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"ABSTRAKLatar Belakang: Studi ini bertujuan untuk mengamati dampak aplikasi Tumescent ONEPERMIL dan segi keamanannya pada skin flap yang telah mampu pulih hidup dari cedera iskhemia sebelumnya. Metode: Studi eksperimental dengan kontrol dan randomisasi dilakukan pada 40 groin flap dari 20 ekor Rattus novergicus strain Wistar yang sehat berbobot 220-270 gram. Infiltrasi Tumescent ONEPERMIL, infiltrasi salin normal dan grup kontrol dilakukan pada flap yang berhasil pulih vital 100% dari cedera iskhemia yang dikondisikan melalui pemasangan klem selama 15 menit pada pedikelnya. Perfusi flap dimonitor melalui pengukuran tekanan oksigen transkutaneous (TcPO2), sebelum dan sesudah infiltrasi dilakukan. Vitalitas flap dinilai secara klinis maupun menggunakan Analyzing Digital Images® di hari ke 7 paska prosedur infiltrasi dan resetting flap pada tempatnya. Analisa statistik dilakukan dengan test Chi-square (p<0,05).Hasil: Penilaian akhir menunjukkan kepulihan hidup seluruh groin flap tanpa ditemukan tanda nekrosis. Pengukuran TcPO2 pada flap sebelum dan sesudah prosedur infiltrasi menunjukkan perbedaan yang signifikan (p<0,0001) namun masih berada dalam batasan prediksi flap akan pulih hidup.Kesimpulan: Aplikasi Tumescent ONEPERMIL pada groin flap yang telah pulih hidup dari cedera iskhemia sebelumnya, tidak menimbulkan dampak nekrosis pada flap.

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ABSTRACTBackground: To observe the effect of One-per-mil tumescent injection on viable skin flaps that previously had suffered from an ischemic insult, so as to ascertain One-per-mil tumescent safety application in the related theme. Methods: 40 groin flaps from 20 healthy Wistar strained-Rattus novergicus weighing 220-270 grams were conditioned to acute ischemia by clamping the pedicle for 15 minutes. Merely totally survived and viable flaps on the seventh postoperative day were randomly divided into: One-per-mil tumescent infiltration group(A), normal saline infiltration group(B), and control group(C). Before and after the infiltration, transcutaneous oxygen tension (TcPO2) measurement was performed, and the changes values were calculated by statistical analysis using ANOVA and Paired T-Test. Viability of flaps was assessed clinically and by using AnalyzingDigitalImages® 7 days later.Results: TcPO2 readings yielded a decreasing value significantly (p<0.001) following both One-per-mil tumescent and normal saline infiltration. However, all groin flaps survived with no signs of tissue necrosis. Conclusion: One-per-mil tumescent injection into viable skin flaps is safe even though the flaps had previously suffered from an ischemic condition."

"ABSTRACTThe aim of this study was to compare the immediate postoperative period of participants rehabilitated with dental implants placed with a conventional technique or with a minimally invasive technique, without a mucoperiosteal flap elevation (flapless). Participants who needed implant placement were divided into two groups: one group was operated using a mucoperiosteal flap elevation (GA), and the other with a flapless surgical technique (G B). Objective clinical parameters including oral hygiene, mouth opening, inflammation (facial perimeter), surgical time and analgesic consumption, as well as subjective parameters of pain and degree of satisfaction with the procedure, were evaluated. 48 implants were placed in 30 participants (15 participants per group). Oral hygiene index, maximum interincisal opening, pain and analgesic consumption values had a significant difference between groups favoring the flapless technique at 24 h and 7 days but at the 15 days follow-up the differences were only significant for oral hygiene and pain (P < 0.05); there were no statistically significant differences between groups in terms of facial perimeter values and surgical time (P > 0.05). Average on the degree of satisfaction was of 2.6 (SD 0.8) for G A and 3.6 (SD 1.02) for G B (P = 0.06). One implant placed in G A (2.0%) failed before prosthetic loading due to mobility and pain at 3 months follow-up. Participants operated for implant placement with flapless surgical technique go through less postoperative discomfort. Both techniques show high success rates, but to perform a flapless technique patients must be properly selected."

