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"Background: Free flap is one of modality to close the defects in plastic surgery. To close the defects in hand, foot, head and neck, the flap that needed is the thin and pliable flap to reach the good quality and aesthetic result. One of the effort to obtain thin and pliable flap is by preserving the perforator vessel and removing the fat tissue, both procedure can be done during the elevation of the flap. In this study we try to show the pattern of subdermal plexus, perforator vessels and subcutaneous fat on anterolateral thigh, deep inferior epigastric artery perforator and thoracodorsal artery perforator flap. This pattern can be used to make the thinning procedure easier.Patient and methods: The study is performed on five fresh cadaver. After elevating the 9X15 cm flaps, we inject the vessel with colored latex solution. According to the pattern of colored vascular plexus then we perform the thinning procedure. Flap thickness and position of subdermal plexus are measured, also the form of fat lobule is observed.Result: We elevate 23 flaps, the thicker is DIEAP (mean 11,7 mm), ALT (mean 14,5 mm) and TAP (mean 9,0 mm). The subdermal plexus site from the skin is 2,3 mm on ALT flap, and 2,0 mm on DIEAP and TAP flap. The form of fat lobule according to the superficial fascia is lamellar on deep layer and areolar on superficial layer, the subdermal plexus is sitting superficial to the areolar form of fat lobule. Conclusion: The safe thinning procedure according to our study can be performed to the deeper layer of subdermal plexus (2,0-2,3 mm from the skin), or within the areolar form of fat layer."

"Pendahuluan: Masalah fungsional dan kosmetik semakin meningkat akibat adanya defek pada area craniofacial termasuk mandibula yang membentuk bagian bawah wajah. Rekonstruksi mandibula bertujuan memberikan kemungkinan maksimal dari hasil fungsional dan estetik. Hasil yang optimal dari fungsi rekonstruksi mandibula adalah salah satu tujuan dari penggunaan teknik flap bebas fibula. Dengan bantuan dari perkembangan system proses komputer dalam desain dan pembuatan, operasi craniomaxillofacial dapat dilakukan dengan bantuan komputer melalui berbagai bentuk dan variasi tujuan. Dalam rangka menelaah kualitas dari penelitian yang telah tersedia dan memberikan informasi untuk pengambilan keputusan, kajian mengenai perbadingan operasi dengan bantuan komputer (CAS) dengan metode konvensional freehand (CFS) menjadi penting untuk dilakukan. Metode: Pencarian pustaka sistematis dilakukan pada pusat data PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, dan Scopus, mencakup semua studi dengan data utama yang membandingkan hasil akurasi, efisiensi, komplikasi, dan fungsional diantara kelompok CAS dan CFS. Risiko bias studi dinilai menggunakan Newcastle-Ottawa Scale (NOS). Meta-analisis dilakukan melalui Review Manager. Hasil: Enam belas studi kohort memenuhi kriteria eligibilitas dari 355 studi pada pencarian awal. Studi dengan hasil yang sama (akurasi, efisiensi, komplikasi, dan fungsional) dibandingkan antara kelompok CAS dan CFS. Sebanyak 13 studi menunjukkan hasil signifikan secara statistik pada penilaian efisiensi: waktu ischemia lebih singkat (-34.84 menit, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), total waktu operasi lebih singkat (-70.04 menit, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), waktu rekonstruksi lebih singkat (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), dan lama rawat inap yang lebih singkat(-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) pada kelompok CAS dibanding kelompok CFS. Kesimpulan: Kajian sistematis dan meta-analysis menunjukkan hasil yang lebih baik pada kelompok CAS dibandingkan dengan CFS yang signifikan pada hasil efisiensi, Namun beberapa studi melaporkan berbagai analisis statistik dengan berbagai parameter untuk kategori hasil komplikasi, akurasi, dan fungsional. Seluruh studi sepakat bahwa CAS memberikan manfaat yang lebih dibandingkan CFS, walaupun CFS masih dapat menjadi pilihan.

