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Highlights: • Tatalaksana Sindrom Parry-Romberg pada pasien melibatkan rekonstruksi wajah dengan menggunakan free flap dari otot Gracilis. • Dilakukan terapi berupa obat-obatan golongan kortikosteroid, retinoid, antioksidan, dan imunosupresan untuk mengendalikan gejala dan perkembangan penyakit pada Sindrom Parry-Romberg. Abstrak: Latar Belakang: Sindrom Romberg yang juga memiliki sinonim dengan Sindrom Parry-Romberg (juga dikenal sebagai atrofi hemifasial progresif) adalah penyakit langka yang ditandai oleh penyusutan yang progresif serta degenerasi jaringan di bawah kulit, biasanya penyakit ini terjadi pada satu sisi wajah (atrofi hemifasial) tetapi kadang-kadang meluas ke bagian lain dari tubuh. Sebuah mekanisme autoimun dicurigai menjadi salah satu penyebab dari penyakit ini, dan sindrom ini diduga merupakan varian dari skleroderma lokal, untuk penyebab pasti patogenesis dari penyakit yang didapat ini hingga saat ini masih belum dapat ditentukan. Ilustrasi Kasus: Pasien perempuan berusia 23 tahun mengeluhkan ketidaksimetrisan wajah antara sisi kanan dan sisi kiri yang telah dialaminya selama 8 tahun, tetapi keluhan tersebut tidak mengalami perburukan dalam setahun terakhir.Tidak ada riwayat trauma. Dari anamnesis, tidak ada gejala seperti rasa baal atau kesemutan pada wajah sisi kanan, dan tidak ada riwayat penyakit serupa dalam keluarga pasien. Pemeriksaan fisik menunjukkan adanya atrofi pada musculus region Frontotemporal sisi kanan hingga cheek dextra. Pemeriksaan intraoral mengindikasikan oklusi gigi yang normal.Hasil pemeriksaan Saraf Cranial ke-7 (nervus fasialis) menunjukkan fungsi yang normal, termasuk kemampuan mengangkat alis, mengkerutkan dahi, mencucu, dan tersenyum pada kedua sisi wajah. Pemeriksaan mata menunjukkan visus yang baik pada mata kanan dan kiri, gerak bola mata yang normal, dan tidak ada penglihatan ganda. Pembahasan: Dilakukan tatalaksana berupa rekonstruksi dengan free flap dari otot Gracillis tungkai kanan pasien untuk sisi kanan wajah pasien yang di anastomosis dari arteri dan vena temporalis superior. Selain menggunakan free flap gracillis, Sindrom Parry-Romberg juga dapat menggunakan terapi lainnya seperti obat-obatan golongan kortikosteroid (topical dan intralesi), retinoid, anti-oksidan, dan imunosupresan. Kesimpulan: Pengobatan Sindrom Parry-Romberg dapat melibatkan berbagai pendekatan, termasuk prosedur bedah rekonstruksi dan penggunaan obat-obatan tertentu. Pilihan terapi harus dibicarakan antara pasien dan tim medis yang merawat untuk memastikan perencanaan pengobatan yang paling sesuai untuk kasus ini

