT OF HASAN SADIKIN HOSPITAL (RSHS) FROM JANUARY 2012 - DECEMBER 2015 Setiagung A Bowo*, Almahitta C Putri** Division of Plastic, Reconstructive and Aesthetic Surgery *Department of Surgery University of Indonesia-Cipto Mangunkusumo Hospital **Department of Surgery Padjadjaran University-Hasan Sadikin Hospital 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 over 4 years (2012-2014) by collecting data through medical records of patients treated at burns unit. Data of demography, characteristic of patients, wound isolates bacteria and sensitivity was collected. Result: A total 205 patients were admitted to burn unit of RSHS and 164 patients can be analyzed, which 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 showed 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 very 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 sensitive to meropenem and commonly resistant to the third generation of cephalosporins antibiotic. It was became multi drug resistance bacteria.
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ABSTRACT FREE PAPER PO 001 TOTAL NASAL RECONSTRUCTION Affandi Wiramur*, Sitti Rizaliyana** Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine / Dr.Soetomo General Hospital Surabaya Background: Total nasal defects present daunting challenges to the reconstructive surgeon. The nose is a composite tissue structure composed of the nasal skeleton, an internal lining of mucosa, and an external layer of skin. The topography of the external nose is a graceful blend of convexities, curves, and depressions that reect the underlying shape of the nasal skeleton. The nasal skeleton can be fabricated with bone and cartilage. Methods: A patient requiring total nasal reconstruction after undergoing extensive excision due basal cell carcinoma. These patient has been done forehead ap to coverage the defect post-excision by head and neck surgeon, unfortunately failed. Total nasal reconstruction is done using a radial forearm free ap prefabricated. Results: A radial forearm free ap prefabricated is used to close the defect due to forehead ap failure. Prefabricate the replacement structures performed 3 weeks before ap transfer. A nonvascularized costal bone grafts is used to substitutes for the nasal bones, and full-thickness skin graft is used for inner lining. Silastic tubes are inserted to maintain proper shape and caliber of the nostrils. Conclusions: A total nasal defect can be successfully reconstructed with a radial forearm free ap prefabricated. Although it will requireing some ap debulking and separation of esthetic subunits, the patient is very pleased with the result and functional outcome. Keywords: radial forearm free ap prefabricated, total nasal reconstruction. Correspondence: Affandi Wiramur, Resident of Plastic Reconstructive and Aesthetic Surgery Programme, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Mayjend. Moestopo 6-8 Surabaya, phone : 031-5501316.
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ABSTRACT FREE PAPER PO 004 COMPARATIVE AESTHETICS POST LABIOPLASTY UNILATERAL WITH MILLARD TECHNIQUE AND RANDALL - TENNISON TRIANGULAR Azis Beru Gani, Fonny Josh Background: Quality of life of patients is determined by the effectiveness and aesthetic results of operations labioplasti. There are several techniques that can be used labioplasty the lower lip Z-plasty (Bauer, Trusler, Tondra and Tennison) and upper lip Z-plasty (Millard, Wynn, Mulliken) and a combination of upper and lower Z-plasty (Skoog). However, the surgical technique is most often used in the Plastic Surgery Department of Hasanuddin, namely engineering and technical Millard Randall-Tenison Triangular Flap Repair. Methods: This study used a descriptive observational design with a sample of 24 people with 12 people each operation Millard and 12 people Randall - Triangular Tennison in 2012-2014 at Hikmah Hospital. Mortier Modied Score to assess Red Lip, White Lip and Scars. Results: The average ratings Red Lip Aesthetics (Vermillion) Mechanical Millard 1.43 to 1.38 while Tennison. The average ratings White Lip Aesthetics Mechanical Millard 1.72 while 1.47 Tennison. Average ratings Esthetic Scars Mechanical Millard 1.50 to 1.47 while Tennison. Conclusion: Aesthetics post labioplasty unilateral Millard technique better than Tennison Keywords: Labioplasty unilateral, Millard technique, technique Tennison
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ABSTRACT E-POSTER PO 001 TOTAL NASAL RECONSTRUCTION Affandi Wiramur*, Sitti Rizaliyana** Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine / Dr.Soetomo General Hospital Surabaya
Background:Total nasal defects present daunting challenges to the reconstructive surgeon. The nose is a composite tissue structure composed of the nasal skeleton, an internal lining of mucosa, and an external layer of skin. The topography of the external nose is a graceful blend of convexities, curves, and depressions that reect the underlying shape of the nasal skeleton. The nasal skeleton can be fabricated with bone and cartilage. Methods: A patient requiring total nasal reconstruction after undergoing extensive excision due basal cell carcinoma. These patient has been done forehead ap to coverage the defect post-excision by head and neck surgeon, unfortunately failed. Total nasal reconstruction is done using a radial forearm free ap prefabricated. Results: A radial forearm free ap prefabricated is used to close the defect due to forehead ap failure. Prefabricate the replacement structures performed 3 weeks before ap transfer. A nonvascularized costal bone grafts is used to substitutes for the nasal bones, and full-thickness skin graft is used for inner lining. Silastic tubes are inserted to maintain proper shape and caliber of the nostrils. Conclusions: A total nasal defect can be successfully reconstructed with a radial forearm free ap prefabricated. Although it will requireing some ap debulking and separation of esthetic subunits, the patient is very pleased with the result and functional outcome. Keywords: radial forearm free ap prefabricated, total nasal reconstruction. Correspondence: Affandi Wiramur, Resident of Plastic Reconstructive and Aesthetic Surgery Programme, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Mayjend. Moestopo 6-8 Surabaya, phone : 031-5501316.
