Kusumastuti, Nadia
Yayasan Lingkar Studi Bedah Plastik

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Problems In Cleft Lip Nose Patients Undergoing Augmentation Rhinoplasty With Rib Graft : A Case Report Kusumastuti, Nadia; Sudjatmiko, Gentur
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.v1i2.46

Abstract

Correction of a cleft lip nasal deformity remains a challenging procedure in reconstructive surgery. Many different procedures have been suggested to address the problem, but few techniques have worked well and consistently. We present a case of secondary cleft nasal deformity after repair of unilateral complete cleft lip and palate on the left side. The corrective procedures carried out included closed method rhinoplasty and dorsal nasal augmentation with rib graft which was fixed to the nasal septum with needle. The patient showed satisfactory immediate post-operative result, with correction of depressed alar base and satisfying dorsal and tip projection. However, 5 months post operative result showed deviation of nasal tip to the cleft side, which we suspected was due to: warping of the rib graft, soft tissue deficiency in the cleft side which exerts pulling forces to the warping graft, and lack of rigid fixation of the graft. After appraising pitfalls encountered in augmenting nasal dorsum of cleft patients with rib graft, we concluded that some preventive measures need to be done to avoid those problems, namely: balanced cross sectional carving of rib graft, cantilever graft with plate and screw to the nasal bone, and addressing pulling force from lack of soft tissue in the cleft side by adding columellar strut graft or alar contour graft.
Frontoethmoidal Encephalomeningocele Revisited : The Convenience Of Teamwork Approach, A CaseSeries Kusumastuti, Nadia; Handayani, Siti; Hatibie, Mendy; Diah, Enrina; Bangun, Kristaninta
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.v1i5.103

Abstract

Background: Frontoethmoidal encephalomeningocele (FEEM) is a congenital defect of the skull which poses many problems to the patient as it results in many craniofacial and neural morbidities. While recently surgical correction of this disease is done in a single-stage procedure, many in Indonesia still perform twostage surgery which bears more risks and is technically difficult to achieve good aesthetic results. This case series intend to assess the feasibility and convenience of teamwork approach between plastic surgeon and neurosurgeon in correcting FEEM in a single-stage operation. Methods:We reviewed 8 patients with FEEM treated in Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo Hospital Jakarta from November 2005 until March 2010. Four of the cases were secondary cases from Neurosurgery Department, and the other 4 cases were treated in single-stage operation, in teamwork with Neurosurgery Department, using the Chula technique. Results of each surgery was assessed using objective parameters, which are Intercanthal Distance (ICD) and Interorbital Distance (IOD); and also subjective parameters which is aesthetic improvement.Result: All of the patients showed significant improvements in ICD and IOD measurements. No complication was found intra and post-operatively. All patients, especially the ones treated with singlestage surgery show good aesthetic results. Conclusion: To achieve goals of defect correction and aesthetically pleasant appearance, single-stage surgery in teamwork with the neurosurgery department seems to be most suitable and convenient.
Medicinal Leech Therapy as an Alternative Treatment for Vein Problems after Free Flap Surgery: A Case Report Soengkar, Amru; Kusumastuti, Nadia; K., Dewi Haryanti; Adib, Affan
Jurnal Plastik Rekonstruksi Vol 1 No 6 (2012): November - December Issue
Publisher : Yayasan Lingkar Studi Bedah Plastik

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jpr.v1i6.114

Abstract

Background: Venous stasis due to vein thrombosis is a complication after microsurgical procedure which if left untreated, may ultimately lead to flap failure. Medicinal leech has been useful as a conservative treatment to overcome venous stasis in cases where it is not possible to perform salvaging procedure.Patients and Methods: A 28-year-old female who suffered from a defect on the right heel following traffic accident. The patient was initially treated by performing sural flap to cover the heel defect, but was unsuccessful. Next reconstruction was done with free radial forearm flap, however in the early postoperative period vein compromise was seen which was caused by vein thrombosis. Even though heparinization therapy was immediately begun, the result was still unsatisfactory, so medicinal leech therapy was performed to prevent loss of entire flap tissue.Results: Leeches turned out to be bulging due to sucking process on the congested venous. The sucking result on this patient was satisfactory.Summary: This study shows that free tissue transfers with surgically unsalvageable venous obstruction can be helped by leech therapy protocol.