Jurnal Rekonstruksi dan Estetik

Jurnal Rekonstruksi dan Estetik, June 2025

JURNAL REKONSTRUKSI DAN ESTETIK — 2025-05-28

Back Matter

LOCAL FLAP TECHNIQUES OUTCOME FOR SACRAL PRESSURE ULCERS CLOSURES: A SYSTEMATIC REVIEW

Yanuar Ari Pratama — 2025-06-01

Highlights:

Local flap reconstruction for sacral defects due to chronic pressure ulcers faces major challenges, including a high risk of infection, recurrence, and the complex sacral anatomy.
Effective local flap techniques tailored to patient needs such as, the Clover Style, Modified Parasacral Bilobed, and Bilobed Flaps have been shown to improve both functional and aesthetic outcomes.

Abstract:

Introduction: Sacral pressure ulcers (PUs) pose a major challenge, especially in bedridden and elderly patients, due to risks like infection and delayed healing. Surgical reconstruction using local flaps offers effective defect closure with low donor-site complications. This systematic review analyzes local flap techniques for sacral PU reconstruction based on studies published from 2019 to 2024.

Method: A comprehensive literature search was conducted in PubMed, selecting empirical studies that met predefined inclusion criteria. A total of seven studies were reviewed, comprising five case series and two case reports.

Result: The findings highlight multiple local flap techniques, including the Clover-Style Fasciocutaneous Perforator Flap, Modified Parasacral Perforator-Based Bilobed Flap, and Bilobed Flap, each demonstrating favorable outcomes with high flap survival rates and minimal complications. These techniques offer advantages such as tension-free closure, enhanced vascularity, and reduced recurrence risk, making them viable alternatives for sacral PU management.

Conclusion: Local flap reconstruction is a reliable and effective method for managing sacral pressure ulcers, with high success rates and good healing outcomes. Flap selection depends on defect size, patient condition, and surgeon expertise. A multidisciplinary approach involving preoperative imaging, wound care specialists, and physiotherapists can enhance surgical success. Further research, particularly randomized controlled trials, is needed to strengthen evidence-based flap selection criteria. Overall, local flaps remain the mainstay in sacral pressure ulcer reconstruction, contributing to improved patient quality of life.

CHRONIC WOUNDS : RISK FACTORS AND EVIDENCE-BASED INTERVENTION

Veronica Abebia Beginanta Pinem — 2025-06-01

Highlights:

Identifies key risk factors for chronic wounds and the underexplored role of genetics and immune dysregulation in healing.
Explores advanced interventions like smart bandages and bioengineered skin, while addressing accessibility challenges.
Highlights the potential of personalized medicine and digital health in improving patient-centered wound care.

Abstract:

Introduction: Chronic wounds are a pervasive and escalating public health issue, characterized by their inability to progress through the typical phases of healing, resulting in prolonged tissue damage and patient morbidity. Common types include diabetic, pressure, arterial, and venous ulcers. Factors like comorbidities, infection, poor circulation, and inadequate care delay healing. This review aims to explore the risk factors for chronic wounds and evaluate evidence-based interventions to optimize treatment outcomes, thereby improving patient care and reducing healthcare costs.

Methods: A thorough literature review was performed using peer-reviewed journals and reliable medical databases, focusing on articles from the past 10 years for relevance. The search used keywords like "chronic wounds," "risk factors," "management," and "evidence-based interventions," selecting studies that addressed the epidemiology, causes, and treatment of chronic wounds.

Results: The review identified major risk factors for chronic wounds, such as diabetes, poor circulation, neuropathy, infection, and aging. Effective treatments discussed include advanced dressings, debridement, negative pressure wound therapy, and skin grafts. A multidisciplinary, patient-focused approach was found to improve healing outcomes.

Conclusion: Understanding the risk factors of chronic wounds and applying evidence-based, personalized treatments can significantly improve healing outcomes. Ongoing research and innovation are essential to address gaps in care and enhance patient management.

PRESSURE INJURY PATIENTS CHARACTERISTIC IN SOUTH EAST INDONESIA WARRANTS IMMEDIATE INITIATION OF PREDICTIVE ASSESSMENT TOOLS: A CHART REVIEW

Angela Djunaedi — 2025-06-01

Highlights:

The absence of Stage 1 pressure injuries reflects the need for a predictive assessment tool.
The majority of patients were aged 60–71 and had unstageable pressure injuries.
The main referring departments were Internal Medicine, Cardiology, and Pulmonology.