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ABSTRACT E-POSTER PO 004 COMPARATIVE AESTHETICS POST LABIOPLASTY UNILATERAL WITH MILLARD TECHNIQUE AND RANDALL - TENNISON TRIANGULAR Azis Beru Gani, Fonny Josh Background: Quality of life of patients is determined by the effectiveness and aesthetic results of operations labioplasti. There are several techniques that can be used labioplasty the lower lip Z-plasty (Bauer, Trusler, Tondra and Tennison) and upper lip Z-plasty (Millard, Wynn, Mulliken) and a combination of upper and lower Z-plasty (Skoog). However, the surgical technique is most often used in the Plastic Surgery Department of Hasanuddin, namely engineering and technical Millard Randall-Tenison Triangular Flap Repair. Methods: This study used a descriptive observational design with a sample of 24 people with 12 people each operation Millard and 12 people Randall - Triangular Tennison in 2012-2014 at Hikmah Hospital. Mortier Modied Score to assess Red Lip, White Lip and Scars. Results: The average ratings Red Lip Aesthetics (Vermillion) Mechanical Millard 1.43 to 1.38 while Tennison. The average ratings White Lip Aesthetics Mechanical Millard 1.72 while 1.47 Tennison. Average ratings Esthetic Scars Mechanical Millard 1.50 to 1.47 while Tennison. Conclusion: Aesthetics post labioplasty unilateral Millard technique better than Tennison Keywords: Labioplasty unilateral, Millard technique, technique Tennison
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ABSTRACT E-POSTER PO 005 HEMOSTATIC PERFORMANCE OF HONEY SOAKED OXYDIZED REGENERATED CELLULOSE (SURGICEL MADU); AN ANIMAL STUDY P Admodiwirjo, S Handayani, B Suhartadi. Plastic and Reconstructive Surgery, Departement of Surgery, Universitas Indonesia Background: Surgicel (oxidized regenerated cellulose/ ORC) widely use as local hemostatic agent to minimise surgical bleeding in plastic surgery. Honey has numerous advantage in wound healing. It has been proven to accelerate epithelialisation and promote wound healing. In order to adopt this numerous advantages of honey while control surgical bleeding, some of our senior consultant soak local hemostatic agent (ORC) with honey. But there isn’t any information regarding interaction between honey and ORC. This research aimed to asses this interaction. Methods: An animal study design to asses hemostatic performance of ORC after been soaked with honey. 27 rats will be divided into 3 groups, where each group of lacerated liver will be treated with ORC alone, honey soaked ORC and control. Amount of blood exanguinated from liver laceration and the bleeding time will be recorded. Statistical analysis: Subjects’ characteristic will be shown descriptively in table with mean and standard deviation. Before apply a hypothesis test, Kolmogorov smirnov test use for assesing sample normality. If we found p> 0.05 it will considered as normal distribution. If we found the data is normally distributed then we do an One-Way ANOVA test for the hypothesis. If data distribution is not normal, Kruskal-Wallis test will be used. Statistical signicance was dened as p<0.05. Analysis will be performed using the statistical software SPSS 17.
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ABSTRACT E-POSTER FP 007 AN ALTERNATIVE TREATMENT AFTER TUMOR ABLATION AT MAXILLOFACIAL REGION FOR GERIATRIC PATIENT : CASE SERIES Beni Herlambang, Kristaninta Bangun Plastic Surgeon Division, Surgery Department, Faculty of Medicine University of Indonesia Jl. Diponegoro No. 71, Central Jakarta,Indonesia Background: Reconstruction at maxillofacial region for closed defect can be applied many reconstructions method. In geriatric patient with tumour in maxillofacial region for ideal reconstruction with several stages that must be allowed for patient, such as local ap or microsurgical tissue free ap. In geriatric patient there are problem for complien patient, underlying disease for local recurrence of malignant tumor and geriatric problem, cost, and also some of patients not want to take several operation procedure. There are an an alternative treatment if reconstructions can not be done such as prostethic maxillofacial for replacing the reconstruction methods. Material and methods: Study case series at three patient with malignant tumor at maxillofacial region. The patients had been done wide excision operation for tumor ablation and there are defect after the procedure. The patient with older patient and geriatric problem. And we performed the alternative treatment for closed the defect because the ideal reconstruction can not be done. The patient refuse to perform undergo staged operation reconstruction, and also there are still risk of local recurrence of malignant tumour. Result: After wide exicion operation for tumor ablation maxillofacial region,the patient have used the prostethic maxillofacial. The patient had satised for this method. Conclution: There are many reconstructruction methods after wide exicion operation for tumour ablation maxillofacial region. If the ideal reconstruction can not be done, there still a alternative treatment for closed the defect with prostethic maxillofacial. Key Word: maxillofacial reconstruction, prostethic maxillofacial
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ABSTRACT E-POSTER PO 008 SUCCESFUL SURGICAL MANAGEMENT OF GIANT CONDYLOMA ACUMINATUM, AN AIDS PATIENT : A CASE REPORT Doni Setiawan*, Beta Subakti Nata’atmaja** Introduction: Giant condyloma acuminatum, also called a Buschke-Löwenstein tumor, rst described in 1925, is a slow-growing, locally aggressive, destructive tumor of the ano-genital region. Scrotal tumors are rare. Reports on giant condyloma acuminatum lesions in patients with HIV and AIDS are surprisingly even rarer. The incidence is estimated to be 0.1% in the general population. Case presentation: In this report, we present a case of 34-year-old man with AIDS who was undergoing anti-retroviral therapy started two years prior to the development of the scrotal mass. He was found to have a giant condyloma acuminatum of the scrotum, that causing to be restrictied immobilization. Wide surgical excision and scrotal reconstruction with pedicled bilateral medial thigh ap was performed, signicantly improving his quality of life. Conclusion: Decision making regarding the goals of surgical intervention in the terminally ill is a complex process. The options include conservative medical palliation or palliative excision versus a curative excision that has the potential for signicant morbidity. Wide surgical excision with local ap reconstruction signicantly improved the quality of life of the patient described herein. The challenges presented by emerging or unusual presentations of surgical pathology secondary to HIV and AIDS in patients who are on anti-retroviral therapy provide an opportunity for research and the establishment of guidelines for the use of adjuvant chemotherapy in these patients. Keywords: Scrotal reconstruction, Giant condyloma acuminatum, Bilateral medial thigh ap, HIV/AIDS. Correspondence: *Doni Setiawan, resident of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316, email:
[email protected]. **Beta Subakti Nata’atmaja, Plastic surgeon, staffs of Departement Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Jl.MayjenMoestopo 6-8 Surabaya, phone and fax : 031- 5501316.
