https://jprjournal.com/index.php/jpr/issue/feed Jurnal Plastik Rekonstruksi 2021-04-23T06:16:43+00:00 Mohamad Rachadian Ramadan, M.D. editor@jprjournal.com Open Journal Systems <table style="height: 345px; width: 476px; background-color: #f8f8ff;"> <tbody> <tr style="height: 45px;"> <td style="width: 157px; padding-left: 30px; height: 45px;"><span style="color: #ff9900;"><strong>Journal Summary</strong></span><br /><strong><br />Title</strong><br /><strong>Initials</strong><br /><strong>DOI</strong><br /><strong>e-ISSN</strong><br /><strong>p-ISSN</strong><br /><strong>Editor-in-Chief</strong><br /><strong>Managing Editor</strong><br /><strong>First Published</strong><br /><strong>Frequency</strong><br /><strong>Publisher</strong><br /><strong>City &amp; Country</strong><br /><strong>Contact</strong></td> <td style="width: 308px; height: 45px;"><strong><br /><br />Jurnal Plastik Rekonstruksi</strong><br />JPR<br /><a title="Content Registration" href="https://search.crossref.org/?q=Plastik+rekonstruksi&amp;type-name=Journal+Article&amp;publisher-name=Jurnal+Plastik+Rekonstruksi&amp;container-title=Jurnal+Plastik+Rekonstruksi" target="_blank" rel="noopener">Prefix 10.14228 by </a><img src="https://ijain.org/public/site/images/apranolo/Crossref_Logo_Stacked_RGB_SMALL.png" alt="" width="60" height="14" /><br /><a title="ISSN Online" href="http://issn.pdii.lipi.go.id/issn.cgi?daftar&amp;1440210206&amp;1&amp;&amp;" target="_blank" rel="noopener">2089-9734</a><br /><a title="ISSN Print" href="http://issn.pdii.lipi.go.id/issn.cgi?daftar&amp;1432642827&amp;1&amp;&amp;" target="_blank" rel="noopener">2089-6492</a><br />M. Rachadian Ramadan, MD <br />Narrotama Tunjung H.,MD<br />March 2012 (On Going)<br />Twice a Year (March &amp; September)<br />Lingkar Studi Bedah Plastik Foundation<br />Jakarta, <a title="Wonderful Indonesia" href="https://www.indonesia.travel/gb/en/home" target="_blank" rel="noopener">Indonesia</a> <img src="https://vignette.wikia.nocookie.net/elderscrolls/images/d/d6/Indonesia_flag.png/revision/latest?cb=20140315065152" alt="" width="20" height="13" /> <br />editor@jprjournal.com</td> </tr> </tbody> </table> <p style="text-align: justify;"><strong><br />Jurnal Plastik Rekonstruksi<sup> </sup></strong>is a scientific international journal focusing on plastic, reconstructive and aesthetic surgery. The journal is peer-reviewed and open access, covering articles from all subdisciplines of plastic and reconstructive surgery, including burns, craniomaxillofacial, hand surgery, reconstructive microsurgery, and oncoplastic, wounds and experimental, external genital and aesthetic surgery. Basic science and experimental studies associated with plastic, reconstructive and aesthetic surgery also covered. All scientific article types are welcomed, including clinical case reports and studies, experimental research, ideas and innovations, viewpoints and surgical techniques.</p> <p style="text-align: justify;"><strong>Jurnal Plastik Rekonstruksi</strong> is indexed by the following abstracting and indexing services such as <a title="Google Scholar" href="https://scholar.google.co.id/citations?hl=en&amp;user=Qq3vR48AAAAJ&amp;view_op=list_works&amp;authuser=1&amp;gmla=AJsN-F5m-aAX2csNChV0DHPGNyzPA1eIChonODbs1K7Mkhn9l92SFlzkv1gPnxw3eraBTJyNL9hAyzBZPBoCtwaToB2-gc6j7Q" target="_blank" rel="noopener"><strong>Google Scholar</strong></a>, <a title="Sinta 4 Ristekbrin" href="http://sinta.ristekbrin.go.id/journals/detail?id=2054" target="_blank" rel="noopener"><strong>Sinta Ristekbrin</strong></a>, <a title="Portal Garuda" href="http://garuda.ristekbrin.go.id/journal/view/14768" target="_blank" rel="noopener"><strong>Portal Garuda</strong></a>, <a