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Background: Major functional and cosmetic problems will arise from defects in craniofacial regions, including mandible which constructs the shape of lower third of the face. The aim of mandibular reconstruction is to achieve the best possible functional and aesthetic outcomes. The optimal return of mandibular bone function is one of the reconstruction goals using free fibular flap (FFF). With aid of the evolving computer processing system for design and manufacturing, craniomaxillofacial surgery can be conducted with computer-aided surgery in many forms and varied proposes. In order to evaluate the quality of available article and to provide information for decision-making, review of comparison between computer-aided surgery (CAS) and conventional freehand surgery (CFS) need to be evaluated.

Methods: A systematic search was conducted on PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, and Scopus, including all studies with primary data that compared accuracy, efficiency, complication, and functional outcomes between CAS and CFS group. Risk of bias for included studies were assessed based on Newcastle-Ottawa Scale. Meta-analysis was performed in Review Manager.

Results: Sixteen cohort studies were included that meet the eligibility criteria from initial searches of 355 studies. Studies with the same outcome (accuracy, efficiency, complication, and functional) are compared in CAS and CFS group. Thirteen studies demonstrated statistically significant efficiency outcomes: shorter ischemia time (-34.84 minutes, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), shorter total operative time (-70.04 minutes, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), shorter reconstruction time (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), and shorter length of hospital stay (-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) in CAS group than CFS group.

Conclusion: Systematic review and meta-analysis demonstrated higher outcomes CAS group compared to conventional group significantly in efficiency outcomes. However, some studies performed diverse statistical analysis on several parameters for outcomes category such as complications, accuracy, and functional. All studies agreed that CAS group has higher benefits than conventional method, although the conventional method is still an option."

"Pendahuluan: Hydrofiber merupakan materi balutan luka yang memiliki kemampuan absorbsi dan memberikan suasana lembab yang baik, namun belum diketahui potensi kemampuannya sebagai hemostat. Penelitian ini bertujuan untuk melihat potensi kemampuan hemostasis hydrofiber. Metode: Studi eksperimental in-vitro dan in-vivo menggunakan kontrol dan randomisasi dilakukan pada 7 ekor tikus (in-vitro) dan 14 ekor tikus (in-vivo) Rattus novergicus strain Sprague-Dawley yang sehat dengan berat 200-300 gram. Pada penelitian in-vitro didapatkan 32 sampel darah 1mL. Pada 16 sampel kelompok perlakuan ditambahkan 5mg hydrofiber; 16 sisanya berfungsi sebagai kontrol. Waktu koagulasi dihitung dan dianalisis menggunakan independent t-test. Pada penelitian in-vivo subjek dikelompokkan menjadi 3 grup yang masing-masing terdiri dari 9 buah luka dan ditutup dengan hydrofiber, alginat atau kasa lembab salin. Selisih berat darah yang diserap tiap balutan dihitung dan dianalisis menggunakan uji Kolmogorv-Smirnov, sedangkan selisih luas area perdarahan dihitung dengan uji Anova (p<0.05). Hasil: Dari penelitian in-vitro didapatkan hasil tidak terdapat perbedaan antara waktu koagulasi sampel darah dengan hydrofiber dibandingkan dengan tanpa hydrofiber [p=0.119 (CI -7.47-62.28)]. Sedangkan pada penelitian kedua didapatkan hasil tidak terdapat perbedaan pada selisih berat [p=0.163 (CI 31.41-54.83)] dan selisih luas (p=0.788 (CI 2.83-3.28)] antara kelompok hydrofiber, alginate, dan kasa lembab salin. Diskusi: Hydrofiber tidak memiliki perbedaan dalam hal hemostasis bila dibandingkan dengan alginat dan kasa lembab salin yang sudah lama diketahui memiliki kemampuan hemostasis; dapat disimpulkan bahwa hydrofiber berpotensi memiliki kemampuan hemostasis.

