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"Proceedings from the first International Symposium on Primo Vascular System 2010 (ISPS 2010) with special topics on cancer and regeneration was held in Jecheon, Korea during September 17-18, 2010. Includes coverage of new study results that have better revealed the functional aspects of PVS, including its roles in the areas of regenerative medicine and cancer."

"Aneurisma intrakranial sakular terjadi akibat lemahnya dinding pembuluh darah karena hilang atau rusaknya tunika muskularis. Belum ada penelitian yang bertujuan memperkuat dinding aneurisma intrakranial dengan cara menumbuhkan kembali lapisan tunika muskularis. Penelitian-penelitian Mesenchymal Stem Cells (MSC) pada hewan coba berhasil menumbuhkan otot polos vaskular pada aneurisma aorta dan arteri karotis. Diharapkan MSC dapat berperan dalam pembentukan tunika muskularis pada aneurisma intrakranial.Penelitian ini bertujuan menganalisis hubungan pertumbuhan tunika muskularis aneurisma intrakranial pada hewan coba dengan perlakuan pemberian Bone Marrow Mesenchymal Stem Cells (BM MSC) dan manipulasi tekanan darah tikus, dengan penanda SM-actin dan calponin.Sebanyak 40 tikus Wistar diinduksi aneurisma selama 16 minggu. Modifikasi penurunan tekanan darah dan pemberian BM MSC pada minggu ke16, 18. Tikus dialokasi random ke dalam empat kelompok, yaitu hipertensi tanpa BMMSC, normotensi tanpa BMMSC, hipertensi dengan BMMSC, dan normotensi dengan BM MSC. Pada akhir minggu ke18 dilakukan nekropsi untuk pemeriksaan histopatologi, ekspresi SM-actin dan calponin terhadap aneurisma intrakranial, serta penilaian histopatologi pembuluh darah ekstrakranial.Sebanyak 27 tikus memenuhi kriteria sampel dengan 62 aneurisma intrakranial. Pada kelompok dengan pemberian BMMSC didapatkan 8 (53,33%) aneurisma memberikan ekspresi SMα-actin (p = 0,014; OR = 14,86) dan 8 (70,00%) ekspresi calponin (p = 0,008; OR = 7,78). Terdapat 4 (57,14%) aneurisma dengan ekspresi SMα-actin (p = 0,070, OR = 2,33) dan 7 (87,5%) dengan ekspresi calponin (p = 0,01, OR = 42,00) pada kelompok normotensi dengan pemberian BM MSC. Pada keempat kelompok tidak didapatkan perbedaan luas dan tebal tunika media arteri karotis (p = 0,616 dan p = 0,222) dan arteri iliaka (p = 0,452 dan p = 0,325). Pemberian BMMSC berhubungan dengan ekspresi SMα-actin dan calponin positif pada dinding aneurisma, menunjukkan pertumbuhan tunika muskularis. Faktor tekanan darah berhubungan dengan ekspresi calponin namun tidak berhubungan dengan ekspresi SMα-actin. Pemberian BM MSC tidak memberikan efek terhadap tunika media pembuluh darah ekstrakranial.

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Saccular intracranial aneurysm is a weak arterial wall caused by degeneration of tunica muscularis. There is still no research focused on strengthening intracranial aneurysm wall by restoring or regenerating tunica muscularis. The mesenchymal stem cells research in animal model had successfully regenerate vascular smooth muscle in abdominal aorta and carotid artery aneurysm. MSC is expected to have a role in regeneration of tunica muscularis in intracranial aneurysm.The objective of this study is to analyze the association between regeneration of tunica muscularis in intracranial aneurysm by BM MSC administration and blood pressure manipulation with SMα-actin dan calponin marker.Forty male Winstar rats were subjected to intracranial aneurysm induction for sixteen weeks. Then, the rats were randomly assigned into four groups, which were hypertension, normalized blood pressure, bone marrow mesenchymal stem cells BM MSC administration and hypertension group, and normalized blood pressure and BM MSC administration group. At the end of 18th week, all rats were sacrificed and evaluated for histopathology, immunohistochemistry (SMα-actin dan calponin), and extracranial artery structure.Twenty-seven rats with 62 aneurysms were eligible for sample criteria. Eight (53.3%) and fourteen (70.0%) aneurysms in group with BM MSC administration expressed SMα-actin (p = 0.014, OR = 14.86) and calponin (p = 0.008, OR = 7.78). In normotension and BM MSC administration group there were 4 (57.1%) aneurysm with SMα-actin expression (p = 0.070, OR = 2.33) and 7 (87.5%) with calponin expression (p = 0.01, OR = 42.00). There were no significant differences of wall area and thickness of carotid artery (p = 0,616 and p = 0,222) and iliac artery (p = 0.452 and p = 0.325) among four groups. In conclusion BM MSC administration was associated with SMα-actin and calponin expression on aneurysm wall, indicating regeneration of tunica muscularis. BM MSC administration was related to tunica muscularis regeneration, Blood pressure manipulation and BM MSC administration was related to calponin expression but was not related to SMα-actin expression. No effect of BM MSC administration was found on extracranial arteries."

