Atmodiwirjo, Parintosa
Yayasan Lingkar Studi Bedah Plastik

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The Advantages of Vascularized Fibular Bone Graft For Mandibular Tumor Reconstruction Atmodiwirjo, Parintosa; Putri, Nandita Melati
Jurnal Plastik Rekonstruksi Vol 1 No 1 (2012): January - February Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i1.31

Abstract

Mandibular reconstruction are often indicated in patient who underwent ablation or excision of the mandible due to malignancy of the oral cavity.In this paper we will discuss about the mandibular reconstruction with use of alloplastic implant, and vascularized bone graft. Four cases of oral cavity tumor which were referred to the plastic surgery division at Cipto Mangunkusumo hospital during 2005-2011, after being diagnosed with oral cavity tumor were re-viewed. Mandibular reconstruction can be done using alloplastic implant, non-vascularized bone graft or vascularized bone graft. In this paper we studied four patients who needed mandibular reconstruction after ablation of oral cavity tumors. Patients who underwent reconstruction with alloplastic implants all had complications such as broken hardware. Where as in patient who underwent free fibular tissue transfer there were no complications at all. We can conclude that in less vascularized surrounding tissue as in cases that received or will receive other treatment such as chemotherapy or radiation that vascularized bone graft are superior. The bone healing in vascularized bone graft also does not depend on creeping substitution like in non vascularized bone graft.
Innervated Bilobed Radial Forearm Free Flap For Tongue Reconstruction Atmodiwirjo, Parintosa; Bangun, Kristaninta; Handayani, Siti; Djamaloeddin, Chaula; Nindita, Eliza
Jurnal Plastik Rekonstruksi Vol 1 No 1 (2012): January - February Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i1.28

Abstract

Hemiglossectomy defects need reconstructions to restore normal functions and aesthetic outcomes. It is therefore prudent that well-planned reconstructive technique is needed for a good functional substitution for the defect.This case report describes a 30 years old male who developed T2N1M0 squamous cell carcinoma of the left tongue. The patient underwent a tongue reconstruction following his hemiglossectomy involving floor of the mouth without mandibular resection.The optimum method of reconstructing a major defect such as hemiglossectomy with floor of the mouth resection is best carried out by using microvascular free tissue transfer. We conclude that the radial forearm free flap is good method for reconstructing major defects of the tongue. The radial forearm free flap is thin, can be raised without patient position change, has constant vascular anatomy, and provides an advantage in the aesthetic aspect at the donor site.
Microsurgery Technique in the Foot Reconstruction of Soft Tissue Defects: A Review of 4 Cases Atmodiwirjo, Parintosa; Sandhi, Afriyanti
Jurnal Plastik Rekonstruksi Vol 1 No 1 (2012): January - February Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i1.30

Abstract

The restoration of an intact covering is the primary surgical requisite following soft tissue defects in the foot because deep healing can be no better than the surface covering. Soft tissue defects that expose underlying bones, joints, and tendons pose challenging problems and require a free tissue transfer for a successful reconstruction.Total of 4 flaps in the foot was performed between February 2009 to February 2010. We reconstructed soft tissue defects in the foot in 4 patients using 3 free anterolateral thigh (ALT) flaps and 1 free radial forearm (RF) flap. Trauma was the commonest cause in our patients.Free ALT and RF flaps provided stable and durable long-term wound cover in all patients. Complications were few and manageable.Free tissue transfer has become commonplace in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experience, we found that the using of free ALT and RF flaps in foot defects reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.
Free Vascularized Dermofat Flap For Contouring Maxilla In Fibrous Dysplasia Patients Atmodiwirjo, Parintosa; Martina, Nungki Ratna
Jurnal Plastik Rekonstruksi Vol 1 No 2 (2012): March - April Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i2.42