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ABSTRACT E-POSTER FP 009 FACIAL ATROPHY LESION TREATMENT WITH MODIFIED DERMAL-FAT GRAFT: A TECHNIQUE TO IMPROVE GRAFT SURVIVAL (CASE REPORT) Krahmadi E, Josh F, Rieuwpassa AJ Div. of Plastic, Dept. of Surgery, Faculty of Medicine Hasanuddin University, Makassar, Indonesia Introduction and Objectives: Objectives: Many procedures were used to manage facial tissue atrophy such as dermal-fat graft, fat injections, galeal ap, free aps, or cartilage and bone graft. Ideal soft tissue ller should be safe with low immunogenicity, efcient with stable long term results and practical with low cost and ease of use. Dermal-fat graft is one of simple and safe method for management of facial atrophy. In this paper, the authors introduce modied dermo-fat graft technique to decrease the resorption rates of the graft. Case Description: Description: Reported female, 26 years old with facial atrophy after submandibular abcess when she was 6 months old. Modied dermal-fat graft was performed to ll the soft tissue countour deformity at left mandible region. The outcome show that modied dermal-fat graft is is successfully ll the defect defect and the graft still last till till 1 years post surgery without any reduction. Conclusions: Case with facial tissue atrophy can be managed with Conclusions: with modied dermal-fat grafting technique to decrease the resorption rates of the graft. Atrophy, Dermal-fat graft Key Words: Words: Facial Atrophy,
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ABSTRACT E-POSTER PO 010 NON-SURGICAL MANAGEMENT OF METHICILLIN-RESIST METHICILLIN-RESISTANT ANT STAPHYLOCOCCUS AUREUS PRESSURE ULCERS: A CASE REPORT
Over the period of 20 to 30 years, Methicillin-resistant S. aureus (MRSA) strains have been present in hospitals as hospital-acquired MRSA. They have become a major cause c ause of nosocomial infection. Pressure infection. Pressure ulcers, as the most common condition encountered in long-term hospitalized patients, are reservoirs for S. aureus and the phenotype MRSA that may impact nosocomial infections. Methicillin-resistant S. aureus bacteria colonize the skin and open wounds and may interfere with wound healing. These microorganisms existence in pressure ulcers exaggerate not only the length of stay, paramedics’ workload, healthcare cost, but also patient and his family emotional burden. In special condition, for example, patient with pressure ulcers and other comorbids that contraindicated for surgical management, there’s still a choice for non-surgical management. We reported the case of a 57-year-old Asian bed-ridden man with history of MCI for which PCI was performed, multiple cardiac dysrhythmia of VT/VF with DC shocked was performed, lung edema, hypertension, diabetes mellitus and pressure ulcers grade III at region sacrum and perineum with MRSA. Initially, the pressure ulcers cleansed with antiseptic and coated with honey-lled gauze. Initially, One of the protocol in diminishing MRSA is decolonization procedure. We did this procedure by treating the wounds with mupirocin zalf. After MRSA declared negative, the wound treated with honey-lled gauze mixed betaine+polyhexanide liquid and gel. During 7 weeks of wound care management, granulation tissues were appeared at the pressure ulcers, especially at sacrum region, with more than 80% reepitelization. As conclusion, in a complex pressure ulcer patient with comorbids, we may consider the non-surgical management as an option considering c onsidering the patient needs and consent.