"Kidney cancer : principles and practice is a comprehensive and interdisciplinary textbook that encompasses all clinically relevant aspects of the disease. This new edition has been extensively updated and includes brand new material covering the most recent developments in kidney cancer diagnosis and therapy. The user-friendly and clinically oriented content of the book guarantees that it will be of great interest to a wide range of medical professionals, and every effort has been made to ensure that contributions are both easy to understand and directly related to patient care. Content presentation departs from the usual dense chapter format featuring a lengthy series of paragraphs. Instead, each chapter contains several boxed sections, including one that summarizes essential "take home points" for the busy clinician and another that presents a patient-oriented case highlighting the clinical application of elements discussed in that chapter. In addition, accessible original images, illustrations, and diagrams (some in full color) are used to simplify particularly complex material. "

"Intensity modulated radiotherapy (IMRT) dan volumetric modulated arc therapy (VMAT) merupakan teknik radioterapi yang sering digunakan karena kompleksitasnya yang tinggi memungkinkan pemberian dosis yang maksimal pada target dengan meminimalkan dampak terhadap jaringan sekitar. Prosedur patient-specific quality assurance (PSQA) dibutuhkan untuk memastikan kesesuaian yang baik antara dosis perencanaan pada TPS dan dosis yang diterima saat pemberian pengobatan. PRIMO adalah perangkat lunak yang dapat melakukan PSQA dengan simulasi rekonstruksi berkas dynalog. Penelitian ini bertujuan untuk melakukan verifikasi dosis perencanaan awal dan hasil simulasi untuk memastikan dosis yang diberikan sesuai dengan yang direncanakan, serta mengevaluasi kriteria penerimaan yang telah ditetapkan sebelumnya. Sebanyak 5 data perencanaan dan berkas dynalog IMRT dan VMAT pasien kanker head and neck disimulasikan menggunakan PRIMO untuk mendapatkan distribusi dosis, kemudian dibandingkan dengan hasil perencanaan TPS untuk mendapatkan nilai gamma pass rate (GPR), percentage of agreement (PA) dan root-mean-square error (RMS) sehingga dapat dievaluasi. Perbandingan menunjukkan bahwa GPR 3%/3 mm dan 2%/2 mm memiliki hasil yang baik, dengan nilai rata-rata lebih besar dari 95% dan standar deviasi yang cukup kecil. Namun, evaluasi PA yang dilakukan menunjukkan hasil yang kurang memuaskan, banyak perbandingan struktur pada DVH yang menunjukkan nilai kurang dari 99% yang menjadi batas kelulusan verifikasi. Sedangkan RMS hampir tidak memiliki dampak langsung terhadap penyimpangan distribusi dosis yang dihasilkan dan memiliki nilai yang jauh lebih baik dari batas yang ditentukan. Metode verifikasi dosis menggunakan GPR dan RMS masih menjadi relevan karena mendapatkan hasil yang sesuai dengan rekomendasi, bahkan dapat menerapkan batas yang lebih ketat menggunakan kriteria GPR 2%/2 mm ≥95% dan RMS <1 mm. PA masih belum dapat menjadi evaluator tunggal, namun bisa menjadi pendukung dari parameter lainnya.

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Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) allow the delivery of maximum possible dose to the target while minimizing the influence on surrounding tissues. Patient-specific quality assurance (PSQA) is required to ensure good agreement between the planning dose by TPS and the dose received during treatment delivery. PRIMO can perform PSQA using dynalog files reconstruction simulation. This study aims to verify the simulation dose to ensure the dose delivered is in accordance with the planning dose, and to evaluate the previously established acceptance criteria. A total of 5 planning data and dynalog files for IMRT and VMAT head and neck cancer patients were simulated in PRIMO to obtain dose distribution, their results were compared to TPS planning results to obtain gamma pass rate (GPR), percentage of agreement (PA), and root-mean-square error (RMS) for evaluation. The comparison showed the 3%/3 mm and 2%/2 mm GPRs had good results, with average values greater than 95% and relatively narrow standard deviations. PA evaluation showed unsatisfactory results, with many comparisons on dose-volume histogram (DVH) having values less than 99% as the verification pass limit. Root-mean-square error (RMS) affected almost nothing in the deviation of simulated dose distribution and had better values than the specified limit. The dose verification method using GPRs and RMS was relevant because the evaluation results produced within the recommendations, stricter limits of GPR 2%/2 mm ≥95% and RMS <1 mm could be applied. The PA could not be the sole evaluator but complement other parameters for verification."