Highlights: • Fournier's gangrene remains a serious condition with a relatively high mortality rate. • Early identification of predisposing factors, combined with invasive and aggressive treatment approaches, is crucial in mitigating morbidity. Abstract: Introduction: Fournier's gangrene is a rare and rapidly progressive, necrotizing fasciitis affecting the external genitalia and perineum. Based on the case series that have been reported, the incidence rate of this case is 88% with a mortality rate of 20%-40%. The study aims to share our policy in managing Fournier's gangrene and identifying risk factors that can affect the outcome of defect closure. Methods: The medical records of 10 patients with Fournier's gangrene who presented at the Dr. Soetomo Hospital Surabaya from January 2017 to December 2018 were reviewed retrospectively. We analyzed the characteristics of the patients, risk factors, methods of defect closure, and case outcome. There are 10 Fournier's gangrene patients at Dr. Soetomo Academic General Hospital from January 2017 to December 2018. We analyzed the patient's medical records retrospectively on the patient's characteristics, risk factors, method of closing Fournier's gangrene defects, and the final outcome of the case. Results: There were ten men enrolled in the study, and the mean age was 49.3 ± 11.51 years. All patients received broad-spectrum antibiotic therapy, and extensive surgical excision. This study found that diabetes mellitus and uncontrolled patient blood sugar levels, statistically there is no effect on failure of defect closure in Fournier gangrene patients, but clinically, the relative risk value shows that blood glucose levels have a risk factor of 6 times. increasing the incidence of failure to close the Fournier gangrene defect. Conclusion:Fournier's gangrene is still considered a severe disease with fairly high mortality rate. Early recognition of predisposition factors associated with invasive and aggressive treatment options is very important in efforts to to reduce morbidity.

Highlights: • The study revealed that there were no notable variations in the ultimate scores, regardless of whether the cleft lip was complete or an alveolar cleft was present. • If the palate cleft was not present, unilateral cleft lip repair yielded considerably superior results, showing enhancements in both total lip and nose scores. Abstract: Introduction: Cleft lip and/or palate is the most common craniofacial congenital anomaly encountered by the plastic surgeon. Both reconstruction and outcome assessment are challenging. This study aimed to assess the outcome of unilateral cleft lip repair in the Surabaya CLP Center. Methods: All patients who underwent unilateral cleft lip repair in 2017 were included in the study. Those without complete photographs at minimally 52 weeks after surgery were excluded. The photographs of patients taken at least one-year post-surgery were assessed using a modified cleft lip evaluation profile (MCLEP) index. The data were then analyzed using statistical software. Results: There were 38 subjects included in the study. There was no significant difference in the final scores obtained based on completeness of the cleft lip and the presence of alveolar cleft. The total nose score was significantly better in the left side cleft (p = 0.002). When palate cleft was absent, the total lip score (p= 0.038), the total nose score (p = 0.008), and total score (p = 0.000) were also significantly better. Conclusion: The unilateral cleft lip repair in CLP Center Surabaya yielded good and symmetrically acceptable results. The study failed to observe the different outcomes of unilateral cleft lip repair based on completeness of the cleft lip and the presence of alveolar cleft. However, the unilateral cleft lip repair outcome was significantly better in the absence of palate cleft.

Highlights: • Split Lateral Forehead Flap Technique was successful. • Eyelid Reconstruction was Challenging. Abstract: Introduction: Eyelids reconstruction after tumor resection has be one of the most challenging procedures in reconstructive plastic surgery. Small defects may be closed by primary suture or covered by small local flaps or skin graft. But in large eyelids defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Many techniques have been described, but in this case, the author suggest a split lateral forehead flap designed to cover upper and lower eyelids. Case Illustration: A Male 51 years-old-patient, presented himself in our clinic with a basal cell carcinoma involving the right upper and lower eyelids. The tumor had a history of 7 years, without any pain or vision disorders involved. Tumor was widely excised, leaving a full thickness on upper and lower eyelids. The inner lining palpebral was replaced by composite auricular graft following by lateral cantophexy. A lateral forehead flap raised with a right temporal pedicle, and the distal part of flap was split in half, and inset into the upper and lower eyelids defect. The donor region was closed with an STSG from Femur Dextra. After 14 days the flap was divided, the functional result was excellent. Discussion: At first, surgeons were worried of raising forehead flaps beyond the midline, fearing that by splitting the distal flap would cause its compropmise. However, rich anastomostic plexus exists between the major forehead angiosomes lined by the smaller calibre "choke” vessels. Conclusions: Periorbital Basal cell carcinoma resection may leave great defect to the underlying tissue. The need to provide adequate support to this structure requires complex techniques with minimum two flaps. In our case, we performed a split lateral forehead flap with a good functional and cosmetic outcome.

