Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.
{"title":"Combined Free Flap Reconstruction Following Head And Neck Cancer Resection: Chimeric And Double Free Flap Reconstruction","authors":"P. Atmodiwirjo, Tasya Anggrahita","doi":"10.14228/JPR.V5I1.252","DOIUrl":"https://doi.org/10.14228/JPR.V5I1.252","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage. \u0000Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months. \u0000 Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions. \u0000 Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients. \u0000 \u0000 \u0000 \u0000","PeriodicalId":364477,"journal":{"name":"Jurnal Plastik Rekonstruksi","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126041322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Burn injury is considered as major problem because of high mortality and morbidity. One of the several managements to decrease the mortality rate is wound excision. This study aimed to describe the characteristics of burn mortality in our burn unit and its association with timing of tangential excision. Method: We collect data of burn patients who died in 2016 at Burn Unit of Cipto Mangunkusumo Hospital. We investigate the association of mortality and timing of tangential excision. The data were compared with other studies from online databases. Result: Thirty-four burn patients died at RSCM Burn Unit from January - December 2016. 13 patients underwent early tangential excision, the rest had delayed or no tangential excision. Only length of stay (LOS) has statistically significant result. The early tangential excision group has significantly longer median LOS (p=0.003) compared to delayed tangential excision. From five relevant studies, three studies had higher mortality in early tangential excision group compared to delay group but fewer complications and shorter LOS. Two studies reported a significant reduction in mortality in early tangential excision group while culture positive wounds were more frequent in the delay group. Conclusion: Mortality in our patients in early tangential excision group is fewer than the delayed one. The early tangential excision group has longer length of stay compared to delay tangential excision. Although there are pros and cons from the literature review, we suggest that early tangential excision should be done in burn patients.
{"title":"Demographic Characteristic Of Burn Mortality And Its Relation To Tangential Excision At Burn Unit Of Cipto Mangunkusumo National General Hospital","authors":"A. Wardhana, D. Kurniasari","doi":"10.14228/JPR.V5I1.253","DOIUrl":"https://doi.org/10.14228/JPR.V5I1.253","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Background: Burn injury is considered as major problem because of high mortality and morbidity. One of the several managements to decrease the mortality rate is wound excision. This study aimed to describe the characteristics of burn mortality in our burn unit and its association with timing of tangential excision. \u0000 Method: We collect data of burn patients who died in 2016 at Burn Unit of Cipto Mangunkusumo Hospital. We investigate the association of mortality and timing of tangential excision. The data were compared with other studies from online databases. \u0000 Result: Thirty-four burn patients died at RSCM Burn Unit from January - December 2016. 13 patients underwent early tangential excision, the rest had delayed or no tangential excision. Only length of stay (LOS) has statistically significant result. The early tangential excision group has significantly longer median LOS (p=0.003) compared to delayed tangential excision. From five relevant studies, three studies had higher mortality in early tangential excision group compared to delay group but fewer complications and shorter LOS. Two studies reported a significant reduction in mortality in early tangential excision group while culture positive wounds were more frequent in the delay group. \u0000 Conclusion: Mortality in our patients in early tangential excision group is fewer than the delayed one. The early tangential excision group has longer length of stay compared to delay tangential excision. Although there are pros and cons from the literature review, we suggest that early tangential excision should be done in burn patients. \u0000 \u0000 \u0000 \u0000","PeriodicalId":364477,"journal":{"name":"Jurnal Plastik Rekonstruksi","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126539147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intense and prolonged pain often caused by burn injuries. The greatest pain is mostly experienced during dressing changes to maintain healing and banish the infection. This review is conducted to assess the effectiveness and safety of different analgesia agents or methods for dressing changes in burn patients. Method: Searches of studies conducted from 4 electronic databases, using keywords “Analgesia”, “Dressing”, “Bandages”, “Changes” and “Burns”. We included randomized and quasi-randomized trials assessing and comparing the effects of different analgesia agents, analgesia methods for dressing changes in burns patients. We excluded trials reporting only pharmacokinetic and physiological outcomes, comparing drug dosages, with exception for those using different drugs in the same class. Result: Multiple databases search retrieved 144 studies. 17 trials are eligible involving 700 patients. Analgesia using pharmacological agents in 7 trials; 5 trials elaborating primary treatments and 2 trials as the adjunct treatment complementing the major analgesia. Two primary analgesia treatments were studying the role of patient-controlled analgesia (PCA), while 3 trials using caregiver delivered. Ten trials were observing the role of non-pharmacological analgesia. Conclusion: There was inadequate evidence from comparisons tested in randomized trials to confirm the dependent effectiveness of various techniques of analgesia, individual methods, or to assess the administration of different drug adjuncts for providing analgesia during dressing changes. Given the unresolved questions about the management of these conditions, we suggest that preference should be focused on the large scale, optionally, multi-center randomized observations of the primary methods.