"ABSTRAKSampai saat ini, walaupun terapi akupunktur telah diakui, namun pertanyaantentang bagaimana rangsang pada titik akupunktur dapat menimbulkan efek terapimasih belum dapat dijawab secara lengkap dan memuaskan. Para ahli di duniaberbeda pendapat mengenai hal tersebut. Kim Bong Han adalah yang pertama kalimelaporkan telah menemukan bahwa ada struktur khusus yang terlibat dalammenghantarkan rangsang akupunktur, dan struktur yang dimaksud bukanlahpembuluh arteri, vena, limf, maupun saraf, namun merupakan struktur anatomibaru, yang diyakini sebagai jejaring meridian. Struktur tersebut kemudian diberinama Sistem Bong Han. Empat puluh tahun setelah Kim Bong Han menghilang,Kwang Sup Soh dkk. berhasil melakukan penelitian untuk menemukan kembaliapa yang telah ditemukan Kim Bong Han dan memberi nama baru menjadi SistemPrimo-Vaskular SPV .Penelitian ini dilakukan untuk membuktikan bahwa benar ada struktur SPV padapermukaan organ interna tikus. Berbeda dengan berbagai-penelitian terdahulu,penelitian ini mengambil sampel dari tikus yang sudah dibunuh. Penelitian inimerupakan penelitian desktiptif menggunakan hewan coba 3 ekor tikus Wistar.Keberadaan SPV dideteksi secara makroskopis dengan menyemprotkan TrypanBlue pada permukaan organ interna tikus. Struktur seperti benangterwarna biruyang merupakan ciri khas SPV ditemukan pada permukaan hati dan lambung.Setelah dibuat sediaan histologi dan diwarnai dengan H E terlihat strukturpembuluh berlumen, yang berisi struktur seperti serat/ pembuluh kecil dan unsursel. Gambaran histologi seperti ini berbeda dengan pembuluh arteri, vena, limf,maupun serat saraf, sehingga dapat disimpulkan bahwa struktur khusus yangberbeda itu memang ada. Karena itu, diperlukan penelitian lanjutan yang lebihdetil untuk mengeksplorasi berbagai unsur penyusun maupun fungsi strukturtersebut."

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""ABSTRACT"Until recently when acupuncture has already been used widely, the questionsabout how does acupuncture produce therapeutic effect cannot be answeredclearly. There are still dissenting opinions about it. Kim Bong Han was the first todeclare the existence of special new anatomical structures that were differentfrom arteries, veins, lymphs, and nerve fibers, which corresponded to theacupuncture meridian system. The structure was then called the Bong HanSystem. Forty years after the disappearance of Kim Bong Han, Kwang Sup Soh etall began the research to rediscover the Bong Han System. They succeeded tofind the structures and changed the name into Primo Vascular System PVS .This research was conducted to discover and prove the existence of PVS oninternal organ surface of rats. Different from previous reports, this research used3 scarificed Wistar rats. The existence of PVS in rats was detected by sprayingTrypan Blue on internal organ surface. Thread like structures in blue colorappeared on the organ surface of liver and stomach of two rats. The thread likestructures showed specific macroscopic characteristics of PVS. After beingprocessed into histological specimen and stained with H E, we could observethe histological appearance of vessels with fibers or small ducts and cells insidethe lumen. These appearances were different from arteries, veins, lymph vessels,and nerve fibers. In conclusion, the PVS does exist and needs further researchwith a specific design to identify the composition and function of the PVS."

"ASBTRACTPurpose: Splenic infarction may occur if the splenic branches are injured or ligated accidentally during gastrectomy. We used three-dimensional computed tomography (3D-CT) imaging to distinguish the vascular anatomy of the splenic hilum in individual patients, focusing on the splenic polar branches and the gastric branches.Methods: The subjects of this study were 104 patients who underwent computed tomography (CT) with intravenous contrast before gastrectomy. SYNAPSE 3D® (Fujifilm Medical, Tokyo, Japan) was used to generate the 3D-CT images. The total spleen volume and the area supplied by the superior polar artery (SPA) in each patient were estimated using the "liver analysis" function.Results: The SPA without the gastric branch (supplying only the spleen), the SPA with the gastric branch (supplying both the stomach and the spleen), and the posterior gastric artery (supplying only the stomach) were present in 14, 45, and 18% of the patients, respectively. The SPA supplied 12% of the total spleen volume on average; however, it supplied over 30% in two patients.Conclusion: We identified the vascular anatomy around the splenic hilum in over 100 patients. Based on our findings, we recommend preservation of the SPA when it is supplying a large area of the spleen. Preoperative 3D-CT analysis provides useful information to optimize safe gastrectomy."