Highlights: • Complex syndactyly reconstruction presents surgical challenges, often resulting in rotational, angular, and nail deformities post-surgery. • The early correction of congenital syndactyly, combined with dorsal rectangular flap usage and full-thickness skin grafts, leads to satisfactory outcomes and reduces the need for multiple surgeries per web Abstract: Introduction: Syndactyly is failure of differentiation in which the fingers fail to separate into individual appendages. It is the most common congenital hand anomaly, with an incidence of 1 in 2,000 to 2,500 live births. Surgical separa­tion of fingers as early as 6 month-old is indicated when syndactyly involves digits of unequal length (i.e., ring and little fingers). Early separation is also required in complex syndactyly and cases of acrosyndactyly. The timing of sur­gery of all other cases of syndactyly remains somewhat controversial; most suggest surgical correction before age of 18 months, whereas others prefer to wait until after this age. Case Illustration: A 13-year old boy, presented with fusion of all fingers of the right hand at birth. Prior to his current visit, he underwent partial separation of the right fingers at the age of 6 y.o. at a local hospital. Following partial separation, the fingers did not grow normally. Cur­rent X-ray showed atrophy and deviation of middle phalanx. We performed separation of syndactyly between index and middle finger, and between fourth and small finger in our hospital. Interdigital webbings are released using local flap and the remaining raw surface is covered using full-thickness skin grafts. On follow up, the patient showed good functional and aesthetic outcome. He is able to write with his right hand with better coordination. Discussion: Complex syndactyly reconstruction is a challenging surgical problem. Common post surgical findings include rotational deformity, angular deformity, and nail deformity. We describe how we have altered our approach in these findings. Conclusion: Congenital syndactyly should be corrected early in life. Careful dissection, the use of a dorsal rectangular flap in combination with 2 volar triangular flaps, and use of full thickness skin grafts ensure a satisfactory outcome and minimize the number of operations per web.

Highlights: • Marjolin's ulcer can develop into squamous cell carcinoma, typically resulting from chronic scar tissue due. • Diagnosis and treatment follow standard malignant lesion protocols, with staging based on UICC classification using histopathological findings. Abstract: Introduction: Marjolin's ulcer is a malignant lesion from a scar due to burn trauma, chronic osteomyelitis, chronic inflammation, or chronic fistulae. This type of ulcer is rare, usually progressively growing on unhealed wound, accompanied by chronic trauma especially burn scar. Marjolin's ulcer can form different types of pathologies`. Squamous cell carcinoma is the most type of histology. Previously, there was 3 Marjolin's ulcer reported in Indonesia. Case Illustration: Reporting 3 Marjolin's ulcer case on Dr. Soetomo General Academic Hospital since 2008 to 2016. Two patients have history of unhealed chronic wound and one patient has history of burn injury 27 years ago. From the histopathology examination, all the results are squamous cell carcinoma. All patient undergo wide excision surgery done by surgical oncologist. All the defect is closed by flap modality. One patient's defect is closed by latissimus dorsi flap, the other with anterolateral thigh free flap, and the latter is closed by latissimus dorsi free flap. Remain raw surface close by split thickness skin graft. Discussion: Marjolin's ulcer is malignant lesion from scar due to burn trauma, chronic osteomyelitis, chronic inflammation, or chronic fistulae. Marjolin's ulcer sometimes grow become squamous cell carcinoma although require a long time. Treatment this case is same the other malignancy. Diagnosis should be confirmed by clinical, radiological, and pathological. Staging can use the classification of UICC (Union for International Cancer Control) in accordance with the histopathological results. Conclusion: Surgery serves as the primary approach for achieving local control, and radiotherapy plays a supplementary role, which must be supported by vigilant oncological monitoring.