title="Lens" href="https://www.lens.org/lens/scholar/search/results?q=Jurnal%20plastik%20rekonstruksi&amp;page=0&amp;limit=10&amp;orderBy=%2Bscore&amp;filterMap=%7B%22source.title%22:%7B%22Jurnal%20Plastik%20Rekonstruksi%22:true%7D%7D&amp;dateFilterField=year_published&amp;previewType=SCHOLAR_ANALYSIS&amp;preview=true&amp;regexEnabled=false&amp;useAuthorId=false&amp;stemmed=true&amp;authorField=author" target="_blank" rel="noopener"><strong>Lens,</strong></a> <strong><a href="https://www.wizdom.ai/journal/jurnal_plastik_rekonstruksi/2089-6492" target="_blank" rel="noopener">Wizdom AI,</a></strong> <strong><a href="https://app.dimensions.ai/discover/publication?search_text=Jurnal%20Plastik%20Rekonstruksi&amp;search_type=kws&amp;search_field=full_search&amp;and_facet_source_title=jour.1364612">Dimension</a></strong>, <a href="https://www.worldcat.org/search?q=Jurnal+Plastik+Rekonstruksi&amp;fq=&amp;dblist=638&amp;fc=yr:_25&amp;qt=show_more_yr%3A&amp;cookie#%2528x0%253Aartchap%2Bx4%253Aartcl%2529%2C%2528x0%253Aartchap%2Bx4%253Adigital%2529format"><strong>WorldCat</strong></a>, and <a title="Scilit" href="https://www.scilit.net/journal/4172400" target="_blank" rel="noopener"><strong>Scilit</strong></a>. Since 2020, <strong>Lingkar Studi Bedah Plastik Foundation</strong> as the publisher of <strong>Jurnal Plastik Rekonstruksi </strong>has signed and implemented the <a title="Dora Declaration" href="https://sfdora.org/signers/" target="_blank" rel="noopener"><strong>DORA declaration</strong></a>. Currently, Jurnal Plastik Rekonstruksi is the official journal of <strong>Plastic, Reconstructive, and Aesthetic Surgery Training Program, Faculty of Medicine, Universitas Indonesia.</strong><br /><br />The plastic surgery community and researchers from any part of the world, from any socioeconomic level, are welcome to submit their study to JPR. The journals will always strive to be the open platform for plastic surgery research without any social, and politic barriers. The editorial boards sincerely hoped that the journals will serve as the catalyst to spread the science of plastic surgery to the world, improve patient safety, and increase surgical outcomes. JPR follows the overall purpose of the Lingkar Studi Bedah Plastik Foundation®, the supporting organization behind the journal, to teaches and sustain international plastic surgeons, to afford essential patient care, professional attitude and good ethical standards through education and research.<br /><br /></p> <h4><span style="text-decoration: underline; color: #3366ff;"><strong>Top 5 Most Downloaded Articles:</strong></span></h4> <p>1. <a href="https://www.jprjournal.com/index.php/jpr/article/view/29">Raymond et al. Medial Plantar Flap for Reconstruction of Heel Defect</a></p> <p>2. <a href="https://www.jprjournal.com/index.php/jpr/article/view/130">Ibadurahman et al. Is The ‘Rule of Tens’ a Necessary Screening Criteria in Cleft Lip Surgeries</a></p> <p>3. <a href="https://www.jprjournal.com/index.php/jpr/article/view/155">Martina et al. Mortality Analysis of Adult Burn Patients</a></p> <p>4. <a href="https://www.jprjournal.com/index.php/jpr/article/view/53">Samiadji et al. Synechia of Major Labia and It’s Operative Technique: A Case Report</a></p> <p>5. <a href="https://www.jprjournal.com/index.php/jpr/article/view/149">Utama et al. The Incidence of Palatal Fistula Postpalatoplasty in Children with Dental Caries: A Multi Centre Study</a></p> <h4> </h4> <h4><span style="text-decoration: underline; color: #3366ff;"><strong>Top 5 Most Viewed Articles:</strong></span></h4> <p>1. <a href="https://www.jprjournal.com/index.php/jpr/article/view/155">Martina et al. Mortality Analysis of Adult Burn Patients</a></p> <p>2. <a href="https://www.jprjournal.com/index.php/jpr/article/view/37">Mahandaru et al. The Effect Of Aloe Vera On Healing Process Of Incision Wound</a></p> <p>3. <a class="pkpStatistics__itemLink" href="https://www.jprjournal.com/index.php/jpr/article/view/178" target="_blank" rel="noopener"><span class="pkpStatistics__itemAuthors">Prasetya et al.