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ABSTRACT E-POSTER PO 011 INTRA-LESIONAL ALCOHOL INJECTION FOR FACIAL VASCULAR VASCULAR MALFORMATION; TREATMENT AND CHALLENGES Prasetyanugraheni Kreshanti, MD, Krista Ekaputri, MD Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Cipto Mangunkusumo Hospital - Universitas Indonesia Background: Intra-lesional alcohol injection is an effective treatment modality in the management of vascular malformation. It is relatively safe with skin sk in necrosis as the most common complication. The author reported 3 cases of alcohol injection under general anesthesia to treat vascular malformation. Unfortunately, Unfortunately, there are 2 cases that suffered from skin necrosis after the injection. This condition was overcome by application of honey dressing and surgery. The surgeon and the patients are satised with the result and no recurrences in long term follow up. However, we still have difculty determining the right dose of alcohol that can develop the brosis of the vascular malformation without producing skin necrosis. Aim: To nd optimal dose of intra-lesional alcohol injection, which does not cause skin necrosis. Methods: This is an EBCR. We use Pubmed to conduct the search using keywords “vascular malformation”; “ethanol sclerotherapy or alcohol injection”; and “skin necrosis”. We found 7 related articles. Results: In those articles, we were unable to nd the right dose of ethanol ethanol that can develop the brosis of the vascular malformation without producing skin necrosis. Conclusion: Skin necrosis complication in intra-lesional alcohol injection may be avoided.. Even necrosis seems terrible; it still can be managed with surgery. Intra-lesional avoided alcohol injection combined with surgery is quite reliable in the management of vascular malformation and preventing recurrences. Keywords: vascular malformation; intra-lesional alcohol injection; ethanol; skin necrosis
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ABSTRACT E-POSTER PO 012 MESENCHYMAL STEM CELLS THE NEXT GENERATION OF BURN TREATMENT Maulina Rachmasari, Aditya Wardhana Department of Surgery; Division of Plastic Surgery Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta
Background: Burn trauma is still one of cause of morbidity and mortality. Although survival rates are increasing, burn trauma usually involves a large body surface area that needs a better skin substitutes that can cover and retain normal skin durability with minimal donor requirements. Stem cells have been introduced as a new prospects modality of wound covering. Recent research has shown the great potential of stem cells in improving the rate and quality of wound healing. Methods: Mesenchymal stem cells (MSCs) is the most common type of stem cell used in burn wound. These cells had been conducted by PT. Sel Punca Laboratory. The source for MSCs used in this study is adipose tissue, which provides a rich source of MSCs. The stem cell therapy were administered locally at the site of the burn wound for two patients. Then we mark the area that already epithelized. These MSCs was assessed at day 3, 7 and 11 for rate of wound healing. Results: We put the MSCs in 5 different sites for these patients. Then we assessed whether there are progression in epithelialization. Both patients showed an advancing epithelialization from the edge around 0,5 – 1,5 cm. Conclusion: This study aims to highlight the benecial therapeutic effect of stem cells in burn wound healing. However, because of the very high harvesting and culturing expenses, and also insufcient data on the safety of MSCs for human use, there is still need for further developments in MSCs research and gradually decreasing costs so the use of MSCs will become a potential alternative to improve burn healing. Keywords: Mesenchymal stem cell, burn
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ABSTRACT E-POSTER PO 013 LONG TERM MAXILLARY GROWTH EVALUATION AFTER THE NON DENUDED MUCOPERIOSTEAL PALATOPLASTY TECHNIQUE M Rachmasari, P Kreshanti,S Handayani, J Pancawati, AJ Susanto, G Wangge Department of Surgery; Division of Plastic Surgery Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Jakarta Background: Conventional two ap palatoplasty technique will made 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 maxilary growth impairment. In 2011, we studied the non denuded mucoperiosteal palatoplasty technique. This technique precipitated the epithelialization process of the lateral defects. Faster epithelialization is expected to decrease wound contraction and in the long run will result in good maxillary growth. Aim of study: To evaluate long term maxillary growth in unilateral cleft lip and palate patients repaired with the non denuded mucoperiosteal palatoplasty technique. Methods: This is a case control study to compare the maxillary growth of 3 groups consists of unilateral cleft lip and palate patients repaired with the non denuded mucoperiosteal palatoplasty technique, conventional two ap palatoplasty and normal population. The outcome will be evaluated from cephalometry and GOSLON YARDSTICK method from dental casts. Data will be analysed using SPSS version 22. Keywords: maxillary growth evaluation, cephalometry, Goslon Yardstick, two ap palatoplasty
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ABSTRACT E-POSTER PO 014 BUNIONPLASTY IN PLASTIC SURGERY POINT OF VIEW Maria Valentine, Budiman Plastic Surgery Division, Department of Surgery, Faculty of Medicine University of Indonesia – Ciptomangunkusumo Hospital, Plastic Surgery Division, Department of Surgery Gatot Soebroto Central Army Hospital Jakarta Indonesia
