Microautologous Fat Transplantation (MAFT) sebagai Rekonstruksi Lanjutan pada Kasus Deformitas Maksilofasial Pasca Trauma

Latar Belakang: Teknik Microautologous Fat Transplantation (MAFT) merupakan sebuah metode yang relatif baru untuk memindahkan lemak dari lokasi tubuh tertentu ke lokasi tubuh yang diinginkan dengan suatu alat khusus. Teknik transfer lemak sebenarnya sudah dilakukan sejak tahun 1893 namun terkendala dengan masih banyaknya lemak yang diresorpsi sehingga memerlukan beberapa kali tindakan ulangan. Teknik Microatutologus Fat Transplantation menggunakan MAFT Gun pertama kali dilakukan oleh Lin et al. pada tahun 2006. Teknik ini telah menunjukkan hasil yang baik dalam bidang estetik maupun rekonstruksi menggantikan teknik dermofat graft yang bersifat lebih invasive. Deformitas pada wajah akibat dari hilangnya sejumlah volume lemak dapat diatasi dengan MAFT Gun yang bersifat minimal invasif. Pada tulisan ini dilaporkan satu kasus penanganan deformitas maksilofasial pasca reposisi dan fiksasi fraktur tulang wajah dengan Microautologous Fat Transplantation sebagai salah satu modalitas. Pasien dan Metode: Jaringan lemak diambil dengan spuit 60 cc tekanan negatif kemudian dilakukan sentrifugasi dengan kecepatan 3000 rpm selama 10 menit untuk memisahkan komponen lemak dan plasma. Lapisan lemak murni selanjutnya ditransplantasikan pada area wajah menggunakan MAFT Gun di bawah mata 3.5 ml, pipi 20.5 ml, dagu 3 ml, dan pelipis 1 ml. Hasil: Lama tindakan 2 jam 30 menit, prosedur anestesi sedasi sedang dan blok nervus infraorbitalis, nervus mentalis, dan nervus supraorbitalis, dan nervus supratrochealis ipsilateral. Deformitas dapat teratasi, longterm follow up 3 bulan pasca operasi tidak banyak jaringan lemak yang diresorpsi, sehingga penampilan masih baik. Kesimpulan: Teknik MAFT Gun merupakan prosedur yang efektif untuk memperbaiki kontur wajah, peremajaan wajah, memperbaiki area yang cekung, dan mengembalikan volume termasuk mengoreksi deformitas wajah akibat fraktur maksilofasial pasca reposisi fraktur maksilofasial yang kurang sempurna. Prosedur yang dilakukan relatif tidak invasif. Jaringan lemak dapat diambil dari berbagai area tubuh yang memiliki jaringan lemak berlebih. Menggunakan MAFT Gun yang telah tersertifikasi, proses transfer lemak dapat dilakukan secara akurat dan konsisten. Hasil MAFT cukup memuaskan bagi pasien, sehingga memungkinkan prosedur MAFT menjadi alternatif solusi untuk mengoreksi deformitas maksilofasial pasca reposisi dan fiksasi yang mungkin hanya memerlukan tindakan touch up satu sampai dua kali saja

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

Background:There is an increasing patient expectation for better esthetics, manifesting through anatomical harmony, projection, and volume of the upper lip relative to the lower lip, in patients with cleft deformity. The aim of this study is to investigate the outcome of vermilion augmentation using autologous dermofat graft (DFG) to enhance the lip using both quantitative and qualitative assessment.Methods:Patients with secondary cleft lip deformity who received the surgical treatment in our institution from 2015 to 2018 were recruited. Panel assessment was performed on standardized preoperative and postoperative digital photographs. A patient questionnaire was used for the reported outcome. Image processing and analyses were applied to measure the lip change. Statistical analyses were performed.Results:A total of 91 patients were included. The mean age at operation was 22.7 years, and postoperative follow-up was 3.6 years. There were no complications in the study group. The panel assessment showed significant improvement ( P < .00001) on upper lip vermilion in both frontal and lateral profile views. Ninety-five percent of patients reported improvement of the upper lip projection and volume. Quantitative image analysis showed an increase in the upper lip vermilion ratio in 97% of the cases in frontal views and improvement of the vermilion projection in 87% of the cases in the superimposed lateral views.Conclusions:The use of DFG is an effective and reproducible method for vermilion augmentation and aesthetic enhancement in patients presenting with upper lip insufficiency relative to the lower lip.

Post-Ocular Trauma Corneal Staphyloma in a Child Living in an Underdeveloped Region of Eastern Indonesia

Ocular trauma occurring in children often leads to visual impairment or blindness when it is not properly managed. This often occurs in underdeveloped regions with difficult access to professional care at local health facilities. We report a case of post-trauma corneal staphyloma in an underdeveloped region of eastern Indonesia to illustrate the importance of proper management of ocular trauma in areas lacking such expertise and where patients have difficulty accessing even basic health care. During a community health outreach in Southwest Sumba, eastern Indonesia in May 2017, a 7-year-old boy presented with white protrusion of the left eye of 3 years’ duration following an event of sharp trauma. The patient lived in an inaccessible and impoverished area. Upon contemporary examination, visual acuity of the left eye was 1/300 while that of the right eye was 6/6. Anterior examination revealed corneal staphyloma of the left eye, and its posterior segment could not be evaluated. The patient was transported to an eye care center in Jakarta, receiving a stock prosthesis implant while awaiting a corneal evisceration procedure with dermofat graft. Ocular trauma is one of the most common causes of visual impairment in children. This case illustrates the consequences of inadequate post-trauma management and the importance of prevention of infection.