</span> <span class="pkpStatistics__itemTitle">The Application of Moist Exposed Burn Ointment (MEBO) and Binahong Leaves in Treating Partial Thickness Burn : A Case Report</span></a></p> <p>4. <a class="pkpStatistics__itemLink" href="https://www.jprjournal.com/index.php/jpr/article/view/219" target="_blank" rel="noopener"><span class="pkpStatistics__itemTitle">Tetrapod Fracture: Surgical Anatomy Revisited As A Guide For 3D Reduction Using Carroll Girard T-Bar Screw</span></a></p> <p>5. <a href="https://www.jprjournal.com/index.php/jpr/article/view/35">Sukasah et al. Sidik-Chaula Urethroplasty and the Manset Flap for Non-Glanular Hypospadias Repair</a></p> https://jprjournal.com/index.php/jpr/article/view/321 Microsurgical Reconstruction During Covid-19 Pandemic Setting: A Systematic Review and Clinical Applications 2021-04-23T06:16:43+00:00 Parintosa Atmodiwirjo parintosa.atmodiwirjo@ui.ac.id Mohamad Rachadian Ramadan rachadianramadan@gmail.com Nadhira Anindita Ralena dita.ralena@aiesec.net Sara Ester Triatmoko saraester.triatmoko@gmail.com <p><strong>Introduction:</strong> 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.</p> <p><br /><strong>Method:</strong> 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.</p> <p><br /><strong>Results:</strong> 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.</p> <p><br /><strong>Conclusion:</strong> 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. </p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Parintosa Atmodiwirjo, Mohamad Rachadian Ramadan, Nadhira Anindita Ralena, Sara Ester Triatmoko https://jprjournal.com/index.php/jpr/article/view/322 Characterizing the Functional and Cosmetic Outcomes of Pedicled Neck Flaps in Patients Who Underwent Partial Tongue Resection: A Systematic Review 2021-04-23T06:16:29+00:00 Parintosa Atmodiwirjo parintosa.atmodiwirjo@ui.ac.id Nadhira Anindita Ralena nadhira.anindita@ui.ac.id Mohamad Rachadian Ramadan rachadianramadan@gmail.com Sara Ester Triatmoko saraester.triatmoko@gmail.com <p><strong>Introduction:</strong> 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.</p> <p><br /><strong>Method:</strong> 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.</p> <p><br /><strong>Results:</strong> 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.</p> <p><br /><strong>Conclusion:</strong> 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. </p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Parintosa Atmodiwirjo, Nadhira Anindita Ralena, Mohamad Rachadian Ramadan, Sara Ester Triatmoko https://jprjournal.com/index.php/jpr/article/view/316 Apert Syndrome: Case Series and Review of The Literature 2021-03-11T03:19:03+00:00 Silvina Silvina otodidakbanget@gmail.com Rizka Khairiza rkhairiza@gmail.com Muhammad Rizqy Setyarto riza_prihadi@yahoo.com <p><strong>Summary:</strong> Apert syndrome is a type 1 acrocephalosyndactyly, a rare syndrome characterized by the presence of multiple craniosynostoses, dysmorphic facial manifestations, and syndactyly of hand and feet. It affects 1:100.00 of birth and the second most common of syndromic craniosynostosis. Molecular genetic tests that identify the heterozygous pathogenic variant in FGFR2 genes - identical with Apert syndrome cost too high to be applicable in developing countries. Therefore, the diagnosis of Apert syndrome should be suspected from the clinical findings.