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Background: Hydrofiber is a highly absorbent dressing with its ability to promote wound healing. Because of its structure similarity with alginate, hemostatic property of hydrofiber is being questioned. This study was aimed to explore hemostatic property of hydrofiber.

Methods: In-vitro and in-vivo experimental study was performed in healthy Sprague- Dawley rats weighing 200-300 gram. A number of 32 blood samples were collected from 7 animals for in-vitro study; 16 samples were added with hydrofiber, while the rest functioned as control. Coagulation time between hydrofiber and control were analyzed using independent t-test. The in-vivo study involved 27 deep dermal wounds that were divided into 3 groups where each group of wounds was covered with hydrofiber, alginate, and saline gauze dressing respectively. Amount of blood that was absorbed by each dressing were analyzed using Kolmogorv-Smirnov test, while bleeding surface area after dressing were analyzed with Anova test (p<0.05).

Results: There is no significant difference in terms of coagulation time between hydrofiber and control [p 0.119 (CI -7.47-62.28)]. The amount of blood that was absorbed by each dressing [p 0.163 (CI 31.41-54.83)] and the bleeding surface area after dressing [p 0.788 (CI 2.83-3.28)] were also not significantly different between hydrofiber, alginate, and saline soaked gauze.

Conclusion: Hydrofiber shows potential hemostasis property, as it has no difference in its profile of coagulation time and amount of absorbed blood with the profiles shown by alginate and saline soaked gauze."

"ABSTRAK Pendahuluan:Obstruksi duodenum kongenital merupakan salah satu kelainan bawaan pada saluran cerna yang tersering. Fungsi peristaltik merupakan hal yang ingin dicapai pada pascabedah. Resiko terjadinya translokasi bakteri pada kasus obstruksi membuat pasien jatuh dalam kondisi sepsis hal ini akan memengaruhi waktu tercapainya fungsi peristaltik dan pada akhirnya akan meningkatkan morbiditas dan mortalitas. Selain itu, infeksi nosokomial yang mengancam neonatus menyebabkan sepsis pada neonatus juga akan memengaruhi waktu tercapainya fungsi peristaltik. Penelitian ini ditujukan untuk mencari hubungan sepsis dengan waktu tercapainya fungsi peristaltik. Metode: Desain penelitian ini adalah potong lintang menggunakan data sekunder yaitu pasien obstruksi duodenum tanpa disertai kelainan bawaan berupa gastroschizis, omphalocele dan atresia intestinal lain yang telah dilakukan operasi di RSCM periode bulan Januari 2010-Juli 2016. Subjek dikelompokkan menjadi sepsis dan non sepsis kemudian dilakukan analisis untuk melihat hubungan dengan waktu tercapainya fungsi peristaltik serta menganalisis variabel perancu yaitu, usia gestasi, berat badan lahir, kelainan bawaan, kondisi hipoksia dan ketidakseimbangan elektrolit. Analisis data dilakukan univariat, bivariat Mann Whitney, Chi Square atau Fischer dan multivariat (regresi linier) dengan nilai p <0,05 dianggap bermakna. Hasil: Dari 31 subjek didapatkan bahwa median waktu tercapainya fungsi peristaltik pada subjek sepsis dan non sepsis yaitu 12,5 dan 5 hari (p <0,0001). Hubungan antara waktu tercapainya fungsi peristaltik dengan sepsis (p <0,0001), usia gestasi (p = 0,004) dan kondisi hipoksia (p = 0,02). Pada analisis multivariat didapatkan hasil antara sepsis dengan waktu tercapainya fungsi peristaltik dengan nilai p = 0,011 dan nilai R Simpulan: Pada penelitian ini sepsis merupakan faktor utama yang memengaruhi waktu tercapainya fungsi peristaltik. Mengingat cukup jauhnya perbedaan waktu yang dicapai antara kelompok sepsis dan non sepsis maka perlu dilakukan pengontrolan maupun pencegahan kondisi sepsis baik dalam prabedah maupun pascabedah sehingga dapat menurunkan morbiditas dan mortalitas. ABSTRACT Introduction: A common site for congenital duodenal obstruction is the duodenum. Peristaltic function is to be achieved in the postoperative, respectively. Intestinal obstruction has been shown to induce bacterial translocation and that event would be associated with an increased risk of sepsis conditions. That condition would affecting the achievement of peristaltic function and ultimately increased morbidity  and mortality. In addition, nosocomial infections that threaten neonates cause sepsis also will affect the achievement of a peristaltic function. Therefore, the aim of this study was to investigate the relationship between sepsis with timing achievement of peristaltic function postoperatively. Methods: This study is cross sectional study design. The research data was obtained from medical records of patients with duodenal obstruction without congenital abnormalities such as gastroschizis, omphalocele and other intestinal atresia that have underwent operations in RSCM period January 2010 to July 2016. Subject are grouped into sepsis and without sepsis. The relationships between sepsis and timing achievement of peristaltic function also confounding variabels (gestational age, birth weight, congenital abnormalities, conditions of hypoxia and electrolyte imbalance) were analyzed. Data analysis was performed using univariate, bivariate (Mann Whitney, Chi Square or Fischer) and multivariate (linear regression) with significance p Results: The study included 31 subjects. Time were needed to achieved peristaltic function (median value) are 12,5 days in patients with sepsis and 5 days in patients without sepsis. Bivariate analysis between timing achievement of peristaltic function are sepsis with p <0,0001, gestational age with p = 0,004 and hypoxic conditions with p = 0,02. Multivariate analysis have shown relationship between sepsis and timing achievement of peristaltic function with p = 0,011 and R Conclusion: In this study, sepsis is a major factor affecting the achievement of a peristaltic function . Considered the differences time to achieved peristaltic function between sepsis and without sepsis is significant. Therefore,it is necessary to control and prevent sepsis preoperatively and postoperatively thus reducing morbidity and mortality."