Background: Bunionplasty can be considered as an aesthetic procedure for foot surgery on behalf of treating bunion. It is a common condition, particularly in women with inappropriate footwear, such as shoes that overly tight in toes and high heels. Indication for surgery is common, with more than 150 different surgical procedures to correct the condition have been described, with most of surgery intervention were done by orthopedics and podiatry Case Report: We presented one case of female, 28 years old, with chief complain deformity and pain on her rst toe of both feet since 2 years ago. The use of pointed toe and high heels shoes was undeniable. From the clinical appearance, we can see deformity of rst toe in both feet, which can be classied to grade 3 Manchester scale. We performed proximal phalangeal osteotomy and plating with 2.0 plating system and also buniectomy. Early mobilization was achieved; no complication found post surgery, and patient was satised with the result. Discussion: Concomitant foot deformity may have interfered in process of bunion, other than the use of tight and pointed shoes. Most procedures offered in the literature for correction of hallux valgus do work if properly performed in the right indications. Osteotomy and plating may offer the fastest mobilization post procedure with comparable result with other procedure, it also reduces risk of infection and twisting of the osteotomy part compare to the use of K-wire for xation. Summary: Correcting pain and deformity, avoiding recurrence, establishing normal foot function, and early mobilization are the ultimate goals of bunion surgery, which can be met with this procedure. Although many elds have been done invention in bunion surgery, bunionplasty is one of many procedures that plastic surgery should be conquered at. Keywords: bunion, hallux valgus, hallux abducto valgus, varus deformity,
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ABSTRACT E-POSTER PO 016 DEGLOVING HAND INJURY : IS “SANDWICH FLAP” STILL AN OPTION? Michelle Athina Gatot Soebroto Central Army Hospital Design and function of the hand is an amazing work of anatomic engineering for the effective functions of the hand. Therefore any injury to the underlying structures of the hand carries a potential risk of serious handicap. And many of these injuries affect the dominant hand, thereby impeding patient’s ability to work or cope with their social obligations To reduce this risk even the smallest hand injuries require proper medical evaluation. The goal with injuries of the hand is rapid and accurate entail evaluation and treatment. The degloving injuries of hand remain a persistent challenge. A case that we found in RSPAD Gatot Soebroto, used an anterolateral chest and medial upper arm – sandwich ap to treat a 23-year-old, right-handed male worker with degloving injuries of 1/3 part of metacarpal region until distal of ngers. The ap was designated to cover the entire circumference of metacarpal-phalanxes sustaining degloving injury and to form mittenhand, after debrided. The total lengths of the distal phalanxes of four ngers were almost completely retained. The donor defect was covered with split-thickness skin graft. Eighteen days after the initial operation, the second operation performed aiming to detach the ap. Six months later, the third operation was done to separate the index nger and middle nger and also to shortened the tip of the nger. One year after the rst operation the patient had an aesthetically acceptable hand with limited function. The fourth operation was performed to separate the middle nger and ring nger. As nal result, he can do his daily activities and back to work again. Therefore we considered that salvaging degloved hand can be done using this old fashioned hand sandwich ap technique when urgent need arises. In case of hand degloving injury, then sandwich ap is still an option.
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ABSTRACT E-POSTER PO 017 THE EFFECT OF TOPICAL SIMVASTATIN GEL TO EPITHELIALIZATION PROCESS, COLLAGEN SYNTHESIS, AND FIBROBLAST PROLIFERATION, OF FULL THICKNESS WOUND ON WISTAR STRAIN RAT (RATTUS NORVEGICUS) M. Amirsyah*, A. Santoso Budi, L. Zarasade** Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya Abstract: Wounds have always been one of the most important subjects that experimental researches were dedicated to. Insulin has been used for long as a anti diabetic agent which was reported to have some pleiotropic effects such as induced growth factor. In this study we aimed to determine the effect of insulin on wound healing process in laboratory rats by means of stereological and histopathological analyses. 18 male Rattus novergicus rats with a 2 cm 2 full thickness wound on their back were divided into three groups, Insulin group that received 0,5 Unit/100 gram gel, base of gel group that treated only with gel base and NaCl group that received no treatment but daily irrigation with normal saline. Duration of the study was 5 days. Wound closure rate, epithelization, broblast proliferation, collagen bundles synthesis and thick of epitel were determined. Keywords: Insulin, Wound healing, Epithelization, Fibroblast proliferation, Collagen bundles Correspondence: Mirnasari Amirsyah, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr.Soetomo General Hospital Surabaya, Mayjen Moestopo rd. 6-8 Surabaya, phone : 031-5501316.
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ABSTRACT E-POSTER PO 019 THE OBJECTIVE MEASUREMENT OF MARGINAL EPITHELIAL CREEPING OF SPLIT-THICKNESS SKIN GRAFT USING TRANSPARENT PLASTIC PAPER: AN IDEA AND INNOVATION METHOD Muda Muzakkie, Aditya Wardhana Plastic Reconstructive and Aesthetic Surgery Division, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Background: Split thickness skin graft (STSG) is common and ideal wound coverage in extensive burn. Meshed and postage-stamp skin graft are allowed for expansion and wide coverage. Evaluating and measure marginal epithelial creeping of meshed and postage-stamp skin graft with photograph has some limitation: subjective interpretation, pixel and saturation difference in every sequel and not given an actual size. In this study, we made an innovation of objective method to measure epithelial creeping of STSG using transparent plastic paper. Materials and Methods: Subjects are extensive burn patients in Burn Unit, Cipto Mangunkusumo Hospital that need STSG as wound coverage. 1:3 ratio of meshed STSG and 1:4 ratio of postage-stamp STSG were applied to 8x8 cm 2 recipient site. Immediate skin graft was drawn on sterilized transparent plastic paper with black ink. STSG and marginal epithelial creeping were drawn on another sterilized transparent plastic paper on Day-5 with red ink, and on Day-10 with blue ink. Marginal epithelial creeping on transparent plastic paper were measured and analyzed with digital image analyses. Results: At the day of STSG insetting, STSG were drawn on transparent plastic paper as the pattern. The day-5 and day-10 of marginal epithelial creeping were evaluated and measured in percentage, with the day-0 pattern as the reference. There was increasing of epithelial on day-10 rather than day-5 that we can measure objectively and given the actual size. Conclusions: Using drawn transparent plastic paper as measurement tool of marginal epithelial creeping of split thickness skin graft given an objective interpretation, easy to apply and low price. Keywords: objective measurement, epithelial creeping, STSG