</p> <p>Three cases from the Community of Indonesian Apert Warrior Group were collected. These series were based on medical and surgical records. We obtained the patient characteristic from the phenotypic manifestations only.</p> <p>We present cases of 6-years-old male, 2-years-old female, and 3-years-old female, respectively, with similar anatomical findings, such as skull shape abnormality, midface hypoplasia, intraoral disfigurement, and hands and feet deformities that resemble Apert Syndrome. Our series presents similar Apert syndrome characteristics, such as typical craniofacial dysmorphic with symmetrical syndactyly of both upper and lower extremities. These clinical findings are essential to establish an initial diagnostic of Apert Syndrome.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Silvina Silvina, Rizka Khairiza, Muhammad Rizqy Setyarto https://jprjournal.com/index.php/jpr/article/view/312 Application of Buccal Fat Pad as Adjunct Flap for Lateral Defect Closure in Palatoplasty 2021-03-07T10:48:41+00:00 Nurwahida Nurwahida nwh@gmail.com Connie Christina conniechris@gmail.com Malvin Jonathan bandungjuli2017@gmail.com <p><strong>Summary:</strong> Cleft lip and palate are the most widely recognized craniofacial congenital malformation. The buccal fat pad (BFP) can be utilized to close lateral fistulas at the time of palatoplasty due to its rich blood supply and simple accessibility. The aim is to report on the use of BFP as a pedicled flap in cleft palate surgery and to discuss promising results for this reconstructive concept. The case subject was a five-year-old male born with cleft lip and palate; the cleft lip was operated on 4 months old. The patient was operated on using Bardach's two flap palatoplasty techniques, and for the closure of the lateral lining defect, the BFP was used as a pedicled flap.</p> <p>After the surgery, no abnormality was found, including infection, graft loss, palatal fistulas, or cheek depression. All wounds were fully epithelialized. In palatoplasty, BFP is a safe and reliable method with a fast healing benefit.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Nurwahida Nurwahida, Connie Christina, Malvin Jonathan https://jprjournal.com/index.php/jpr/article/view/320 Nasal Aesthetic Evaluation Following Pre-Surgical Naso-Alveolar Molding Application: A Single-Blinded Cohort Retrospective Study in Indonesia 2021-04-12T02:46:14+00:00 Kristaninta Bangun kristaninta.s3@gmail.com Chaula Luthfia Sukasah chauladjamaloeddin@yahoo.com Jenisa Amanda Sandiarini Kamayana jenisa.kamayana@gmail.com Adi Basuki basuki_09@yahoo.com Jessica Halim jessiica.halim@yahoo.com Nur Eulis Pujiastuti Nahdiyat nep.nahdiyat@gmail.com Agatha Novell Harsanto agathanovell@gmail.com Arvin Pramudita arvin.pramudita@gmail.com <p><strong>Introduction</strong>: As a major facial aesthetic unit, the nose is one of the significant features in cleft lip and palate repair. The use of a naso-alveolar molding (NAM) device was known to help narrow the cleft gap and improve nasal aesthetics. This study aims to evaluate post-operative nasal morphology in unilateral cleft lip and palate patients who had used presurgical NAM, particularly in an established craniofacial centre in one of developing countries.</p> <p><strong>Methods</strong>: A cohort retrospective study was conducted at Cleft Craniofacial Centre, Cipto Mangunkusumo Hospital Indonesia, comparing the nasal symmetry in unilateral cleft lip patients with and without prior application of NAM (NAM and control group), twelve months following primary cheiloplasty. Differences between the cleft and normal side were assessed using standard basilar view photographs based on five points nasal measurements.