"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."

"ABSTRAKLatar Belakang:Teknik conventional two flap palatoplasty akan menimbulkan defek lateral tanpa adanya pelindung periosteum. Defek lateral yang terbuka ini akan menyebabkan rentannya terkena kontaminasi dan infeksi. Hal inilah yang akan menimbulkan kontraksi luka, pembentukan skar dan mengganggu pertumbuhan maxilla.Tahun 2011, terdapat studi mengenai teknik ldquo;The Non Denuded Palatoplasty rdquo;. Teknik ini meninggalkan sebagian periosteum yang diharapkan dapat mempercepat proses epitelisasi pada defek lateral. Epitelisasi yang lebih cepat diharapkan mengurangi terjadinya kontraksi luka dan kedepannya dapat tercapai pertumbuhan maksila yang baik.Metode:Merupakan studi kasus kontrol yang terdiri atas 2 grup membandingkan pertumbuhan maksila pasien dengan celah bibir dan langit-langit unilateral komplit yang dikerjakan dengan teknik conventional ldquo;Two Flap Palatoplasty rdquo; dan teknik ldquo;The Non Denuded Palatoplasty rdquo;. Hasil pengukuran cephalometri dicatat serta dibuat cetakan gigi untuk tiap pasien kemudian dikategorisasi menggunakan metode GOSLON YARDSTICK. Data yang diperoleh dianalisis dengan SPSS versi 20.Hasil:Terdapat 4 pasien di kelompok ldquo;The Non Denuded Palatoplasty rdquo; dan 10 pasien pada teknik conventional ldquo;Two Flap Palatoplasty rdquo;. Hasil pengukuran cephalometri SNA, SNB dan ANB menunjukkan bahwa kedua grup tersebut masuk dalam golongan maloklusi tipe III defisiensi maksila . Sementara hasil GOSLON Yardstick memperlihatkan GOSLON tipe III sebagai kelompok yang sering ditemukan bagi kedua grup dengan reliabilitas inter-rater baik p=0.839 . Pada penelitian ini tidak ditemukan korelasi antara variabel cephalometri dengan skor GOSLON.Kesimpulan:Hasil studi kami menunjukkan bahwa teknik modifikasi ldquo;The Non Denuded Palatoplasty rdquo; tidak berhubungan secara signifikan terhadap pertumbuhan maksila. Namun penelitian ini memiliki beberapa keterbatasan, yaitu ukuran sampel yang sedikit karena faktor keluarga, sosial dan faktor lainnya yang berada di luar kendali tim peneliti. Selain itu usia pasien yang dievaluasi ialah 7-9 tahun, dimana hasil ini bukan merupakan hasil akhir. Kata Kunci: Evaluasi pertumbuhan maksila, cephalometri, GOSLON YARDSTICK, Two Flap Palatoplasty

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ABSTRACTBackground Conventional Two Flap 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 maxillary growth impairment.In 2011, we studied ldquo The Non Denuded Palatoplasty rdquo 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.Methods This is a case control study to compare the maxillary growth of 2 groups consists of unilateral cleft lip and palate patients repaired with ldquo The Non Denuded Palatoplasty rdquo technique and Conventional Two Flap Palatoplasty. The outcome will be evaluated from cephalometry and the dental cast for each patient areevaluated using GOSLON YARDSTICK method. Data will be analyzed using SPSS version 20.Results A total of 4 patients in The Non Denuded Palatoplasty group and 10 in the Conventional Two Flap Palatoplasty. The cephalometric SNA, SNB and ANB point showed Class III skeletal jaw relationship or deficient maxilla. While the GOSLON yardstick type III are the frequent GOSLON on both group with good inter ratter reliability p 0.839 based on Mann Whitney test. In these study there were no correlation between cephalometric variables with GOSLON score.Conclusion Our results showed that modification The Non Denuded Palatoplasty technique made no statistically significant difference to the maxillary growth. However this study has several limitations, which are the sample size was small due to family, social and other factors that are beyond the control of the investigating team. Also the age of evaluation 7 9 years , means that the result is not the final outcome. "