Abstract:

Introduction: Pressure injury (PI) is a worldwide health problem, a burden in many aspects, and influences life quality. Every PI case would be different due to several underlying factors and conditions which hindered the prevention strategies. We share the overview of PI patients on South East Indonesia.

Method: A descriptive-retrospective study with chart review approach was held to review all case of PI consulted to plastic surgery from 2021-2023. Basic demographic data was collected along with the wound area, PI stage, and referrer department.

Result: PI was more frequent in Male patients insignificantly (p=0.069) developed more PI (55.13%) than female patients (44.87%). Almost half of PI case occurred in patients with more than 60 years old of age (48.71%). Most case were referred by the internal medicine, pulmology and cardiology department (43.59%) and mostly located in sacral region, (64.10%). Unstageable PI was found the most (48.72%) while no stage 1 PI was consulted.

Discussion: The finding of the study existing knowledge about the risk factors for pressure injuries (PI), particularly sensory and motor impairment as well as immobility. The absence of stage 1 PI underscores the importance of a standardized predictive assessment tool to enhance early detection and intervention. Integrating routine visual inspection and palpation into the assessment process could improve the early recognition of PI. The intervention should be extended to educational program to family caregiver in discharge planning.

Conclusion: PI incidence corresponds with known risk populations. Hospital leadership should implement predictive PI assessment tools and incorporate PI education into discharge planning to improve early detection and intervention.

PROFILE OF KELOID PATIENTS IN SURGICAL WOUNDS: A STUDY AT DEPARTMENT OF PLASTIC AND RECONSTRUCTIVE SURGERY, DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA (2019-2022)

Diandra Yasmin Nurfaiza — 2025-06-01

Highlights:

Previous keloid surgery mostly caused keloid recurrence.
The most common symptom that accompanies keloids in surgical wounds was itching.
Surgery and combination therapy were the most used therapy.

Abstract:

Introduction: Keloid is an abnormal scar resulting from disruptions in the wound healing process. Clinically, keloids extend beyond the original wound margins and progressively enlarge into dense, firm nodules. They can develop following various forms of trauma, including surgical procedures. Several factors contribute to keloid formation in surgical wounds, such as age, gender, genetics, skin color, hormones, incision location, wound tension, and delayed healing.

Methods: This retrospective descriptive study analyzes medical records of patients diagnosed with keloids due to surgical wounds at the Department of Plastic and Reconstructive Surgery, Dr. Soetomo General Academic Hospital, Surabaya, between 2019 and 2022.

Results: Among 58 keloid patients, 23 developed keloids following surgery. The most common risk factor was a history of previous keloid surgery. The majority of patients were female, aged 17–25 years, students, and had no family history of keloids. The most frequent keloid location was the chest, with an onset of ≥1 year, a size of <20 cm², and associated itching. Surgical excision and combination therapy were the most commonly used treatment approaches.

Conclusion: Previous keloid surgery is the primary risk factor for developing keloids in surgical wounds. Surgery and combination therapy remain the most frequently employed treatment strategies.

ASSESSMENT OF MAXILLOFACIAL TRAUMA IN KANJURUHAN GENERAL HOSPITAL MALANG USING FACIAL INJURY SEVERITY SCALE (FISS) SCORING SYSTEM

Kunthi Kencana Makayasa Putri — 2025-06-01

Highlights:

Most maxillofacial trauma cases were mild, based on FISS scoring.
The average FISS score was 3.37, with most patients scoring 2 (24.7%).
Larger studies are needed to confirm FISS as a prognostic tool.

Abstract:

Introduction: Maxillofacial trauma is a unique form of trauma that may lead to various facial function disabilities. One method to assess the severity of maxillofacial fractures is the Facial Injury Severity Scale (FISS). This study aims to describe and evaluate the severity of maxillofacial trauma cases in the Emergency Room of Kanjuruhan General Hospital Malang using the FISS scoring system, from January 2022 to December 2023.

