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"Pendahuluan : Fraktur Midface merupakan fraktur yang sering terjadi dapat dapat memberikan efek baik dari segi estetik dan fungsi. Fraktur Midface yang tidak ditangani dengan baik akan merubah bentuk wajah menjadi tidak proporsional, salah satunya wajah yang menjadi lebih lebar dan panjang, terdapat depresi malar. Tata laksana dengan reposisi segmen fraktur dan fiksasi interna merupakan pilihan utama. Metode : Data yang diambil dari status estetik dengan menggunakan studi cross sectional pada pasien dengan fraktur midface sebelum operasi ORIF didapatkan di rekam medis, dan data setelah opeasi ORIF didapatkan dari follow up (4 years), kemudian dilakukan pengukuran dari proyeksi vertical, horizontal dan warm?s view. Hasil : Berdasarkan analisis fotografi dari proyeksi vertikal didapatkan 3 pasien memiliki proporsi muka yang baik, 3 pasien memiliki proporsi wajah yang baik dikarenakan perbedaan rata-rata. Berdasarkan analisis fotografi dari proyeksi horizontal didapatkan 3 pasien memiliki panjang muka yang berbeda, 2 pasien memiliki dystopia, 1 pasien memiliki enophtalmus. Berdasarkan analisi fotografi dari proyeksi worm?s eye didapatkan 4 pasien memiliki depresi malar eminensMengenai hasil estetika, didapatkan 4 pasien (66,6 %) puas dengan simetrisitas wajah setelah operasi. 2 pasien (33,3 %) mengeluhkan tidak puas dengan penampilan akhir setelah operasi. Kesimpulan : Untuk dapat mengevaluasi hasil operasi ORIF di Divisi Bedah Plastik Rumah Sakit Ciptomangunkusumo. Tidak hanya dibutuhkan registrasi data awal yang baik, tetapi juga dibutuhkan sarana dan fasilitas untuk mendapatkan evaluasi jangka panjang pada pasien terutama lokasi pasien yang jaraknya jauh dari lokasi rumah sakit.

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Background : Midface fracture is a fracture that often occurs may be able to give a good effect in terms of aesthetics and functionality. Midface fracture that is not handled properly will change the shape of the face become disproportionate, one of which face becomes wider and longer, there is a malar depression. The management of the segment repositioning fracture and internal fixation is the main option.

Methods : Data taken from the status aesthetic using cross sectional study in patients with fractures midface before surgery ORIF obtained in medical records, and the data after opeasi ORIF obtained from follow-up (4 years), then the measurement of the projected vertical, horizontal and warm's view.

Result : Based on the photographic analysis of the vertical projection obtained 3 patients have a good proportion of the face, 3 patients had good facial proportions due to differences in average. Based on the photographic analysis of horizontal projection obtained 3 patients had a different face long, 2 patients had a dystopia, 1 patient had enophtalmus. Based on the photographic analysis of the worm's eye projection obtained 4 patients had a malar depression eminens. Regarding the aesthetic results, obtained four patients (66.6%) are satisfied with simetrisitas face after surgery. 2 patients (33.3%) complained of is not satisfied with the final appearance after surgery.

Conclusions : To be able to evaluate the results of ORIF surgery in the Division of Plastic Surgery Hospital Ciptomangunkusumo. Not only the data registration needed a good start, but also the infrastructure and facilities needed to obtain a long-term evaluation of the patients, especially the location of patients that were located far from the location of the hospital."

"Pendahuluan: Fraktur yang mengenai midface akan menyebabkan gangguan fungsi baik fungsi mata maupun oklusi. Walaupun angka kejadian fraktur midface cukup tinggi, terdapat gangguan fungsional, dan membutuhkan biaya yang besar untuk tatalaksana menggunakan mini plate dan screw, tidak ada informasi mengenai hasil fungsional setelah tatalaksana fraktur midface. Metode: Data mengenai status fungsional pasien dengan fraktur midface sebelum operasi ORIF didapatkan dari data rekam medis dan data setelah operasi ORIF didapatkan dari pemeriksaan objektif dan subjektif. Status fungsional meliputi diplopia, gerakan bola mata, maloklusi, dan gangguan nervus fasialis dan nervus infraorbita. Hasil: Semua pasien yang dievaluasi menunjukkan perbaikan status fungsional setelah operasi ORIF. Kesimpulan: Pasien dengan fraktur midface yang telah menjalani operasi ORIF di Divisi Bedah Plastik Rumah Sakit Cipto Mangunkusumo menunjukkan adanya perbaikan pada diplopia, gerakan bola mata, oklusi, dan fungsi nervus fasialis dan infraorbita pada evaluasi jangka panjang.