"Hipospadia merupakan salah satu kelainan kongenital yang terjadi pada 1 per 300 kelahiran dan 20% dari keseluruhan kasus adalah hipospadia proksimal. Faktor yang menentukan jenis teknik operasi yang akan digunakan diantaranya yaitu letak meatus, ada tidaknya chordee, ketersediaan prepusium, kualitas lempeng uretra, dan pengalaman operator. Penelitian ini bertujuan untuk membandingkan penggunaan Teknik Tubularized Incised Plate(TIP), Duckett, dan Onlay Island Flap (OIF) sesuai dengan pengalaman di Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian retrospektif analitik ini melihat data rekam medis dan status khusus urologi dari pasien hipospadia proksimal dengan letak meatus uretra di penis proksimal, penoskrotal, dan skrotal yang menjalani tindakan release chordeedan uretroplasti di RSCM dari tahun April 2002 sampai Mei 2014. Terdapat 119 pasien yang terdiri dari 33 pasien dengan teknik TIP, 50 pasien dengan teknik Duckett, dan 36 pasien dengan teknik OIF. Rata-rata umur kelompokTIP 4,87±3,05 tahun, kelompok Duckett 6,33±6,02 tahun, dan kelompok OIF 4,68±3,27 tahun. Lokasi meatus uretra terbanyak di penoskrotal pada TIP 24/33 (72,7%), Duckett 37/50 (74.0%), dan OIF30/36 (83,3%). Ukuran penis kecil ditemukan pada TIP, Duckett dan OIF yaitu 4/33 (12,1%), 10/50 (20,0%), dan 6/36 (16,7%). Kelompok TIP 21/33 (63,6%) memiliki lempeng uretra yang cukup lebar, sedangkan pada Duckett dan OIF lebih banyak memiliki lempeng uretra yang sempit yaitu 26/50 (52%) dan 20/36 (55,6%). Angka komplikasi total TIP 15/33 (45,5%), Duckett 15/50 (30%) dan OIF 5/36 (13,9%), dan menunjukkan hasil signifikan secara statistik p<0,05. Teknik OIF lebih superior dibandingkan TIP dan Duckett dalam hal menurunkan komplikasi secara kumulatif serta memiliki angka kejadian fistula yang rendah pasca rekonstruksi hipospadia proksimal primer.

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Hypospadias is a congenital disorder that occurs in 1 per 300 births with 20% of cases are proximal hypospadias. The location of meatus, presence of chordee, availability prepuce, quality of the urethral plate, and operator experience are factors that determine in selecting operative technique. This study aimed to compare the use of Tubularized Incised Plate (TIP), Duckett, and Onlay Island Flap (OIF) following the experience at Cipto Mangunkusumo Hosptal (RSCM). Data gathered from patients medical records and urological status of proximal hypospadias with proximal, penoscrotal, and scrotal urethral meatus who underwent chordee released procedure and urethroplasty at RSCM from April 2002 to May 2014. There were 119 patients consisting of 33 patients with TIP techniques, 50 patients with Duckett, and 36 patients with OIF techniques. The mean age of patients underwent TIP was 4.87±3.05 years old, Duckett was 6.33±6.02 years old, and OIF was 4.68±3.27 years old. Urethral meatus was mostly found at penoscrotal with a total of 24/33 (72.7%), 37/50 (74.0%), and 30/36 (83.3%) cases, respectively. Small penis was found in TIP, Duckett, and OIF with a total of 4/33 (12.1%), 10/50 (20.0%), and 6/36 (16,7%) cases, respectively. In TIP group, 21/33 (63.3%) cases had a fairly wide urethral plate, whereas in Duckett and OIF were mostly of the cases have narrow urethral plate, with a total of 26/50 (52%) and 20/36 (55.6%) cases, respectively. Complications were found at 15/33 (45.5%) cases of TIP, 15/50 (30%) cases of Duckett, and 5/36 (45,5%) cases of OIF with statically significant results p <0.05. The OIF technique was found to be superior to TIP and Duckett in terms of reducing complications and having a low incidence of fistula after primary proximal hypospadias reconstruction."