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ABSTRACT E-POSTER PO 021 EXPLOSIVE MAJOR BURN: Case Report and Literature Review Noi Maya Anggrita Sari MD 1, Liliyanto MD 2 1 General Practioner and staff on General Hospital Of Manggar City, East Belitung, Indonesia 2 Practical General Surgeon and staff on General Hospital Of Manggar City, East Belitung, Indonesia Major burn is one of the most serious and life-threatening form of trauma. Inhalation injury leads to pulmonary injury and increases burn mortality. Extensive burn on young adult patient not only affect physical, psychological, social and spiritual aspect but also changes in health-related quality of life with the possibility of scarring and contracture. This article is a case report and review of an overview of burn injury not only treatment strategies but also discussion on etiology, clinical presentation, burn prognosis based on studies and recent research reports. A 20-yr-old male patient was admitted to our hospital after gas explosion accident at work. Altogether 56% TBSA was burned by ame (2nd3rd degree). The regions affected were face, right buttock, and circumferential pattern burns on both lower arms, both thighs, and both legs. The patient had a distressed facial expression and was cooperative. He showed few signs of inhalation injury such as facial burn, burning nose hairs, eyebrows, and hair; carbonaceous sputum, hoarseness, with history of trapped in room during incident. He had little breathing difculty, although obvious swelling, particularly on head, was observed. Wounds were presented as red, red white, and charred in appearance, parts were dry with diminished sensation, other parts had blisters and painful to the touch, capillary rell >3sec. During emergency, airway was secured, uid resuscitation was administered according to Parkland formula, crystalloid was preferred. The speed of resuscitation was monitored in relation to urine output. The burned areas were scrubbed with normal saline and closed with silver sulfadiazine and gauze, and taken to the icu and fully monitored. The laboratory’s result showed leukocystosis. Surgical management was performed every 3-5 days. Dressing was changed daily with silversulfadiazine and honey. Positioning management was performed to prevent contracture on the extremities. The patient was hospitalized and discharged after 40 days. Keywords: Major burn, Inhalation injuy, Circumferential burn injury
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ABSTRACT E-POSTER PO 022 SURVIVAL OF COSTOCHONDRAL VERSUS CALVARIAL BONE GRAFT AS BIOMATERIALS FOR ORBITAL VOLUME RESTORATION SURGERY : A SYSTEMATIC REVIEW Nurliati Sari Handini, Kristaninta Bangun Division of Plastic Reconstructive & Aesthetic Surgery, Department of Surgery, Universitas Indonesia Background: Biomaterials are known to be used in orbital volume restoration surgery following blow out fracture. The choices may include costochondral graft or calvarial bone graft. This study aims to analyze published evidence regarding those two options for orbital volume restoration surgery for its survival in maintaining orbital volume. Methods: A systematic literature review is performed to include publications based on set inclusion and exclusion criteria. Strategies of literature search are used with search terms combined as appropriate in PubMed Medical Subject Headings (MeSH) terms. Risk, benet, and survival of costochondral graft and calvarial bone graft in relation to orbital volume restoration are noted. Rates of infection, diplopia, and enophthalmus are compared between the two biomaterials. Results: We hypothesize that there may be inadequate evidence to determine which one is superior between the two biomaterials for orbital volume restoration surgery. Conclusion: Surgeon preferences may play the role in resulting inconsistent inconclusive data. Certain parameters may be included to propose an algorithm and help in decisionmaking process case-by-case, hence ending the controversies. The two biomaterials may have equal stand in orbital volume restoration surgery.
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ABSTRACT E-POSTER PO 023 CLEFT CRANIOFACIAL CENTER JAKARTA: PROFILE OF PALATAL INDEX AND FISTULA FORMATION Pritha Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery Cipto Mangunkusumo Hospital - Universitas Indonesia Background: Fistula formation has been the main complication of palate repair. Its formation proposed to be affected upon a number of factors such as the width of the cleft, the amount of deciency of the palate segments, and other extrinsic variables such timing of the repair, gender, surgical procedures and the performing surgeon. Performing integrated cleft treatment over 4 years we observed that most of our patients came with a wide gap of cleft palate. Thus it encourage us to study about the ratio of cleft width to the sum of the palatal shelves width that is dene as the palatal index. Methods: A retrospective study of 52 cases underwent cleft palate repair in Cleft Craniofacial Center between 2013 and 2015. Data collected include age, gender, type of cleft palate, surgical technique, palatal index, and stula formation. The severity is classied into 3 degrees: mild (0-0.2), moderate (0.2-0.4), and severe (>0.4). Fistulas formation was determined from physical examination on third week, but nasal-alveolar stulas and intentionally unrepaired anterior palatal stulas were excluded. Results: A total of 52 consecutive patients, aged 10 months to 21 years old with 32 boys (61.5%) and 20 girls (38.5%). Cleft type include incomplete, complete and bilateral cleft in 13 (25%), 28 (53.8%), and 11 (21.2%) cases respectively. Two-ap palatoplasty performed in 39 (75%) and Veau-Wardill-Kilner in 13 (25%). The severity based on palatal index are 2 (3.8%), 8(15.3%), and 43 (83.9%) cases for mild, moderate, and severe cleft respectively, without any stel formation in mild and moderate group and 10 (19%) in severe group.
