The Use of Hyperbaric Oxygen Therapy for Ear Reconstruction: A Case Series

Introduction: The unique anatomy of the ear makes the reconstruction more challenging. Microtia and auricula hematomas are deformities or defects that can occur in the ear. Treating traumatic injury and congenital malformations of the ears needs some technique and expertise. Hyperbaric Oxygen Therapy is an additional therapy that makes a significant contribution and is effective in wound healing. Case Series: In our first case, a 52-year-old man presented with a traumatic right cauliflower ear due to a traffic accident two weeks before hospital admission. The second case involves a boy 14-year-old who has a Microtia in the right ear with total ear construction performed using autologous costochondral cartilage techniques in a two-stage. Results: Both cases following hyperbaric oxygen therapy, yield good results with good scars, no sign of infection nor tissue necrosis Summary: The combination therapy of reconstructive surgery and administration of oxygen therapy gave satisfactory results in both cases. Five sessions of hyperbaric treatment showed promising results. There is no infection, rapid wound healing, and cessation of flap compromise.

Dietary Soluble Fiber Improved Fecal Consistency in Burned Patients with Diarrhea

Backgrounds: Diarrhea frequently occurs in severely burned patients attributable to impaired intestinal integrity and dysbiosis. Soluble fiber may improve intestinal barrier function, avoid bacterial translocation, then subsequently prevent and treat diarrhea. Soluble fiber is rapidly fermented by commensal bacteria and produces short-chain fatty acids (SCFA). Case Reports: A 51-year-old male with severe burn injury involving 53,5% total body surface area (TBSA) and diarrhea were given soluble fiber as part of his diet. Results: Administration of 6–10 g/d soluble fiber clinically improves stool consistency, assessed by Bristol Stool Scale, in the severely burned patient. The patient was discharged after 19 days of hospitalization with improvement in clinical condition. Summary: SCFA maintains intestinal integrity, supports the growth of commensal bacteria, and inhibits pathogens. There is no specific recommendation regarding fiber intake in burned patients

Bifid Tongue and Cleft Palate: A Rare Congenital Malformation

Background: Congenital bifid tongue without other craniofacial abnormalities is a very rare malformation. Here, we discuss a case of the bifid tongue with cleft palate, reported in a 7-month-old girl with no other syndromes or craniofacial abnormalities. Case Reports: This case report described a 7-month-old girl with an anterior bifid tongue, separated medially by a soft, solitary sublingual mass measuring 3 cm x 2 cm in size. There was also an associated incomplete cleft palate. A soft solitary mass measuring 2 cm x 2 cm in size was also seen within the cleft palate. Results: Computed facial tomography (CT) revealed a midline hard palate defect with an intact alveolar process of the maxilla. Pedunculated cystic lesion suspected with epulis was noted to arise on premaxillary alveolar mucosa. Excision of the tongue and hard palate mass and repair of the bifid tongue were done. Summary: Congenital bifid tongue with a cleft is a very rare malformation with different variations. Early surgical intervention is critical to prevent speech impairment and swallowing disorders. A multidisciplinary approach, including well-planned staged operations and rehabilitation, is important to achieve favorable outcomes.

Three Years Follow-Up of Single-Stage Correction with Modified Chula Technique for Frontoethmoidal Encephalomeningocele: The Advantage of The Teamwork Approach (A Case Report)

Backgrounds: The main objective of Frontoethmoidal encephalomeningocele (FE) treatment are neural morbidities defect correction and aesthetically pleasing looks. Staged procedures are used to be performed in Indonesia. This article aimed to reveal the result of FE correction through the single-stage modified Chula technique (ST-MCT) procedure in collaboration with the neurosurgery team. Case Reports: A rare case of 5 years old girl diagnosed with FE was reported in this study. The FE was slowly increased in size, causing apparent facial deformity and the appearance of telecanthus. An ST-MCT procedure in collaboration with the neurosurgery team was conducted to correct the defects. The IOD values, IPD values, postoperative complications, and anesthetic improvements were evaluated in this study. Result: The patient was well after the surgery, with no complications and short length of stay. There were noted improvement of ICD, IOD and IPD postoperative follow up. At three years after the surgery ICD= 29mm; IOD= 26mm; IPD= 52 mm (normal range). Summary: ST-MCT procedure conducted in collaboration with neurosurgery team had shown excellent correction of ICD, IOD, and IPD values, no complication, shorter length of stay, and minimal scars. It considers as the most proper technique to reach a good result of correction and aesthetically pleasing looks in FE cases.

Epidemiology and Characteristics of Plastic Surgery Cases in Simpang Lima Gumul General Hospital, Kediri Regency During Covid-19 Pandemic

Backgrounds: Chinese Government found the first case of coronavirus disease 2019 (COVID-19) in Wuhan, China, in December 2019. The pandemic impacts the number of visits to plastic surgery clinics in many countries such as Italy and the United States following surgical limitations. This study was aimed to determine the impact of the pandemic on the field of Reconstructive and Aesthetic Plastic Surgery in Indonesia, particularly in Kediri Regency, East Java.Methods: The study design was an analytical cross-sectional study, using data obtained from the medical records of plastic surgery patients at SLG General Hospital in Kediri Regency. The data analysis included descriptive analysis and dummy regression analysis.Results: This study included a total of 29 observations, 14 before the pandemic era and 15 during the pandemic, with a total of 460 individuals from various diagnostic categories. Based on the findings, the number of patients diagnosed with Congenital Disorders, Skin, and Soft Tissue, and Aesthetic Surgery dropped by 7%, 2%, and 6%, respectively. Meanwhile, there was an increased number of patients with Maxillofacial, Burn and Wound Care, and Hand and Microsurgery by 5%, 4%, and 1%, respectively. Conclusions: The average number of patient visits for the Skin and Soft Tissue, Burn and Wound Care, and Hand and Microsurgery categories did not vary much during this pandemic.