"Latar Belakang. Terapi baku emas dalam penutupan defek septum ventrikel (DSV) adalah pembedahan. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSV yang bersifat relatif kurang invasif. Tujuan. Mengetahui perbandingan hasil penutupan DSV perimembran, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter dengan prosedur pembedahan. Metode. Penelitian retrospektif analitik dengan data berupa rekam medis pasien anak dengan DSV perimembran yang datang ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2010-Desember 2013. Hasil. Sebanyak 69 kasus anak dengan DSV perimembran masuk dalam penelitian, terdiri dari 39 kasus dengan prosedur pembedahan dan 30 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (89,7% vs 96,7%, p=0,271). Prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (46,7% vs 7,7%, p < 0,001). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (8 hari vs 3 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Tidak ada perbedaan total biaya antara prosedur transkateter dengan prosedur pembedahan (Rp. 55.032.636 vs Rp. 58.593.320 p = 0,923). Simpulan. Prosedur penutupan DSV perimembran secara transkateter mempunyai efektivitas dan biaya yang sama dengan prosedur pembedahan dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek.

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Background. Surgery has become standard therapy for ventricular septal defect (VSD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude VSD.

Objectives. To compare efficacy, complication, length of hospital stay, and total cost of perimembran VSD closure procedure between transcatheter closure and surgery.

Methods. A retrospective analysis was performed on children with perimembran VSD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2010-December 2031. The patients received transcatheter closure or surgical closure. Data were obtained from medical record.

Results. A total of 69 perimembran VSD cases were included in study, consisted of 39 cases underwent transcatheter closure and 30 cases underwent surgical closure. The efficacy of both procedur were not statistically different (89.7% vs 96.7%, p=0.271). However, surgery procedure had more complication than transcatheter closure (46.7% vs 7.7%, p < 0.001). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (8 days vs 3 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had median total cost Rp. 55.032.636 as compared with Rp. 58.593.320 for surgery procedure (p =0.923).