</p> <p><strong>Results:</strong> A total of twelve patients were enrolled, six with a history of NAM application and six without (control). Overall nasal measurements confirmed a lower mean of differences in the NAM group compared to the control, showing statistically significant results in nostril height, nasal dome height, and columellar height (p &lt;0.05).</p> <p><strong>Conclusion:</strong> This study provides an insight that cleft lip patients with a history of NAM application had superior nasal symmetry compared to patients without presurgical NAM application 1-year post-cheiloplasty. Presurgical NAM application is recommended for patients with unilateral cleft lip and palate.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Dr. dr. Kristaninta Bangun, SpBP-RE(KKF), Prof. dr. Chaula Luthfia Sukasah, SpB, SpBP-RE(K), dr. Jenisa Amanda Sandiarini Kamayana, MRes, dr. Adi Basuki, dr. Jessica Halim, MRes, dr. Nur Eulis Pujiastuti Nahdiyat, MRes, dr. Agatha Novell Harsanto, dr. Arvin Pramudita https://jprjournal.com/index.php/jpr/article/view/309 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 2021-03-07T10:47:33+00:00 Gammaditya Adhibarata Winarno gammawinarno@gmail.com Aditya Wardhana aditya_wrdn@yahoo.com Sanjaya Faisal Tanjunga sanjayafaisal@gmail.com A. S Augiani augiani@gmail.com An’umillah Arini Zidna arinizidna@gmail.com <p><strong>Introduction:</strong> 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 &amp; STSG and delayed TE &amp; STSG.</p> <p><strong>Method:</strong> 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 &amp; STSG group including 32 patients and the delayed TE &amp; STSG group including 10 patients. All data were collected from the medical record and compared between two study groups.</p> <p><br /><strong>Result:</strong> The mean of LOS in a group with early TE &amp; STSG was shorter (9.81±6.41 days) than LOS in the delayed TE &amp; 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 &amp; STSG group was significantly shorter than the delayed TE &amp; STSG group (p=0.012).</p> <p><strong>Conclusion:</strong> In patients with burn injuries, early TE &amp; STSG is associated with a shorter length of stay than the delayed TE &amp; STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Gammaditya Adhibarata Winarno, Aditya Wardhana, Sanjaya Faisal Tanjunga, A. S Augiani, An’umillah Arini Zidna https://jprjournal.com/index.php/jpr/article/view/314 Nutrition Therapy in Type 2 Diabetic Burn Patient 2021-03-07T10:49:28+00:00 Dian Araminta Ramadhania araminta.dian@gmail.com Aditya Wardhana aditya_wrdn@yahoo.com Wina Sinaga wsigana5@gmail.com Yohannessa Wulandari yhon54@gmail.com Mulianah Daya mdayah4@gmail.com Lily Indriani Octovia lily.indriani@gmail.com <p><strong>Summary:</strong> Severe burn patients experience pronounced metabolic changes that caused hyperglycemia. Other existing metabolic conditions such as diabetes mellitus may worsen this condition. Early, adequate, and personalized nutrition therapy may result in better glycemic control and prognosis.A 44-year-old male with severe burn injury involving 27,5% total body surface area (TBSA) and type 2 diabetes mellitus (T2DM) was given early and diabetes-specific nutrition therapy to meet the recommended energy and protein needs. Lower carbohydrate contents and higher mono-unsaturated fatty acids (MUFA) were components of diabetes-specific nutrition therapy. Desirable blood glucose levels, a positive trend of albumin levels, and reduced inflammatory markers were achieved while being given this nutrition therapy. Sepsis was not diagnosed in this patient. The patient was discharged from the hospital after an improvement in clinical condition. Hyperglycemia commonly occurs in critically ill patients, especially with pre-existing T2DM. The provision of prompt and personalized nutrition therapy will improve clinical outcomes.