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ABSTRACT E-POSTER PO 024 EMBOLIZATION AND REDUCTION IN GIANT HAEMANGIOMA GLOSSUS ET LABIALIS INFERIOR : A CASE REPORT Rachmaniar Pramanasari*, Sitti Rizaliyana ** Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital Surabaya Background: Infantile Hemangioma is the most common benign tumor in infants and
childhood that affected 10% of the populations. The caused is unknown and the prevalence in male : female is 1 : 3. In premature infants the prevalence is higher as 30%. Head and neck is a common region for vascular malformation. Giant hemangioma in head and neck can causes a lot of problems. Among the different localizations of vascular malformations in the head and neck region, the tongue has specic characteristics; because it’s not only is susceptible to trauma, but also may cause speaking difculty or swallowing problems. Therefore, comprehensive treatment should be done for a better outcome. Case Report: In this paper, authors reports a rare case of giant hemangioma of the tongue and lower lip in 8 months old infant, referred from Pediatric Department. She has been treated in Pediatric Department with combination therapy using chemotherapy of Vincristin and Kenacort and oral therapy of Propanolol. There’s no decreasing size of the mass after this combination treatments. From Plastic Surgery Department, we combined therapy using embolization and reduction, in order to preserve the function of the tongue and maintain the size after reduction. Result: Giant hemangioma treatment combining embolization and reduction is not only to reduce the bleeding during the operation, but also to maintain post operation growth of hemangioma. Keywords: Hemangioma, Giant, Tongue, Head and Neck, Vascular Malformations, Infant Correspondence: Rachmaniar Pramanasari, Department of Plastic Reconstructive and Plastic Surgery, Airlangga University School of Medicine, Dr. Soetomo General Hospital Surabaya, Jl Mayjen Moestopo 6-8, Surabaya, phone : 031-5501316
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ABSTRACT E-POSTER PO 025 MACROPHAGES BEHAVIOR; AMNION AND MNICROBIAL CELLULOSE IN RAT’S FULL THICKNESS WOUND Saktrio Darmono S. *, Beta S. Nata’atmadja**, David S. Perdanakusuma*** Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr. Soetomo Teaching Hospital Surabaya Indonesia Background: Wound is the most frequent problems faced by a plastic surgeon. A wound is a break or discontinuity of the integrity of the skin, mucosa, or tissue. Many factors can affect the wound healing process. Macrophages as one indicator of wound healing which produces the majority of growth factor. Macrophages present in the wound within 24-48 hours after injury and peaked at 48-72 hours. Currently, there are variety of wound dressing available, which according to research can increase the levels of macrophages in the wound healing process. Objective: Comparing the total amount of macrophages on full thickness wound bed in the use of tulle, amnion and microbial cellulose. Study design: Experimental, post test only group design. Study method: Using 21 male rats Rattus norvegicus . Full thickness wounds were made on the backs of mice. The wound was closed with tulle, amnion and microbial cellulose. The wound was evaluated on the second day. Samples wounds were xed with 10% formalin solution. Examination of samples was done by Wright-Giemsa staining routine / Hemato-eosin under a microscope. Hypothesis: There are differences in the increase in the number of macrophages in the wound bed by the use of tulle, amnion and microbial cellulose. Keyword: macrophage, tulle, amnion, microbial cellulose Correspondence: Saktrio Darmono S., Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University School of Medicine, Dr Soetomo Teaching Hospital, Mayjen Moestopo Street No. 6-8, Surabaya, phone 550131
*Plastic surgery resident at Medical School of Airlangga University/Dr.Soetomo Hospital Surabaya Indonesia **Plastic surgeons, junior staff at Medical School of Airlangga University/Dr.Soetomo Hospital Surabaya Indonesia ***Plastic surgeons, senior staff at Medical School of Airlangga University/Dr.Soetomo Hospital Surabaya Indonesia
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ABSTRACT E-POSTER PO 026 CORRELATION BETWEEN BLOOD GLUCOSE VARIABILITY AND MORTALITY AMONG SEVERE BURN INJURY PATIENTS AT RUMAH SAKIT HASAN SADIKIN BURN UNIT Sandy S. Sopandi, Irra R. Widarda Division of Plastic Surgery Reconstruction and Esthetic, Department of Surgery Fakultas Kedokteran Universitas Padjadjaran – Rumah Sakit Hasan Sadikin, Bandung INTRODUCTION: Severe burn injury incites hypermetabolic response in burn patients, including insulin resistance and hyperglycemia. Hyperglycemia and blood glucose uctuation are associated with the increase of morbidity and mortality risk. METHODS: We evaluated severe burn patients cared in RSHS Burn Unit between 2012-2015. From blood glucose examination during care, we calculated blood glucose variability to be correlated to patients’ mortality outcome. RESULTS: A total of 106 patients fullled inclusion criteria. Patients were classied into two groups based on nal outcome (66 patients survived in the rst group and 40 patients died in the second). Blood glucose variability was higher in the non-surviving group (23.58 compared to 19.93). Mann-Whitney test showed p-value 0.074, hence there was no signicant difference between blood glucose variability between both groups. CONCLUSION: Blood glucose variability of severe burn patients was higher in the nonsurviving group. Therefore, blood glucose is a parameter which needs to be regulated in managing burn patients. Although to evaluate association between blood glucose and mortality, we need another study with a more uniform patient characteristics and routine examination of blood glucose during patient care. KEYWORDS: blood glucose, burns, mortality, variability