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Background: Fractures involving the midface present more challenges due to the impairment on function both occlusion and visual function. In spite of the high number of occurrence, high impact to the impairment on function, and high cost in the treatment due to relatively expensive hardware required (mini plate and screw), there is inadequate information about the outcome after treating midface fracture.

Methods: Data on functional status of patients with midface fracture before ORIF surgery collected from medical records and data after ORIF surgery gathered objectively and subjectively. Functional status including diplopia, eye motility, cranial facial nerve impairment, infraorbita nerve impairment and malocclusion.

Results: All of the patients that have been evaluated was showing improvement in total functional status after treatment with ORIF surgery.

Conclusion: Midface fracture patients underwent ORIF surgery in Plastic Surgery Division, Cipto Mangunkusumo hospital, resulted in the recovery of eye motility function, diplopia, malocclusion and facial and infraorbital nerve impairment at longterm evaluation."

"Objective : To measure sensitivity and specificity diagnostic finding of convensional radiography in midfacial fractur performed at the Emergency room of Cipto Hospital and to evaluate its quality. Design and Main Outcome Measures: In this diagnostic testing 35 patients with clinical signs of midfacial fracture were investigated. All patient underwent radiography examination at the Emergency room (Anteroposterior, Lateral and reverse Waters view). X ray photo were expertised by a plastic surgeon and a radiologist, both of them without knowing the clinical conditions, and by the residen who received the patient at the ER. Then we compare radiographic and intraoperative findings as goal standard, The results were analyzed by statistical testing (for sensitivity, specificity, positive, negative predictive value). Results: The result showed that sensitivity and specificity varied between plastic surgeon, radiologist and residen but still high, and we noted that clinical examinations revealed to be very helpful in the assessment of an inadequate imaging fracture. Conclusion: Conventional radiography performe at the Emergency Room of Cipto hospital has high specificity although the quality is considered substandard. Clinical findings is still very important to distinguished uncertain fracture."