"Latar Belakang:Kanker payudara merupakan kanker dengan jumlah tertinggi pada perempuan di dunia. Meningkatnya angka ketahanan hidup pasien kanker payudara, membuat meningkatnya insiden terjadinya limfedema diakibatkan komplikasi dari Modified Radical Mastectomy(MRM). Belum diketahui apakah ada pengaruh dilakukannya flap jaringan di daerah diseksi kelenjar getah bening pada kanker payudara dengan perbaikan aliran limfe pada daerah tersebut. Tujuan dari penelitian ini adalah mengetahui adanya regenerasi limfatik pada flap jaringan pasien kanker payudara pasca mastektomi dan diseksi aksila.Metode Penelitian: dilakukan penelitian menggunakan desain kuasi eksperimen pada semua pasien kanker payudara yang dilakukan Modified Radical Mastectomy (MRM) dan diseksi aksila dengan menggunakan flap untuk mengurangi kejadian limfedema pasca operasi. Data diambil pada periode januari 2018 sampai Mei 2019Hasil : Terdapat 32 pasien kanker payudara pasca tindakan MRM dan diseksi aksila (16 pasien dengan flap dan 16 pasien tanpa flap). Dari 16 pasien yang dilakukannya flap, terdapat 14 pasien yang mengalami regenerasi limfatik (87,5%) dan 2 pasien yang tidak mengalami regenerasi limfatik (12,5%) pasca pemasangan flap jaringan pada pasien MRM. Terdapat hubungan antara penggunaan flap (p = 0,049 dengan OR 95%CI 5,43 (2,22-32,2)) dan usia (p = 0.042 dengan OR 95%CI0,2 (0,03-0,95))terhadap regenerasi limfatik.Kesimpulan : Terdapat hubungan yang berbeda bermakna antara flap jaringan dengan tanpa flap pada daerah diseksi kelenjar limfe dengan regenerasi limfatik pada daerah tersebut. Tidak terdapat hubungan berbeda bermakna antara komorbid, riwayat radiasi, indeks masa tubuh, stadium TNM, terhadap regenerasi limfatik.

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Background : Breast cancer is the most common cancer in women in the world. Increased survival rates of breast cancer patients, making the increased incidence of lymphedema caused by complications from Modified Radical Mastectomy (MRM). It is not known yet whether there is an effect of doing tissue flap in the area of ​​lymph node dissection in breast cancer with improved lymph flow in the area. The purpose of this study was to determine the presence of lymphatic regeneration in tissue flap of breast cancer patients after mastectomy and axillary dissection.

Research Method : Conducted a study using quasi-experimental design in breast cancer patients with MRM and axillary dissection alone or by using a flap to reduce the incidence of postoperative lymphedema. Data is taken from January 2018 to Mei 2019.

Results : There were 32 breast cancer patients after MRM and axillary dissection (16 patients with flaps and 16 patients without flap). Of the 16 patients who were replaced by flaps, 14 patients needed lymphatic regeneration (87,5%) and 2 patients who did not need lymphatic regeneration (12,5%) after tissue flaps procedure in MRM patients. There is a relationship between the use of flap (p = 0.049 with OR 95% CI 5,43 (2,22-32,2)) and age (p = 0.042 with OR 95% CI 0,2 (0,03-0,95)) to lymphatic regeneration.

Conclusions : There is a significantly different relationship between tissue flaps and without flaps in the area of ​​lymph node dissection with lymphatic regeneration in the area. There is no significant difference between comorbidities, radiation history, body mass index, TNM stage, and lymphatic regeneration."