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ABSTRACT E-POSTER PO 027 EVALUATION OF PRE-REFERRAL MANAGEMENT OF ACUTE BURN PATIENTS IN RUMAH SAKIT HASAN SADIKIN Sandy S. Sopandi, Irra R. Widarda Division of Plastic Surgery Reconstruction and Esthetic Department of Surgery Fakultas Kedokteran Universitas Padjadjaran – Rumah Sakit Hasan Sadikin, Bandung INTRODUCTION: Due to the high incidence of burn injury in Indonesia, primary healthcare staff as the frontline of health service should master acute burn management before referring patients to another facility. This management is an important initial step in the comprehensive management of burn injury. METHODS: We collected medical record of patients referred from another health center to RSHS ER during 2015. We evaluated the diagnosis and management performed including the practice of irrigation, decision to refer, availability of referral letter, evaluation of depth and total burn area, uid resuscitation, and urinary catheter insertion. RESULTS: From the total of 74 patients, 43 patients (58.1%) were referred from healthcare facilities inside Bandung, while the rest were from out of town. Duration median from burn onset until arrival at ER was 6 hours. Sixty one patients (82.4%) had a referral letter with them. Sixty six (89.2%) patients fullled referral criteria according to ANZBA. Correct rst aid water irrigation was performed only on one patient. Referrer’s diagnosis was deemed accurate on two (2.7%) patients. Thirty eight (51.4%) patients did not receive adequate uid. Nine (12.2%) received uid exceeding the required amount while 29 (39.2%) did not receive enough uid. Data regarding previous uid therapy was not available in 5 (6.8%) patients. Urinary catheter insertion was justied in 44 (59.5%) patients. CONCLUSION: Pre-referral management of acute burn injury is far from perfect. Therefore we need efforts to increase health staff’s prowess in acute burn management, such as routine training and continuous education, especially for those working in primary and secondary healthcare facilities. KEYWORDS: burns, diagnosis, management, referral and consultation
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ABSTRACT E-POSTER PO 028 EXPERIENCE WITH NEOVAGINAL CONSTRUCTION IN MALE TO FEMALE RECONSTRUCTION IN HASAN SADIKIN HOSPITAL Galuh A.S., Hardisiswo Soedjana* Faculty of Medicine Padjadjaran University/ Hasan Sadikin General Hospital Bandung *Department of Plastic Surgery Faculty of Medicine Padjadjaran University /Hasan Sadikin General Hospital Bandung Incident of male to female reconstruction stereotypically typically found in patients with Mayer-Rokitansky-Hauser (MRKH) syndrome or androgen insensitive (AIS) syndrome, although several cases was observed from typical average male with no congenital disgurement. Creating neovaginal cavity between the bladder and the rectum had been the main goal of this reconstruction. In our hospital, Inverted-V ap procedure and its modication was tailored to epithelize the neovaginal construction. Total of 7 patients underwent neovaginal construction using this method and its modication ( Four girls with MRKH syndrome, two girl with Androgen resistance syndrome and one male). The dissected length of the neovaginal cavity was estimated about 8- 9 cm. Postoperative stricture or contracture of the neovagina were not found in all patients with follow up period ranged from ½ to 1 months. As a result, Inverted-V ap procedure and/or its modication is an efcient method for vaginal construction in patients with vaginal agenesis or deciency. Key Words vaginal agenesis, MRKH syndrome, androgen insensitive syndrome, male to female reconstruction, neovaginal construction
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ABSTRACT E-POSTER PO 029 SUCCESSFUL SURGICAL REPAIR OF PENILE SILICONE GRANULOMA WITH SPLIT-THICKNESS SKIN GRAFT AND SKIN FLAP: REPORT OF TWO CASES Amila Tikyayala Purnomo*, Chaula L Sukasah Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital Background: The embodiment of masculinity in the physical appearance and size of penis has led many men to undergo penile enhancement therapy with the aims of improving self-esteem and satisfying their sexual partner. Liquid silicone injection is a popular penile augmentation technique which has been used extensively over the last 40 years and is often performed by non-medical and unqualied professionals. One of the well-documented severe complications of silicone injection is penile granuloma (siliconoma) formation. The aim of this study is to report two cases of silicone-induced penile granuloma and the respective surgical management in each case. Case Summary: A 46-year-old male and a 50-year-old male had silicone injection for penile augmentation two years and six months prior to their presentation, respectively. Both patients suffered from debilitating siliconoma formation, which led to physical deformities and disturbance in sexual activities. Surgical treatment consisted of extensive removal of the brotic tissue followed by penile resurfacing using either split-thickness skin graft or skin ap. Both patients recovered satisfactorily after the operation. Conclusion: Proper surgical management of penile silicone granuloma with complete excision of the granulomatous skin followed by replacement with skin graft or ap can restore the appearance and functions of the phallus. Public education is required to increase the public awareness of the dangers of liquid silicone injection and curb the unlicensed use of injectable silicone by non-medical and unqualied professionals. Key Words: Penile silicone granuloma, penile enhancement therapy, penile augmentation, injectable silicone, case report
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