Microsurgical Reconstruction During Covid-19 Pandemic Setting: A Systematic Review and Clinical Applications

Introduction: The outbreak of the novel coronavirus disease 2019 (COVID-19) has taken almost all countries worldwide. This situation has compromised the safety and health of all medical workers, including microsurgeons. Given that there have been various articles published about the recommendations in microsurgical reconstruction during the COVID-19 pandemic, We felt compelled to compile all relevant studies about the microsurgical reconstruction in the COVID-19 pandemic setting, describe the various actions from different perspectives, as well as providing suggestions based on evidence-based medicine. Method: We did a systematic literature search using electronic databases such as PubMed, Embase, Medline, Wiley, and Cochrane using keywords reconstruction, Microsurgery, coronavirus, and COVID-19. All included studies were critically appraised and reviewed. Results: Nine relevant articles were included for the final review, four of them were qualitative studies, and 5 were guidelines. Studies look at various surgeon's experiences from different healthcare systems during the COVID-19 pandemic. The focuses of the included studies are also diverse from head and neck surgery, breast surgery, limb surgery, and general Reconstructive Microsurgery. Conclusion: Microsurgical reconstruction is not suggested to perform during the peak of the COVID-19 pandemic. It is indicated only if necessary after a rigorous review by the multi-disciplinary team. A full PPE, including a Powered Air Purifying Respirators (PAPR) system, fit-tested N95 respirator masks, face shield, and tight-fitting eye protection goggles, are recommended in performing the surgeries.

The Effect of Early Tangential Excision and Split Thickness Skin Graft in Reducing Length of Stay in Burns Patients in Jakarta Islamic Hospital Cempaka Putih

Introduction: Early tangential excision (TE) and split-thickness skin graft (STSG) have increased the outcome in burn patients treated at specialized burn centers. This study was conducted to compare the length of stay (LOS) in burn patients undergoing early TE & STSG and delayed TE & STSG. Method: This is a retrospective cross-sectional study including 42 patients with varied burn degrees, and TBSA admitted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit. Patients were assigned to two study groups, the early TE & STSG group including 32 patients and the delayed TE & STSG group including 10 patients. All data were collected from the medical record and compared between two study groups. Result: The mean of LOS in a group with early TE & STSG was shorter (9.81±6.41 days) than LOS in the delayed TE & STSG group (15.80±5.67 days). The data of LOS between these groups were compared using an independent T-test. The LOS in the early TE & STSG group was significantly shorter than the delayed TE & STSG group (p=0.012). Conclusion: In patients with burn injuries, early TE & STSG is associated with a shorter length of stay than the delayed TE & STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.

Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review

Introduction: Pedicled flaps from infrahyoid, pectoralis major, and trapezius were commonly used for partial tongue reconstruction. Not until a free radial forearm flap was introduced. The flap is recommended for patients with tongue defects ≤ 50% because of its thinness, pliability, and long pedicle. This systematic review explores the functional and cosmetic outcomes of pedicled flaps from the neck region for patients who underwent partial tongue resection or hemiglossectomy. Method: A systematic literature searching was performed on PubMed, Medline, Scopus, Embase, and Cochrane. Keywords included were pedicled flap, neck flap, partial tongue resection, hemiglossectomy, and partial neck surgery. Inclusion and exclusion criteria were applied to the search results. Relevant studies were assessed for their methodological quality using appropriate instruments. Results: Four hundred and twenty-four articles were obtained from the initial literature search. The authors finally gathered 11 full-text articles comparing the pedicled neck flaps with free flaps for partial tongue resection reconstructions. Pedicled neck flaps, such as submental, infrahyoid, sternocleidomastoid, and supraclavicular artery island flap, are clinically relevant for hemiglossectomy reconstruction with comparable functional and aesthetic outcomes. Conclusion: Regional flaps would be a preferred technique in more difficult patients such as those with advanced age, poor nutrition, or multiple medical issues as they are not always acceptable surgical candidates for potentially prolonged microsurgery.

A Rapid Growth of Verrucous Carcinoma After Biopsy: Treatment and Reconstruction

Summary: An increasing amount of evidence from clinical and experimental studies suggests that biopsies, thought to assist with definitive diagnoses, may aggravate tumor progression. We present a case of fast-growing giant verrucous squamous cell carcinoma, observed two weeks following biopsy. A 38-year-old man presented with a nose tumor that recurred two weeks after a biopsy and debridement to remove a lesion that was thought to be an abscess. Wide excision was performed on the tumor, frozen sectioned; the defect was reconstructed with a two-step forehead flap. The rapid tumor growth observed in this case raises the question of whether biopsies or other interventions may accelerate the growth of malignant tumors. Verrucous squamous cell carcinoma is slow-growing with a predilection for oral and nasal mucosa and rarely metastasizes. The patient presented here is an unusual case, with a tumor rapidly growing within fifteen days. A two-staged paramedian forehead flap is the workhorse of nasal reconstruction. Even though the benefit of doing biopsies overall outweighs the potential side effects, further research is required to determine whether biopsies affect the progression of the tumor. Early differential diagnosis is also crucial, as it may affect the patient's plan of treatment and prognosis. Giant tumors on the facial area may cause a functional and cosmetic disturbance. A two-step forehead flap produces a satisfactory cosmetic appearance for the patient one-year post-procedure.