Conclusion. Perimembran VSD transcatheter closure had similar efficacy and costs with surgical closure. Complication rate was lower, and the length of hospital stay was shorter."

"ABSTRAK Latar Belakang Pada penatalaksanaan fraktur maksilofasial secara internal fiksasi diperlukan pemasangan alat miniplate dan screw sampai terjadi penyembuhan tulang Magnesium memiliki potensi sebagai miniplate dan screw pada tulang rahang dengan syarat bersifat biokompatibel dan biodegradasi sehingga tidak diperlukan operasi kembali untuk pengambilan miniplate dan screw Proses equal channel angular pressing ECAP merupakan salah satu metode untuk mengontrol laju korosi logam magnesium dan meningkatkan sifat mekanisnya Untuk pembuatan desain miniplate dan screw dari magnesium ECAP dengan merujuk dari desain safety factor bahan titanium yang biasanya telah digunakan perlu disesuaikan dengan material properti magnesium agar dapat mencegah kerusakan Tujuan menganalisa perbandingan desain miniplate dan screw logam magnesium ECAP terhadap titanium Metode Untuk penelitian ini kami menggunakan metode finite elemen yaitu formulasi perpindahan untuk menghitung perpindahan komponen strain dan tekanan di bawah beban internal dan eksternal Kemudian desain miniplate dan screw dari magnesium ECAP dilakukan analisa simulasi pembebanan yang dianalisa menggunakan teori Von Misses Hasil Hasil desain miniplate dan screw magnesium ECAP yang diharapkan dapat digunakan pada penatalaksanaan fraktur maksilofasial telah dilakukan simulasi pembebanan dengan dilakukan analisa desain menggunakan teori Von Misses kemudian desain direkayasa untuk mengurangi stress yang diterima desain rekayasa magnesium ECAP dibuat menjadi dua tipe yaitu tipe 1 dengan menambah jumlah screw menjadi 8 screw dengan berat total miniplate dan screw sebesar 118 212 mg dan tipe ke 2 dengan merubah diameter head screw menjadi 2x lebih besar dari bentuk semula sehingga berat totalnya sebesar 169 414 mg Kesimpulan Desain alternatif miniplate dan screw magnesium ECAP tipe 1 dapat lebih efektif untuk digunakan pada penatalaksanaan fraktur maksilofasial ABSTRACT Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture ;Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture ;Background In the internal fixation management of maxillofacial fractures the placement of miniplate and screw is necessary until bone repair takes place Magnesium has the potential as a miniplate and screw for the jaws with it rsquo s biocompatibility and biodegradability so that a follow up surgery to remove the miniplate and screw is not necessary The equal channel angular pressing ECAP process is a method to control the corrosion rate of magnesium and increase the mechanical properties In the making of miniplate and screw design from ECAP magnesium referring the safety factor of the titanium design that is already being used adjustments must be made with the characteristics of magnesium so damage can be avoided Objectives to analyze the comparison between magnesium ECAP miniplate and screw design against titanium Methods For this research we used the finite element method which is displacement formulation to calculate component movement strain and pressure under the internal and external load Afterwards the magnesium ECAP miniplate and screw design undergoes a loading simulation which is analyzed with the Von Misses theory Result Design of miniplate and screw magnesium ECAP which expected to be used in the management of maxillofacial fractures has been tested with the stress simulation using Von Misses theory then the design engineered to reduce stress received Engineering design of magnesium ECAP divided into two types type 1 by increasing the number of screw into 8 screws with a total weight miniplate and screws with a total weight miniplate and screw amounted to 118 212 mg and type 2 by changing the diameter of the head screw becomes large than its original shape so that the total weight of 169 414 mg Conclusion Design alternative of miniplate and screw magnesium ECAP type 1could be more effective to be used in the management of maxillofacial fracture "