Abstract

Fibrous dysplasia is a disease that causes bone thinning and growth of lesions in one or more bones and leads to bone weakness and scar formation within the bones. Especially when involving the skull or facial bones, the lesions can cause externally visible deformities. We reported one case of fibrous dysplasia of the maxilla reconstructed in our Plastic Surgery Division of Cipto Mangunkusumo Hospital. Data was taken from the medical and surgery records. In this case, we used the Antero Lateral Thigh (ALT) flap to reconstruct the maxilla and facial contour in 26 years old girl with fibrous dysplasia. After the operation we had daily observation to evaluate the blood flow to the flap and it had satisfactory result without any complication. Ultimately, free vascularized dermofat flap with ALT seems to be suitable for craniofacial contouring surgery, in this case for contouring maxilla. Facial contour could further be improved after secondary reshaping of the healed flaps. This led to nearly perfect long-term facial symmetry in all cases. The ALT proved to be a reliable donor site, providing enough well-vascularized fatty tissue for facial contour augmentation.
Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation Atmodiwirjo, Parintosa; Handayani, Siti; Djaprie, Shelly Madona
Jurnal Plastik Rekonstruksi Vol 1 No 2 (2012): March - April Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i2.44

Abstract

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).
A Thin Anterolateral Thigh Free Flap for Severe Hand Burn Deformity Atmodiwirjo, Parintosa; Mukarramah, Dewi Aisiyah
Jurnal Plastik Rekonstruksi Vol 1 No 3 (2012): May-June Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i3.65

Abstract

Background: Hand is one of the most commonly involved areas in burn injury, resulting in contracture.1 Reconstruction of severe postburn hand deformity is very challenging. Because there is no adjacent skin laxity to allow for local flaps in the burned hand, distant or free flaps should be considered. 2 Application of the thin anterolateral thigh flap in hand reconstruction has become one of the most preferred options for resurfacing of soft-tissue defects after contracture release. 3 Other than closing the defect after contracture release, restoration of hand function is also essential.Patient and Methods: In 2010, a man, 37 years old presented with severe contracture on the right hand due to an explosive flame burn 1,5 years ago. On the right hand, there was hyperextension at the metacarpophalangeal (MCP) joint with flexion on the wrist and thumb abduction with hyperextension at the interphalangeal joint. Our goal is to reconstruct this severe hand burn deformity using thin ALT free flap with flap thickness 4 mm to achieved good hand contour.Results: The thin ALT free flap was vital, and 1-year follow-up gives good hand contours. Patient under rehabilitation therapy from 2 weeks postoperative to attain good functional hand.Summary: A thin anterolateral thigh free flap gives good alternative for resurfacing defect in reconstruction of burn hand than other fasciocutaneous flaps. The advantage are it provides the same color and texture, thin and pliable flap to form good hand contour.
Pectoralis Major Musculocutaneous Flap and Splitthickness Skin Graft for The Reconstruction of Pharyngocutaneous Fistula After Total Laryngeal Resection Atmodiwirjo, Parintosa; Pribadi, Sweety
Jurnal Plastik Rekonstruksi Vol 1 No 4 (2012): July-August Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i4.82

Abstract

Background: Pharyngocutaneous fistula (PCF) is the most frequent complication in the early postoperative period after total laryngectomy. Most PCF respond well to conservative management, but when it fails and the fistula persists surgical closure in indicated. Patients and Methods: Sixty-five year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous fistula. We performed a pectoralis major musculocutaneous flap (PMMCF) to close the fistula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal fistula, the exteriorized muscle part of the "ap was then covered by skin graft.Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled flap to cover defect on the neck area. The skin island of the flap provided an adequate air-thight cover and successfully closed the laryngeal fistula.Summary: PCF is a problematic complication resulting from the resection of head and neck tumor. Early diagnosis and proper multidisciplinary management is required to prevent further morbidity. PMMCF is a simple, easy to perform and reliable option for closure of PCF.
Reconstruction of Distal Phalangeal Injuries with Homodigital Island Flap: a Case Report Atmodiwirjo, Parintosa; Laidding, Sachraswaty
Jurnal Plastik Rekonstruksi Vol 1 No 4 (2012): July-August Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i4.83