Methods: This retrospective study collected data from patients with maxillofacial trauma treated at the Emergency Room of Kanjuruhan General Hospital Malang between January 2022 and December 2023. The variables recorded included age, gender, etiology, helmet use, type of fracture, and treatment received. Each patient was evaluated using the FISS scoring system to determine the severity level.

Results: A total of 73 subjects were included. The youngest patient was 2 years old, and the oldest was 76 years. The average FISS score was 3.37 ± 1.9, with scores ranging from 1 to 9. Most patients had a FISS score of 2 (24.7%).

Conclusion: The majority of maxillofacial trauma cases in the Emergency Room of Kanjuruhan General Hospital were classified as mild according to the FISS scoring system. Further studies with a larger sample size and a complete maxillofacial trauma database are needed to evaluate the prognostic value of the FISS system.

Jurnal Rekonstruksi dan Estetik, June 2025

JURNAL REKONSTRUKSI DAN ESTETIK — 2025-05-28

Front Metter Vol.10. No.1 June 2025

RECONSTRUCTION OF CHIN DEFECT POST BASAL CELL CARCINOMA EXCISION USING RHOMBOID FLAP: A CASE REPORT

Yeremia Maruli Togatorop — 2025-06-01

Highlights:

BCC is strongly associated with UV radiation exposure,commonly affecting the face, but the chin is rarely involved (1.2% incidence).
Chin reconstruction after BCC excision is challenging, requiring careful flap selection for function and aesthetics.
The rhomboid flap is a preferred choice, offering good blood supply, minimal tension, quick healing, and better cosmetic results.

Abstract:

Introduction: Basal cell carcinoma (BCC) is a malignant skin tumor with the highest incidence and originates from the basal cells of the epidermis, with the nodular type being the most common.

Case Illustration: A 76-year-old female patient came with complaints of a lump on the chin that had enlarged and bled easily for 3 years before entering the hospital. The patient was diagnosed with Basal Cell Carcinoma in the chin region.

Discussion: Wide excision was performed under local anesthesia, then the wound was closed with a rhomboid flap. Evaluation after 1 month post-operatively the wound closed well and the scar was disguised.

Conclusion: The chin is a unique aesthetic area with unique contours and shapes, making it a challenge for plastic surgeons to perform reconstruction after extensive BCC excision. The rhomboid flap is a very versatile local flap because it can be used almost anywhere on the body, including the chin.

PEDICLED ABDOMINAL FLAP FOR MALIGNANT DEFECT RECONSTRUCTION: A VIABLE ALTERNATIVE TO FREE FLAP

Bertha Kawilarang — 2025-06-01

Highlights:

Pedicled abdominal flap remains a reliable reconstructive option in the era of microsurgery.
Although a two-stage procedure, it provides safe and functional reconstruction.
Compared to free flaps, it offers a simpler approach with fewer complications—crucial for cancer patients with limited prognosis.

Abstract:

Introduction: The pedicled abdominal flap, a commonly used reconstructive option, remains relevant in the era of advanced microsurgery despite the rising preference for free flaps. While free flaps offer advantages, they also carry risks of flap failure and require complex microvascular anastomosis, making them less suitable for certain patients.

Case Illustration: A 48-year-old female presented with a history of a non-healing ulcer over the left upper arm due to burn scarring from a flame injury sustained 20 years prior. Following tumor resection, debridement of the defect was done which showed complete loss of skin, subcutaneous tissue, and fascia of the upper arm. A rectangle shaped skin flap was designed on the left abdominal region on the same side as the defect on the affected upper arm. A pedicled axial fasciocutaneous flap was harvested from the left lumbar area of the abdomen, utilizing the paraumbilical perforators for vascularity.

Discussion: This case report highlights the use of the pedicled abdominal flap in the reconstruction of defects resulting from malignancy, emphasizing its reliability and suitability in such complex scenarios. For individuals with malignancy, the pedicled abdominal flap is often favored due to its safer, single-stage procedure, minimizing complications and re-operation risks.

Conclusion: Compared to free flaps, the pedicled abdominal flap is a preferable choice in reconstructing defects in cancer patients due to its reliability, reduced risk of flap failure, and relatively simple surgical procedure. This is particularly important for cancer patients, where the focus is on achieving functional reconstruction while considering patient's prognosis.