"Latar Belakang: Tujuan dari manajemen luka bakar adalah untuk menginiasi penutupan luka dini atau epitelisasi, dan untuk mencegah komplikasi akibat sepsis. Namun, dari praktik harian kami, diagnosis dini, terutama dalam menentukan kedalaman luka bakar pada fase akut, cukup sulit karena proses luka bakar terus berlangsung. Pengukuran objektif merupakan metode tambahan yang baik untuk membantu dokter mengevaluasi kedalaman luka bakar, misalnya pencitraan termal FLIR ONE. Tujuan penelitian ini adalah untuk mengevaluasi validitas FLIR ONE termografi sebagai alat untuk menilai kedalaman luka bakar, dan keandalan evaluasi klinis dan FLIR ONE yang dilakukan oleh ahli konsultan ahli luka bakar bedah plastik dan senior residen bedah plastik. Metode: Studi diagnostik yang dilakukan dari November 2019 - April 2020 di pusat kami. Dengan kriteria inklusi disebutkan kami melakukan pengamatan dua kali berdasarkan evaluasi klinis dan juga alat bantu FLIR ONE termografi pada luka bakar superfisial dan mid-dermal dalam waktu 48 jam pascalukabakar, dan hari 3-5 pascalukabakar, dengan outcome yaitu evaluasi klinis yang dilakukan oleh ahli bedah plastik konsultan luka bakar berpengalaman di hari ke 7. Data dikumpulkan dan menganalisis validitas dan realibilitas. Hasil: 43 sampel yang diambil dari laki-laki 15 (53,6%) dan perempuan 13 (46,4%), usia rata-rata 41,82 ± 13,52 tahun. Sebagian besar sampel adalah dari wajah 14 (32,6%), dan ekstremitas atas 11 (25,6%). Realibitas: ICC adalah T1 0,95 dan T3 0,98, menunjukkan angka baik hingga hari ke 7 hari pascalukabar. Kesenjangan evaluasi klinis antara kedua pengamat (konsultan luka bakar bedah plastic berpengalaman dan residen bedah plastik senior) di T1 adalah 6,9% dan di T3 adalah 9,3%. Tidak ada perbedaan yang signifikan dalam penilaian klinis baik di T1 (p = 0,82) dan T3 (p = 0,51) dan tidak ada perbedaan yang signifikan dalam pengukuran menggunakan alat FLIR ONE antara dua pengamat baik di T1 (p = 0,25) dan T3 (p = 0,91 ). Validitas: AUC dihitung pada T1 adalah 0,72 (95% CI: 0,563 - 0,880) p = 0,014 dengan titik batas T1 pada -0,8 ° C, menunjukkan diskriminasi moderat antara kategori penyembuhan yang re-epitelisasi <= 7 hari dan > 7 hari (sensitivitas 62,5%; spesifisitas 78,9%). Kami menggabungkan evaluasi klinis dan T1 dalam waktu 48 jam setelah luka bakar, penggunaan Flir ONE sebagai alat tambahan meningkatkan sensitivitas menjadi 58,33%, spesifisitas 98% dari evaluasi klinis saja. Probabilitas re-epitelisasi temuan klinis kedalaman luka superfisial dengan nilai T1 > -0,8 C memiliki probabilitas tertinggi (90,94%) untuk re-epitelisasi dalam waktu kurang dari sama dengan 7 hari. Kesimpulan: Penelitian ini menunjukkan validitas dan reliabilitas yang baik dari evaluasi klinis saja dan evaluasi klinis dengan FLIR ONE termografi dalam menilai kedalaman luka bakar. Titik potong kami dalam menentukan kedalaman luka bakar adalah -0,8 ° C, dengan hasil probabilitas yang baik untuk membedakan hasil epitelisasi berulang. Penelitian ini juga memberi tahu kami bahwa program residensi bedah plastik di rumah sakit pendidikan kami telah berhasil membangun kompetensi modul yang baik, dan reisden memiliki paparan yang cukup terhadap kasus luka bakar.

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Background: The aim of the management of burn wound is to initiate early wound closure or epithelization, and to prevent sepsis complication. However, from our daily practice, early diagnosis especially in determining the depth of burn wound in acute phase, is quiet difficult as burn wound process is running. Objective measurement may be great adjunct methods to to help clinician evaluating burn wound depth, as an example of FLIR ONE thermal imaging. The objective was to evaluate the validity of FLIR ONE thermal imager as an adjunct tool to assess burn wound depth, and reliability of clinical evaluation and FLIR ONE performed by senior resident of plastic surgery and experienced burn consultant plastic surgeon. Methods: This is a diagnostic study conducted from November 2019 – April 2020 in our center. With inclusion criteria mentioned we did observation twice based on clinical visual and also FLIR ONE thermal imaging on superficial and mid dermal burn within 48 hours post burn, and post burn day 3-5, outcome by clinical evalution done by experienced burn consultant plastic surgeon on day 7. Data were collected and analyze validity and realibility. Result: We had 43 samples taken from male 15 (53,6%) and female 13 (46.4%), average age 41.82 ± 13.52 years. As facial 14(32.6%), and upper extremities 11 (25.6%) as most samples use. Reliability: ICCs were T1 0.95 and T3 0.98, indicating excellent reliability up to 7 days after burn. The gap of clinical evaluation between both observers (experienced burn consultant and senior plastic surgery resident) at T1 is 6.9 percent and at T3 is 9.3 percent. There were no significant difference in clinical assessment both in T1 (p=0.82) and T3 (p=0.51) and no significant difference in measurements using FLIR ONE between two observers both in T1 (p=0.25) and T3 (p=0.91). Validity: the area under the curve was calculated at T1 was 0.72 (95% CI: 0.563 – 0.880) p = 0.014 with a cut-off point of T1 at -0.8°C, shows a moderate discrimination between healing categories re-epithelialization <= 7 days and > 7 days (62.5% sensitivity; 78.9% specificity). We combined clinical evaluation and T1 within 48 hours post burn, the use of Flir One as an adjunct tool increased the sensitivity to 58.33%, specificity 98% of clinical evaluation solely. the probability of re-epithelialization of clinical finding of superficial wound depth with T1 value of >-0.8oC had the highest probability (90.94%) to re-epithelialized in less equal to 7 days. Conclusion: This research showed good validity and reliability of clinical evaluation alone and clinical evaluation adjunct with FLIR ONE thermal imaging in assessment of burn wound depth. Our cut off point in determining the burn wound depth was -0.8° C, with good probability result to differentiate re-epithelialization outcome. This research told us that plastic surgery residency program of our teaching hospital had successfully established a good module competency, and resident had enough exposure to the burn cases."