Abstract

Background: Reconstruction of distal phalangeal defects with exposure of bone, tendon, or joint can be a difficult reconstructive problem, particularly since immediate coverage is of paramount importance for preserving function. The objectives of distal phalangeal defect or fingertip reconstruction included preservation of functional length and sensibility, prevention of symptomatic neuromas, acceptable donor site morbidity, the absence of cold intolerance, mineralization of aesthetic deformity, and quick return to occupational activities.Patients and Method: A review of one case, 26 years old male with phalangeal defect at tip to radial site of 3th finger of right hand, with tendon and bone exposed. After adequate debridement, shape and size of the defect are measured, the flap designed at the ulnar site of the same finger and the vascular of the flap is marked to palmar arch. Lazy “S” incision performed, donor flap is elevated with pedicle and transferred to the recipient site. Donor site was covered up with skin graft. Result: After follow up the homo digital island flap was healed nicely and the skin graft take was 100%, length is less diminish, sensibility conformed with two-point description, joint flexibility is good.Summary: Homodigital island flap is a useful safe option for fingertip or distal phalangeal reconstruction because it offers multiple advantages in comparison with advancement, regional, and free flaps, with an almost negligible donor site defect and can be done in a 1-stage procedure.
Modalities to Treat Penile Glans Amputation: Case Series Sukasah, Chaula L.; Atmodiwirjo, Parintosa; Anindhawati, Nur
Jurnal Plastik Rekonstruksi Vol 1 No 4 (2012): July-August Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i4.88

Abstract

Background: In Indonesia, a country with Muslim population as a majority, circumcision is the most common operation performed in males. However, since circumcisions are also commonly performed by inexperienced individuals and during communal circumcision event, we frequently come across complications. One of the most severe complications is amputation of the penile glans. There are several techniques that can be used to treat this complication. In this paper we present some which have been used in our division and the result. Patient and Methods: We report three cases of traumatic penile glans amputation as a complication of circumcision that has been admitted to Cipto Mangunkusumo Hospital during January 2011 – January 2012. In first case we performed full thickness skin graft, in the second one we performed groin flap, and scrotal flap to reconstruct the third case. We evaluate the result for several months. Results: The three techniques showed no complication, good result in function and also aesthetically acceptable for patient and the family. Choice of technique that has been used to repair the amputated penis depended on the patient condition, and surgeon’s choice.Summary: The three techniques each has advantages and disadvantages, but all of them are acceptable, functionally and aesthetically.
Chimeric Flap for Reconstruction of Severe Traumatic Injuries of the Hand (a Case Report) Atmodiwirjo, Parintosa; Harihadi, Eko
Jurnal Plastik Rekonstruksi Vol 1 No 5 (2012): September - October Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i5.101

Abstract

Background: Injuries of the hand, including loss of digits, are devastating events. Patients often require multiple operative procedures, with prolonged recovery periods. The challenge for the reconstructive surgeon is to minimize the number of operations, shorten the recovery period, and restore the function and aesthetic appearance of the hand. When faced with a difficult reconstruction, the expense, morbidity of the donor site, and operative time must be taken into consideration. The chimeric composite flaps is combination of microanastomoses consist of two flaps or tissue, each with an isolated pedicle and a single vascular source. Patients and Methods: We reported a case of 32-year-old man presenting with skin defect of hand, flexor and extensor tendon expose due to traffic accident after passed critical event and debridement we did chimeric flaps consist of free radial forearm flap and free dorsalis pedis flap based on radial pedicle system and dorsalis pedis pedicle system. Result: 2 weeks postoperative, flap were vital with satisfactory functional and aesthetic outcome and almost all of graft was take as well as all of donor site graft.Summary: In selected cases, the chimeric flap is a good option for the reconstruction of extensive, composite, and three-dimensional defects.