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Objective: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. Design: Observational cohort study. Setting: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. Patients, Participants: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. Interventions: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. Main Outcome Measure(s): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. Results: While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. Conclusion: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

Background Composite graft as a reconstructive therapy option has limitations in size so that it is easily necrotic. Deferoxamine administration has been associated with increased neo-vascularity in wounds. We aimed to compare the administration of deferoxamine and Platelet-Rich Plasma (PRP) injection in a composite graft in rabbits. Methods Thirty New Zealand rabbits were divided into three groups; the control group, the deferoxamine group, and the PRP group. The composite graft with a diameter of 2 cm was taken and replanted after rotating it 180°. The mean graft viability and the mean number of capillaries were evaluated on day 7 (POD 7) by macroscopic and histological evaluation using Hematoxylin-Eosin staining. Results While the mean number of capillaries was not significantly different in control, deferoxamine, and PRP groups (p = 0.21), the mean survival rate in the control, deferoxamine, and PRP groups reached a significant level with p-value of 0.006 (66.6% vs. 63.8% vs. 99.6%, respectively). Conclusions Deferoxamine group had the highest number of capillaries, but had the lowest survival rate. In the PRP group, it had the lowest number of capillaries, but had the highest survival rate., Highlights • Composite grafts yield better results than skin grafts in plastic and reconstructive surgery. • The failure rate of composite graft is quite high due to limitations of re-vasculature. • The usage of deferoxamine might have a beneficial effect on increasing the graft survival.

Background: The wound healing process is closely related to wound care techniques which consist of cleansing, debridement and dressings. In infected wounds, washing with a wound washing solution is expected to reduce the colony of germs and to eradicate the infection. One of the important pathogens in wound is Pseudomonas aeruginosa. In this study we will compare the use of normal saline, chlorhexidine-cetrimide, and prophylbetaine-polyhexanide as wound washing solutions for wounds contaminated with Pseudomonas aeruginosa. Methods: Twenty-seven mice were divided into 3 groups: normal saline, chlorhexidine-cetrimide, and prophylbetaine-polyhexanide group. The wound was made on the mice's back then the Pseudomonas aeruginosa germ was inoculated on the wound. Four hours later, the wound was irrigated with the wound washing solution according to its group. Tissue culture will be taken 18 hours after washing. Result : Propylbetaine-Polihexanide is the most effective wound washing solution on Pseudomonas aeruginosa contaminated wound compare to Normal Saline and Chlorhexidine-Cetrimide. Although, there is no significant difference in the number of Pseudomonas aeruginosa bacteria on the wound bed after washing with Normal Saline, Chlorhexidine-Cetrimide, and Propylbetaine-Polihexanide.

Background: Wound healing is a complex process, relates to wound care methods, wound dressing materials, to wound closure according to the reconstruction ladder. Research on dressing materials for full-thickness wounds is increasingly diverse, from herbs, medicinal active ingredients, to tissue engineering. Platelet-rich fibrin (PRF) as a second generation of platelet derivatives, plays an important role in inflammatory, proliferative, remodeling processes in wound healing. Simvastatin, an anti-hyperlipidemic drug, in its development has a pleiotropic effect, can reduce inflammation, increase proliferation, thereby accelerating wound healing by increasing angiogenesis. This study aims to compare the effectiveness of Simvastatin gel 2.5% with Platelet-rich fibrin (PRF) against angiogenesis, fibroblast proliferation, collagen fiber density, and epithelialization rate. Methods: Thirty six rats were randomly divided into three groups. A 2x2 cm full-thickness wound was made on the back of the Winstar mouse. Group A was a control group, the wounds were applied with Carboxymethylcellulose (CMC gel). In group B, the wound was treated with Platelet-rich fibrin (PRF), and in group C, the wound was given Simvastatin gel with 2.5% concentrate. The wounds in each group were dressed with a dressing. Furthermore, the rats were sacrificed on the 3rd and 7th day after treatment, and the samples were taken. Result. There was a significant difference (p

Background:Closure of the defect with a random skin flap is constrained by the extent of the defect area. Several studies have shown the benefits of administration of PRP (Platelet Rich Plasma) in random skin flap. The purpose of this study is to compare the effect of PRP injection given before flap elevation, after flap elevation and control on the extended random skin flap procedures in rats.Methods: This research is experimental with randomized post test only control group design (n = 27, divided into 3 treatment groups) that compare the effectiveness of PRP injection 24 hours prior to the elevation of the flap, after the elevation of the flap, and control in the extended random skin flap in rats. Random skin flap is made in the ratio 1: 5 on the rat skin. Measurement of viable area were observed on days 1, 7 and 14.Results: There were significantly increased viability of random skin flap on the group with PRP injection 24 hours prior flap elevation compared to other group of treatment. The average of viability on day first 39%±13% ;42%±34%; 62%±14%. On day 7th24%±13%; 36%±26%; 62%±12%.On day 14th16%±15%; 28%±22%; 60%±11%.Conclusion: Injection of PRP on extended random skin flap on rat 24 hours before flap elevationincrease viability of the flap compared to control group and group which receive PRP injection on extended random flap on rat skin after elevation of the flap. Viability increased due to angiogenesis stimulation after PRP injection.

Background: Marjolin’s ulcer is malignant lesion from scar due to burn trauma, chronic osteomyelitis, chronic inflammation, or chronic fistulae. This type of ulcer is rare, usually progressively grow 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 Presentation: Reporting 3 Marjolin’s ulcer case on Dr. Soetomo General 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.Conclusion: 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

Background: 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.Conclusions: 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.

Background: 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. Patient and Operation Techniques: 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.

Pendahuluan. Masalah luka adalah masalah yang sering dihadapi oleh setiap dokter, terutama di bidang Bedah Plastik Rekonstruksi dan Estetik. Banyak penelitian tentang berbagai produk atau faktor yang dapat mempercepat penyembuhan luka, salah satunya adalah platelet-rich plasma (PRP). Allogenic PRP dapat menjadi alternatif pada kondisi yang tidak memungkinkan diambilnya autologus PRP. Tehnik freeze-dried dilakukan untuk menurunkan reaksi imun pada sediaan allogenic PRP.Tujuan dari penelitian ini adalah mengevaluasi efektivitas penggunaan allogenic freeze-dried platelet-rich plasma (PRP) terhadap proses penyembuhan luka full-thickness pada hewan coba (kelinci).Metode Penelitian. Penelitian ini merupakan penelitian eksperimental dengan rancangan post test only design, simple randomized. Variabel terikatnya adalah jumlah fibroblas dan jumlah neovaskularisasi, sedangkan variabel bebas adalah pemberian Paraffin gauze dan Allogenic freeze-dried platelet-rich plasma (PRP). Lima belas ekor kelinci dirandomisasi ke dalam enam kelompok. Luka full thickness dengan kedalaman 2mm dibuat pada punggung setiap kelinci. Luka pada kelompok kontrol diberikan perawatan menggunakan paraffin gauze dan diberikan allogenic freeze-dried PRP pada kelompok perlakuan, pengamatan dilakukan pada hari ke-3, hari ke-9, dan hari ke-14.Hasil. Didapatkan perbedaan bermakna rerata jumlah fibroblas antara kelompok kontrol hari ke-3 dengan perlakuan hari ke-3 (p

Backgrounds: 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 Presentation and Operation Technique: 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

Background: 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 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.Method: 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 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.Conclusions: 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.