"Deteksi dini kelainan vaskularisasi pada flap kulit memerlukan metode pemantauan yang konstan dan dapat diandalkan. Evaluasi melalui fotografi digital dapat menjadi solusi apabila didapatkan foto dengan spesifikasi seragam. Tujuan dari penelitian ini adalah mengembangkan prototipe studio foto portable yang mampu memberikan kualitas foto standard yang disebut sebagai Mini Mobile Medical Photo Studio (MiniMoPS) kemudian dilakukan analisa foto untuk memperoleh data dasar warna dan tekstur kulit hidup dan kulit kadaver. Pembuatan MiniMoPS dilakukan melalui studi literatur dan percobaan yang sesuai dengan kaidah foto studio. MiniMoPS kemudian digunakan untuk pengambilan sampel foto. Studi pendahuluan ini melibatkan 32 foto punggung tangan yang terdiri dari 16 foto kulit sehat dan 16 foto kulit kadaver. Hasil foto digital ini kemudian dianalisa menggunakan Adobe® Photoshop CS6 and ImageJ® freeware untuk mendapat nilai hue, saturasi, kecerahan, masing-masing komponen warna (merah, hijau dan biru) serta tekstur. Hasil foto tersebut menunjukkan nilai untuk kulit hidup adalah hue 33o, saturasi 13.75%, kecerahan 49.5%, Total Digital Number (TDN) 121.58 dan indeks tekstur 120 sementara kulit kadaver memiliki nilai hue 32.813o, saturasi 31.063%, kecerahan 68.188%, TDN 153.95 dan indeks tekstur 155.41. Hasil analisa menunjukkan kulit hidup memiliki warna lebih terang dan tekstur lebih homogen dibandingkan dengan kulit kadaver.

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Flap vitality monitoring remains a challenge for microvascular surgeons. Photo evaluation is potential but should produce a standard photo quality. This study propose the use of a portable photo studio called the Mini Mobile Medical Photo Studio (MiniMoPS) to produce consistent photographs and further analysed the photos to obtain a benchmark data of living and cadaveric skin colour and texture. The MiniMoPS was developed through a preliminary study to accommodate the basics elements of a photo studio. A pilot study was done, with 32 photographs of the dorsum of the hand, 16 from healthy samples and 16 from cadaveric samples. The digital photographs were analyzed using Adobe® Photoshop CS6 and ImageJ® freeware to obtain a quantification of hue, saturation, brightness, colour component (red, green and blue) and texture. Average value of living skin is hue 33o, saturation 13.75%, brightness 49.5%, Total Digital Number (TDN) 121.58 and 120 texture index while cadaveric skin has the following values; hue 32.813o, saturation 31.063%, brightness 68.188%, TDN 153.95 and 155.41 texture index. A significant difference was found between the two groups except for hue. Cut off points for TDN are generated with the range of 122–150. Analysis revealed that living skin gives a comparatively lighter colour and less coarse texture than cadaveric skin. The author proposed a TDN cut off point of 140 for validation in further studies."