{"title":"Analgesia For Dressing Changes In Burns: A Systematic Review","authors":"M. Ramadan, A. Wardhana, A. Sugiarto","doi":"10.14228/JPR.V5I1.249","DOIUrl":"https://doi.org/10.14228/JPR.V5I1.249","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Background: Intense and prolonged pain often caused by burn injuries. The greatest pain is mostly experienced during dressing changes to maintain healing and banish the infection. This review is conducted to assess the effectiveness and safety of different analgesia agents or methods for dressing changes in burn patients. \u0000Method: Searches of studies conducted from 4 electronic databases, using keywords “Analgesia”, “Dressing”, “Bandages”, “Changes” and “Burns”. We included randomized and quasi-randomized trials assessing and comparing the effects of different analgesia agents, analgesia methods for dressing changes in burns patients. We excluded trials reporting only pharmacokinetic and physiological outcomes, comparing drug dosages, with exception for those using different drugs in the same class. \u0000Result: Multiple databases search retrieved 144 studies. 17 trials are eligible involving 700 patients. Analgesia using pharmacological agents in 7 trials; 5 trials elaborating primary treatments and 2 trials as the adjunct treatment complementing the major analgesia. Two primary analgesia treatments were studying the role of patient-controlled analgesia (PCA), while 3 trials using caregiver delivered. Ten trials were observing the role of non-pharmacological analgesia. \u0000Conclusion: There was inadequate evidence from comparisons tested in randomized trials to confirm the dependent effectiveness of various techniques of analgesia, individual methods, or to assess the administration of different drug adjuncts for providing analgesia during dressing changes. Given the unresolved questions about the management of these conditions, we suggest that preference should be focused on the large scale, optionally, multi-center randomized observations of the primary methods. \u0000 \u0000 \u0000 \u0000","PeriodicalId":364477,"journal":{"name":"Jurnal Plastik Rekonstruksi","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126394177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Kreshanti, Vania Aramita Sari, G. Wangge, L. K. Wahyuni
Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia.
{"title":"Speech Outcome Evaluation Of Cleft Palate Patients Underwent Palatoplasty In Plastic Surgery Division Cipto Mangunkusumo Hospital Indonesia","authors":"P. Kreshanti, Vania Aramita Sari, G. Wangge, L. K. Wahyuni","doi":"10.14228/JPR.V5I1.248","DOIUrl":"https://doi.org/10.14228/JPR.V5I1.248","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000Background: Speech is the primary goal of palatoplasty, however, there is no current data available about the long term speech evaluation after palatoplasty in our hospital which is the national referral hospital that has the only cleft craniofacial center in Indonesia. The initial data of speech outcome is required for further research which assessment should be standardized and applicable to Indonesian children that mostly speak bahasa. This study aims to get initial data by evaluating speech outcome of patients that underwent palatoplasty with adapted perceptual assessment words in Indonesian language, and describe factors influencing speech. \u0000Method: This research is a cross-sectional study to evaluate speech outcome of patients underwent palatoplasty in Cipto Mangunkusumo Hospital from October 2010–December 2012 conducted from December 2017 – July 2018. \u0000Result: Total 23 samples were measured for articulation rating where 17 (74%) patients had normal production of majority of phonemes, while there were 6 (26%) patients had predominantly distortion of phonemes. The hypernasality rating were normal in 12 (52%) patients, mild in 5 (22%) patients and moderate in 6 (26%) patients. The speech intelligibility rating were dominantly normal which all speech is understood in 17 (74%) patients and the rest of 6 (26%) patients were listeners attention needed. The velopharyngeal competence were good in 16 (70%) patients, fair in 1 (4%) patients and poor in 6 (26%) patients. \u0000Conclusion: Management of cleft palate patients will be achieved by well integrated services including speech pathologist and orthodontist. By giving the long term follow up to the patients, the optimal outcomes will be achieved. This research can be used as a reference for speech outcome evaluation in cleft palate patients in Indonesia. \u0000 \u0000 \u0000 \u0000","PeriodicalId":364477,"journal":{"name":"Jurnal Plastik Rekonstruksi","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126026225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Bangun, Irinawati Nangingtuari, A. Olivia, M. I. Maulana