"Latar belakang: Kanker serviks merupakan salah satu kanker yang paling banyak ditemui dengan angka kematian yang tinggi di seluruh dunia. Vascular Endothelial Growth Factor (VEGF) merupakan salah satu biomarker yang berfungsi sebagai faktor prognosis pada kanker serviks. Data ekspresinya terkait berbagai karakteristik kanker serviks yang ditemui pada hasil pemeriksaan Ultrasonografi (USG) dan Magnetic Resonance Imaging (MRI) pada pasien kanker serviks di Indonesia masih terbatas.Tujuan: Untuk mengetahui hubungan antara tingkat ekspresi VEGF, pemeriksaan USG, dan pemeriksaan MRI pada pasien kanker serviks.Metode: Studi diagnostik dengan metode cross-sectional dilakukan pada pasien kanker serviks yang datang ke RSUPN Cipto Mangunkusumo pada bulan September 2021 hingga Agustus 2022. Pasien yang didiagnosis kanker serviks yang belum mendapatkan terapi apapun dilakukan biopsi serviks dan pemeriksaan USG dan MRI. Pasien yang tidak dilakukan pemeriksaan USG dan MRI serta biopsi dikeluarkan dari penelitian. Pemeriksaan VEGF dilakukan pada jaringan serviks dan diinterpretasikan menggunakan H-score. Sensitivitas dan spesifisitas pemeriksaan VEGF dan USG dibandingkan dengan hasil MRI.Hasil: Terdapat 65 subjek yang diikutsertakan dalam penelitian (10 subjek stadium awal dan 55 subjek stadium lanjut). Tidak ada perbedaan ekspresi VEGF di antara pasien kanker serviks dihubungkan dengan stadium, tipe histologi, atau ukuran tumor yang berbeda. Ada interreliabilitas minimum antara pemeriksaan VEGF dan MRI. Ada interreliabilitas yang baik antara pemeriksaan USG dan MRI untuk menentukan stadium kanker, invasi parametrium, invasi kelenjar getah bening dan invasi mukosa vesika urinaria dan rektumKesimpulan: Tidak terdapat perbedaan ekspresi VEGF pada pasien kanker serviks dengan karakteristik yang berbeda. Hasil pemeriksaan USG dan MRI sebanding dalam menentukan stadium klinis pada pasien kanker serviks.

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Background: Cervical cancer is one of the most common cancers with a high mortality rate worldwide. Vascular Endothelial Growth Factor (VEGF) is a biomarker that functions as a prognostic factor in cervical cancer. Expression data related to various characteristics of cervical cancer found on the results of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) examinations in cervical cancer patients in Indonesia are still limited.

Purpose: To determine the relationship between VEGF expression levels, ultrasound examination and MRI examination in cervical cancer patients.

Methods: A diagnostic study using the cross-sectional method was conducted on cervical cancer patients who came to Cipto Mangunkusumo General Hospital from September 2021 to August 2022. Patients diagnosed with cervical cancer who had not received any therapy had cervical biopsies and ultrasound and MRI examinations. Patients who did not undergo ultrasound and MRI examinations and biopsies were excluded from the study. VEGF examination was performed on cervical tissue and interpreted using the H-score. The sensitivity and specificity of VEGF and ultrasound examinations were compared with MRI results.

Results: There were 65 subjects enrolled in the study (10 early-stage subjects and 55 advanced-stage subjects). There were no differences in VEGF expression among cervical cancer patients associated with different stages, histological types, or tumor sizes. There is minimal interreliability between VEGF and MRI examinations. There is good interreliability between ultrasound and MRI examinations for determining the stage of cancer, parametrial invasion, lymph node invasion and mucosal invasion of the bladder and rectum.

Conclusions: There are no differences in VEGF expression in cervical cancer patients with different characteristics. The results of ultrasound and MRI examinations are comparable in determining clinical staging in cervical cancer patients."

"Latar belakang: Morbiditas akibat duktus arteriosus paten (DAP) pada neonatus cukup bulan (NCB) cukup tinggi. