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"Objective : To measure sensitivity and specificity diagnostic finding of convensional radiography in midfacial fractur performed at the Emergency room of Cipto Hospital and to evaluate its quality.

Design and Main Outcome Measures: In this diagnostic testing 35 patients with clinical signs of midfacial fracture were investigated. All patient underwent radiography examination at the Emergency room (Anteroposterior, Lateral and reverse Waters view). X ray photo were expertised by a plastic surgeon and a radiologist, both of them without knowing the clinical conditions, and by the residen who received the patient at the ER. Then we compare radiographic and intraoperative findings as goal standard, The results were analyzed by statistical testing (for sensitivity, specificity, positive, negative predictive value).

Results: The result showed that sensitivity and specificity varied between plastic surgeon, radiologist and residen but still high, and we noted that clinical examinations revealed to be very helpful in the assessment of an inadequate imaging fracture.

Conclusion: Conventional radiography performe at the Emergency Room of Cipto hospital has high specificity although the quality is considered substandard. Clinical findings is still very important to distinguished uncertain fracture."

"[ABSTRAKPendahuluan :Fraktur Midface merupakan fraktur yang sering terjadi dapat dapat memberikan efek baik dari segi estetik dan fungsi. Fraktur Midface yang tidak ditangani dengan baik akan merubah bentuk wajah menjadi tidak proporsional, salah satunya wajah yang menjadi lebih lebar dan panjang, terdapat depresi malar. Tata laksana dengan reposisi segmen fraktur dan fiksasi interna merupakan pilihan utama.Metode :Data yang diambil dari status estetik dengan menggunakan studi cross sectional pada pasien dengan fraktur midface sebelum operasi ORIF didapatkan di rekam medis, dan data setelah opeasi ORIF didapatkan dari follow up (4 years), kemudian dilakukan pengukuran dari proyeksi vertical, horizontal dan warm?s view .Hasil :Berdasarkan analisis fotografi dari proyeksi vertikal didapatkan 3 pasien memiliki proporsi muka yang baik, 3 pasien memiliki proporsi wajah yang baik dikarenakan perbedaan rata-rata. Berdasarkan analisis fotografi dari proyeksi horizontal didapatkan 3 pasien memiliki panjang muka yang berbeda, 2 pasien memiliki dystopia, 1 pasien memiliki enophtalmus. Berdasarkan analisi fotografi dari proyeksi worm?s eye didapatkan 4 pasien memiliki depresi malar eminensMengenai hasil estetika, didapatkan 4 pasien (66,6 %) puas dengan simetrisitas wajah setelah operasi. 2 pasien (33,3 %) mengeluhkan tidak puas dengan penampilan akhir setelah operasiKesimpulan :Untuk dapat mengevaluasi hasil operasi ORIF di Divisi Bedah Plastik Rumah Sakit Ciptomangunkusumo. Tidak hanya dibutuhkan registrasi data awal yang baik, tetapi juga dibutuhkan sarana dan fasilitas untuk mendapatkan evaluasi jangka panjang pada pasien terutama lokasi pasien yang jaraknya jauh dari lokasi rumah sakit.

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ABSTRACTBackground :Midface fracture is a fracture that often occurs may be able to give a good effect in terms of aesthetics and functionality. Midface fracture that is not handled properly will change the shape of the face become disproportionate, one of which face becomes wider and longer, there is a malar depression. The management of the segment repositioning fracture and internal fixation is the main option.Methods:Data taken from the status aesthetic using cross sectional study in patients with fractures midface before surgery ORIF obtained in medical records, and the data after opeasi ORIF obtained from follow-up (4 years), then the measurement of the projected vertical, horizontal and warm's view.Result:Based on the photographic analysis of the vertical projection obtained 3 patients have a good proportion of the face, 3 patients had good facial proportions due to differences in average. Based on the photographic analysis of horizontal projection obtained 3 patients had a different face long, 2 patients had a dystopia, 1 patient had enophtalmus. Based on the photographic analysis of the worm's eye projection obtained 4 patients had a malar depression eminens.Regarding the aesthetic results, obtained four patients (66.6%) are satisfied with simetrisitas face after surgery. 2 patients (33.3%) complained of is not satisfied with the final appearance after surgeryConclusions:To be able to evaluate the results of ORIF surgery in the Division of Plastic Surgery Hospital Ciptomangunkusumo. Not only the data registration needed a good start, but also the infrastructure and facilities needed to obtain a long-term evaluation of the patients, especially the location of patients that were located far from the location of the hospital, Background :Midface fracture is a fracture that often occurs may be able to give a good effect in terms of aesthetics and functionality. Midface fracture that is not handled properly will change the shape of the face become disproportionate, one of which face becomes wider and longer, there is a malar depression. The management of the segment repositioning fracture and internal fixation is the main option.Methods:Data taken from the status aesthetic using cross sectional study in patients with fractures midface before surgery ORIF obtained in medical records, and the data after opeasi ORIF obtained from follow-up (4 years), then the measurement of the projected vertical, horizontal and warm's view.Result:Based on the photographic analysis of the vertical projection obtained 3 patients have a good proportion of the face, 3 patients had good facial proportions due to differences in average. Based on the photographic analysis of horizontal projection obtained 3 patients had a different face long, 2 patients had a dystopia, 1 patient had enophtalmus. Based on the photographic analysis of the worm's eye projection obtained 4 patients had a malar depression eminens.Regarding the aesthetic results, obtained four patients (66.6%) are satisfied with simetrisitas face after surgery. 2 patients (33.3%) complained of is not satisfied with the final appearance after surgeryConclusions:To be able to evaluate the results of ORIF surgery in the Division of Plastic Surgery Hospital Ciptomangunkusumo. Not only the data registration needed a good start, but also the infrastructure and facilities needed to obtain a long-term evaluation of the patients, especially the location of patients that were located far from the location of the hospital]"

"ABSTRAKLatar belakang: Diced cartilage banyak digunakan dalam praktek bedah plastik. Keuntungannya sangat beragam, dari rekonstruksi hingga estetik. Tetapi data mengenai viabilitas antara bentuk kasar dan halus belum ada, sehingga penelitian ini bertujuan untuk mendapatkan data dasar tersebut.Metode: Penelitian menggunakan kelinci New Zealand dewasa. Menggunakan tujuh ekor kelinci yang dibagi menjadi tiga grup yaitu grup block cartilage, coarsely diced cartilage dan finely diced cartilage. Pengabilan cartilage dilakukan dari satu sisi bagian telinga kelinci, dibagi dengan ukuran yang sama dan ditanam di bawah kulit scapula. Setelah 12 minggu dilakukan pemeriksaan makroskopik untuk menilai warna, dan kontur dari kartilago yang sudah diimplantasikan lalu juga dilakukan pemeriksaan histologis dengan pewarnaan : Haematoxylin Eosin dan Mason Tricrhome untuk menilai viabilitas masing ndash; masing grup.Hasil: Secara makroskopik didapatkan perbedaan berat cartilage dari masing ndash; masing grup. Masing ndash; masing menunjukkan peningkatan berat cartilage antara sebelum dan sesudah 12 minggu. Tidak didapatkan perbedaan viabilitas antara masing ndash; masing grup, dengan nilai p > 0.312.Kesimpulan: Penggunaan coarsely diced cartilage memiliki keuntungan untuk pengisian volume organ yang besar. Hal ini dikarenakan tidak adanya perbedaan secara makroskopik maupun mikroskopik antra finely dan coarsely diced cartilage.

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ABSTRACTThe use of diced cartilage grafts is common in plastic surgery, it is very useful for reconstruction after secondary accident and malignancies in the facial region. In recent years it is very useful for aesthetic surgery. The study to compare between coarsely and finely diced cartilage is not provide.Methods We use New Zealand white rabbits for this study. We used seven samples with three group, one group of block cartilage, one group of coarsely diced cartilage and the last group of finely diced cartilage. Three equal sized auricular cartilage grafts were harvested from each rabbit and implanted on the scapulae of the same rabbits. Twelve weeks after implantation, all cartilage grafts were examined macroscopically and microscopy. Post implanted cartilage grafts were stained by Haematoxylin Eosin and Thricrhome to know the viability of each group.Result Macroscopically there is different weight before and after implantation, every group was gain the weight. The viability between the each group is not different significant, p 0.312. The advantages for the coarsely diced cartilage than fined diced cartilage was same in contour, color, viability and absorpsion weight was gained .Conslusion We can used the coarsely diced cartilage for the bigger defect that need more volume. The result is same between finely and coarsely in clinical and histologic"

"Latar Belakang: Rekonstruksi pada defek tulang kritikal masih merupakan tantangan yang besar untuk seorang ahli bedah plastik rekonstruksi. Selama ini, baku emas untuk menangani kasus defek tulang tersebut adalah menggunakan autologous bone graft, namun terdapat beberapa kekurangannya seperti morbiditas pada lokasi donor, pemanjangan waktu operasi, donor yang terbatas, dan pemajangan waktu rawat. Mencoba mengatasi kekurangan tadi, muncullah rekayasa jaringan tulang yang memberikan hasil yang menjanjikan dalam regenerasi jaringan tulang biologis yang baru. Beberapa penelitian hewan sebelum, menunjukkan bahwa implantasi secara ortotopik dan ektopik dapat memberikan hasil yang cukup baik dalam regenerasi tulangMetode: Telaah sistematis dilakukan pada Pubmed/MEDLINE, Cochrane Library, dan WHO ICTRP, termasuk semua studi dengan data primer untuk rekayasa jaringan tulang menggunakan kalsium fosfat sebagai bahan rangka, studi pada defek tulang kritikal, baik uji klinis acak terkontrol maupun tidak pada manusia dan hewan. Luaran yang dinilai adalah pembentukan tulang baru yang membandingkan implantasi secara ortotopik (intraperiosteum) dan ektopik (intramuskular). Studi ini menggunakan SYRCLE’s tools untuk menilai risiko bias studi pada hewan.Hasil: Didapatkan lima studi hewan yang memenuhi kriteria eligibilitas dari total 80 studi yang diinklusi pada telaah ini. Dicantumkan karakteristik demografis dari masing-masing studi. Studi yang memiliki luaran klinis yang sama (% area tulang dan % kontak) dibandingan antara implantasi ortotopik dan ektopik. 2 studi menunjukkan bahwa implantasi secara intramuskular menggunakan kerangka yang sudah ditambahkan BMSC memberikan hasil yang baik pada pembentukan jaringan tulang baru. Kerangka kosong tidak menunjukkan adanya pembentukan tulang. Penambahan BMP-2 sebagai factor pertumbuhan dapat meningkatkan osteogenisitas baik pada implantasi ortotopik maupun ektopik.Kesimpulan: Implantasi ortotopik dapat menginduksi pembentukan tulang baru lebih baik daripada implantasi ektopik. Menggunakan kerangka yang ditambahkan BMSC serta BMP-2 pada implantasi intramuskular memberikan hasil yang baik untuk pembentukan tulang baru. Rekayasa jaringan tulang memungkinkan untuk dilakukan dengan implantasi secara ortotopik maupun ektopik

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Background: Critical bone defect reconstruction remains a major challenge in plastic reconstructive surgery. While autologous bone graft is still considered as the gold standard for treating critical bone defects, there are disadvantages like donor site morbidity long operative time, donor limitation, and extended hospital stay. In order to resolve them, bone tissue engineering has emerged in reconstruction medical studies, for they give promising result in regenerating new biological bone tissue. Previous animal studies have shown that implantating orthotopically and ectopically gave promising result in bone regeneration.

Methods: A systematic search was done on PubMed/MEDLINE, Cochrane Library, and WHO ICTRP, including all studies with primary data for bone tissue engineering using calcium phosphate as scaffold materials, studies in critical bone defects, RCT or non RCT in human studies or animal studies. Studies with outcome of new bone formation comparing orthotopic (intraperiosteum) implantation and ectopic (intramusculuar) implantation. We used SYRCLE’s tools for assessing risk of bias of animal studies.

Results: Five animal studies meet the eligibility criteria from a total of 80 studies are included for this review. Characteristics demography of each study are stated. Studies with the same outcome (bone area% and contact%) are compared in orthotopic and ectopic implantation. Two studies showed that intramuscular implantation using BMSC-seeded scaffold give promising result of new bone formation. However empty scaffold did not show any bone formation. Adding BMP-2 for growth factor can improved osteogenecity both in orthotopic implantation and ectopic implantation

Conclusion: Orthotopic implantation can induced new bone formation better than ectopic implantations. Using BMSC-seeded and addition of BMP-2 for intramuscular implantation give good result of new bone formation. Both orthotopic and ectopic (intramuscular) implantation are possible for bone tissue engineering"

"ABSTRAKPendahuluan. Perkembangan analisis wajah pada bedah rekonstruksi wajah sangatlah pesat, sejalan dengan perkembangan teknologi pencitraan dan komputerisasi. Program perangkat lunak yang tersedia pada saat ini, seperti Rhinobase, hanya dapat mengukur daerah hidung, tidak seluruh wajah. Oleh sebab itu dibutuhkan suatu program perangkat lunak yang lebih lengkap, dapat menyimpan data medis, mengukur dan menganalisis foto (fotogrametri dan analisis fotografi) guna merencanakan tindakan operasi rekonstruksi wajah secara keseluruhan. Pengakat lunak ini diharapkan dapat digunakan sebagai alat ukur dan menjadi panduan untuk melakukan tindakan bedah rekonstruksi wajah (reaksilofasial)."

"Midfacial rejuvenation is a comprehensive review of the majority of procedures and options for midfacial aesthetic and corrective surgery. Each contributor offers a unique approach to the midfacial area, with detailed specifics for every technique. Chapters on midfacial anatomy, complications and their management complete the comprehensive coverage of the subject matter, resulting in a reference text that will benefit every practitioner dealing with the midfacial region. Features, one of the first books to focus exclusively on the midfacial area, highly illustrated and with clear, step-by-step instructions on performing a variety of midface lifts, implants, sutures, grafts, and fillers, over 300 full color images, includes in-depth chapters on midfacial anatomy and the anatomic basis of aging, multiple approaches to midfacial rejuvenation by well-known surgeons in fields such as oculoplastics, facial plastics, general plastics, and dermatologists."

"Background: Pada program pelatihan residensi bedah Plastik, pengukiran framework untuk telinga luar pada prosedur mikrotia masih terbatas pada sistem magang. Menurut model berbasis simulasi, residen dapat dilatih sebelum menghadapi pasien sebenarnya. Penelitian ini akan menilai efisiensi dari program pelatihan pengukiran framework telinga luar untuk residen Bedah Plastik Rekonstruksi dan Estetik.Materials and Methods: 14 residen bedah plastik masuk dalam penelitian ini, terbagi menjadi dua grup. Grup I, terdiri dari residen yang pernah mengikuti prosedur mikrotia lebih dari 1 kali sebagai asisten atau pengukir sementara grup II beum pernah. Grup II akan mendapat program pelatihan yang terdiri dari kuliah dan video, dilanjutkan dengan pengukiran dengan subtitusi kartilago dalam bimbingan. Hasil akhir akan dinilai oleh 2 orang konsultan ahli bedah Mikrotia dalam hal presisi anatomi dan ukuran serta kecepatan pengukiran.Result: Penelitian menunjukkan terdapat peningkatan bermakna dalam hal kecepatan pengukiran dengan p=0.003 (p<0.005) antara 2 grup. Sementara dalam presisi anatomi, terdapat peningkatan bermakna pada tinggi tragus dengan p=0.003 (p<0.005) serta penurunann tinggi antitragus dengan p=0.000 (p<0.0005), dan pada nilai lain tidak terdapat perbedaaan yang signifikan diantara 2 grup. Conclusion: Dari penelitian ini, dapat disimpulkan bahwa kecuali tinggi anti tragus, hasil ini menunjukkan efektivitas program pelatihan antara mereka yang belum pernah mengikuti operasi mikrotia dengan mereka yang sudah berpengalaman.

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Background: In Plastic Surgery residency training program, cartilage carving of external ear reconstruction for Microtia's procedure was limited to traditional apprenticeship model. Under simulation based training, resident could be groomed before facing the real patient. This study will be evaluate the efficacy training program for cartilage carving of external ear framework for resident of Aesthetic Reconstructive Plastic Surgery.Materials and Methods: 14 plastic surgery resident will be enrolled in this study, separated into two group. Group I, consisted of resident had experience in Microtia's procedure more than once asisstant or carver meanwhile group II hadn't. Group II will had training program comprised of lecture and video then carving of cartilage substitute under guidance. A week later, both group would carve external ear cartilage framework without guidance. The final result will be assesed by two consultant of Microtia's surgeon in term of anatomical, size appearance of external ear and speed of carving.Result: Study showed that there was improvement in term of speed of carving with p = 0.003 (p<0.005) between both group. Meanwhile, in term of anatomical precision, there was improvement in tragal height with p=0.003 (p<0.005) and decline antitragal height with p=0.000 (p<0.0005), though in other points there was no significant differences between both team. Conclusion: From study, we concluded that except for antitragal height point, this result successfully demonstrated the effectiveness of the training program between those who had never experienced microtia's procedure before than those who had."

"Surgical delay is a manuever that designed to improving survival of skin flap. The basic mechanism of the delay procedure is vascular reorientation that produced by the stimulus of ischemia. This study introduces a new method of surgical delay with ligation suture. This ligation interrupt blood flow to the planned skin flap and thereby producing ischemic condition. We investigated wether this method will improve flap survival, compared with survival in "conventional" surgical delay and non-delay group.Fifty-one McFarlane flaps on rat model were divided in three groups. After 7 days of delay (in the delay group) the flap was elevated. Then, 7 days post elevation, the survival length of the flaps in all groups was measured. Flap survival ii the ligation suture delay group (72,83% ± 3,84%, n=17) was not different from "conventional" surgical delay group (73,34% ± 9,73%, n=17), and significantly greater than in the non-delay group (47,92%± 6,62%, n=17).This study suggest that, in rat model, this ligation suture delay procedure was effective to produces ischemic condition that stimulus changes of blood patterns and thus increasing the flap survival."

"Latar Belakang: Pergeseran dominasi antara laki-laki dan perempuan pada dunia kedokteran terjadi dari waktu ke waktu di berbagai belahan dunia, termasuk di bidang bedah plastik di Indonesia. Profesi yang semula didominasi oleh laki-laki, saat ini didominasi perempuan. Pergeseran dominasi perempuan ini memungkinkan terjadinya masalah-masalah yang berpengaruh pada pendidikan dan pelayanan bedah plastik. Penelitian ini bertujuan untuk mengeksplorasi fenomena dominasi perempuan pada pendidikan spesialis di Indonesia. Metode: Penelitian ini bersifat kualitatif berupa studi fenomenologi. Penelitian dilakukan pada 3 program pendidikan dokter spesialis bedah plastik rekonstruksi dan estetik di Indonesia. Penelitian dimulai pada bulan Januari 2020. Populasi penelitian terdiri dari 4 kelompok, yaitu peserta didik, dosen, pengelola program studi, dan pengguna lulusan. Responden penelitian dipilih menggunakan metode maximum variation sampling. Setiap responden mendapatkan informed consent, seluruh informasi yang diberikan sifatnya rahasia dan tidak memengaruhi proses pendidikan responden. Metode pengumpulan data berupa studi dokumen, Focus Group Discussion (FGD), dan In-Depth Interview. Data penelitian yang diperoleh dari berbagai metode diatas, kemudian dianalisis dan diolah lebih dalam secara tematik. Hasil: Peneliti membagi tema berdasarkan garis waktu proses pendidikan, yaitu: prapendidikan, intra-pendidikan, dan pascapendidikan. Masing-masing proses memiliki tema yang saling memengaruhi proses pendidikan. Pada masa prapendidikan terdapat karakter personal yang dipengaruhi oleh persepsi positif maupun negatif dari masyarakat. Sedangkan iklim lingkungan kerja, dampak dominasi perempuan, dan dimensi budaya memengaruhi kelancaran intra-pendidikan. Pasca pendidikan dan memasuki dunia kerja, peserta didik menginginkan suatu kondisi lingkungan kerja yang ideal dan terdapat preferensi tempat bekerja tertentu untuk mencapai kondisi well-being. Kesimpulan: Dampak dominasi perempuan selama pendidikan hanya akan berpengaruh pada dinamika kehidupan antar peserta didik dan antara peserta didik dengan dosen sebagai mentor. Namun dominasi ini tidak akan memengaruhi kualitas pendidikan dan beban kerja yang diberikan. Pada penelitian ini juga didapatkan fenomena kesenjangan kepemimpinan tidak terjadi selama pendidikan tetapi terjadi pada pascapendidikan. Namun kesenjangan kepemimpinan bukanlah akibat tekanan dalam komunitas, melainkan kecenderungan dari pribadi perempuan pada umumnya di kelompok masyarakat feminim.

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Introduction: Shifting in gender dominance between men and women in the medical field has occurred from time to time globally, including in Indonesia’s plastic surgery. The profession, which was initially dominated by men, is currently dominated by women. This shift in female dominance might allow problems that affect the education and clinical settings of plastic surgery. This study aims to explore the phenomenon of women's dominance in medical residency education in Indonesia. Method: This study is a qualitative study of phenomenology. It was conducted on 3 medical residency programs specializing in reconstructive and aesthetic plastic surgery in Indonesia. The study began in January 2020. The research population consisted of 4 groups, namely students, lecturers, study program managers, and graduate users. Research subjects were selected using the maximum variation sampling method. Each respondent was provided with informed consent, all information given was confidential and did not affect the educational process of the respondent. Data collection methods include document study, Focus Group Discussion (FGD), and In-Depth Interview. Research data obtained from various methods above was analyzed and processed thematically. Results: The themes were categorized based on the educational process timeline, namely: pre-education, intra-education, and post-education. Each timeline had several themes which mutually influenced the educational process. During pre-education there were personal characters which were affected by positive and negative perceptions from society. Whereas the work environment atmosphere, the impact of women's dominance, and the cultural dimension affected the intra-educational process. After graduating from residency program and entering the career life, students expected an ideal working environment and had certain workplace preferences to achieve their well-being. Conclusion: The impact of women's dominance during education affected the daily dynamics among students and their interaction with lecturers as mentors. However, this dominance did not affect the quality of education and workload. We also found that the phenomenon of leadership disparity did not occur during education but occurred in post-education setting. This leadership disparity was not resulted by pressure in the community, but due to the tendency of the women’s personality in general among the feminine community."