Background : Mandibular subcondyle fractures are accounted for 25%-35% of all mandible fractures. Closed treatment has been the preferred treatment for several years because it’s relatively easier and non invasive but the complications that may arise are varied. Open reduction was one of the options that is considered to reduce complications. This study examines whether open reduction was a better choice than closed reduction in the management of mandible subcondyle fracture with parameter outcomes are complications, facial nerve injury, pain, and mouth occlusion. Method: A literature study was conducted from two databases: PubMed and Journal of Cranio-Maxillo-Facial Surgery (JOMS) with predefined keywords and references from 23-28 January 2018. The search was conducted with mandible subcondyle fracture, open reduction, and closed reduction. The search has been limited only for the last 5 years and limited to meta-analysis and systematic review. From the search, there were three articles used based on inclusion criteria in this case review. Result: The reviewed articles showed that open reduction provides better results than closed reduction, although open reduction results in complications of facial injuries and facial nerve weakness, but the complications were transient and tolerable.Conclusion: Based on existing clinical evidence, open reduction was the preferred management rather than closed. reduction due to better outcome and fewer complication.
背景:下颌骨髁下骨折占所有下颌骨骨折的25%-35%。多年来，闭合性治疗一直是首选的治疗方法，因为它相对容易且无创，但可能出现的并发症各不相同。切开复位被认为是减少并发症的选择之一。本研究探讨了在并发症、面神经损伤、疼痛和口腔咬合等参数结果的情况下，切开复位是否比闭合复位更好。方法:从PubMed和Journal of cranio - maxilo - facial Surgery (JOMS)两个数据库中检索2018年1月23日至28日的相关关键词和参考文献，进行文献分析。对下颌骨髁下骨折、切开复位和闭合复位进行了研究。研究仅限于最近5年，并且仅限于荟萃分析和系统评价。从搜索中，根据本病例综述的纳入标准，使用了三篇文章。结果:文献综述表明，切开复位效果优于闭合复位，虽然切开复位会引起面部损伤和面神经无力等并发症，但并发症是短暂的，可耐受的。结论:根据现有的临床证据，切开复位优于闭合复位。减少由于更好的结果和更少的并发症。
{"title":"Open Versus Closed Treatment Of Subcondyle Mandible Fracture: An Evidence-Based Case Report","authors":"K. Bangun, Irinawati Nangingtuari, A. Olivia, M. I. Maulana","doi":"10.14228/jpr.v5i1.247","DOIUrl":"https://doi.org/10.14228/jpr.v5i1.247","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Background : Mandibular subcondyle fractures are accounted for 25%-35% of all mandible fractures. Closed treatment has been the preferred treatment for several years because it’s relatively easier and non invasive but the complications that may arise are varied. Open reduction was one of the options that is considered to reduce complications. This study examines whether open reduction was a better choice than closed reduction in the management of mandible subcondyle fracture with parameter outcomes are complications, facial nerve injury, pain, and mouth occlusion. \u0000Method: A literature study was conducted from two databases: PubMed and Journal of Cranio-Maxillo-Facial Surgery (JOMS) with predefined keywords and references from 23-28 January 2018. The search was conducted with mandible subcondyle fracture, open reduction, and closed reduction. The search has been limited only for the last 5 years and limited to meta-analysis and systematic review. From the search, there were three articles used based on inclusion criteria in this case review. \u0000Result: The reviewed articles showed that open reduction provides better results than closed reduction, although open reduction results in complications of facial injuries and facial nerve weakness, but the complications were transient and tolerable.Conclusion: Based on existing clinical evidence, open reduction was the preferred management rather than closed. reduction due to better outcome and fewer complication. \u0000 \u0000 \u0000 \u0000","PeriodicalId":364477,"journal":{"name":"Jurnal Plastik Rekonstruksi","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122506802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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