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Dian Araminta Ramadhania, Aditya Wardhana, Wina Sinaga, Yohannessa Wulandari, Mulianah Daya, Lily Indriani Octovia https://jprjournal.com/index.php/jpr/article/view/310 The Difference in TBSA Estimation Between Emergency Room and Burn Unit in Second Tier Hospital in Central Jakarta 2021-03-07T10:48:18+00:00 Aditya Wardhana aditya_wrdn@yahoo.com Gammaditya A. Winarno gammawinarno@gmail.com Sanjaya F. Tanjunga sanjayafaisal@gmail.com An’umillah Arini Zidna arinizidna@gmail.com Amani S. Augiani augiani@yahoo.com <p><strong>Introduction</strong>: Burn TBSA estimation is essential to administer fluid resuscitation. There are some methods, including Rule of 9 and Lund-Browder Chart. This study aims to identify the difference in TBSA estimation in Emergency Room &amp; Burn Unit.</p> <p><strong>Method</strong>: We conducted a retrospective cross-sectional study in design. The Inclusion criteria are patients admitted to the Jakarta Islamic Hospital Cempaka Putih (JIHCP) burn unit between April 2015-September 2018, acute patients who have complete demographic data, complete TBSA estimation in the emergency room (ER) and burn unit (BU). Exclusion criteria are patients who do not have complete demographical data and incomplete TBSA estimation between the emergency room and burn unit. The estimation of TBSA in the emergency room is done by General Practitioner, while in the burn unit is done by Plastic Surgeon.</p> <p><strong>Result</strong>: Of all 160 patients admitted, 142 patients are eligible in the inclusion criteria. Most of it was adult males with an average of 28.3 years old, suffering a grade II burn injury caused by scald. There is a higher mean of TBSA estimation in the Emergency room with 15.83 (SD 12.21) compared to the Burn Unit with 12.92 (SD 12.00). The maximum TBSA overestimation in ER reaches 24% TBSA than BU, while the minimum is 0.5%. The Maximum TBSA underestimation in ER reaches 20% TBSA than BU, while the minimum underestimation is also 0.5%. On average, ER overestimates about 6.7% TBSA and underestimates about 2.8% TBSA compared to BU.</p> <p><strong>Conclusion</strong>: The emergency room tends to overestimate the TBSA, with an almost 3% difference in mean (p&lt;0.05). There is an occurrence of a maximum 24% TBSA overestimation while averaging 6.7% TBSA.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Aditya Wardhana, Gammaditya A. Winarno, Sanjaya F. Tanjunga, An’umillah Arini Zidna, Amani S. Augiani https://jprjournal.com/index.php/jpr/article/view/319 Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury 2021-04-01T03:02:18+00:00 Narottama Tunjung narottama.tunjung@ui.ac.id Nandita Melati Putri nalatri@yahoo.com <p><strong>Introduction:</strong> 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.</p> <p><strong>Method:</strong> 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.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion: </strong>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.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Narottama Tunjung, Nandita Melati Putri https://jprjournal.com/index.php/jpr/article/view/313 A Rapid Growth of Verrucous Carcinoma After Biopsy: Treatment and Reconstruction 2021-03-07T10:49:06+00:00 Angelica Gracia Budhipramono angelica.gracia@live.com Sweety Pribadi sweety_pribadi@yahoo.co.uk <p><strong>Summary:</strong> 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.</p> <p>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.</p> 2021-04-23T00:00:00+00:00 Copyright (c) 2021 Angelica Gracia Budhipramono, Sweety Pribadi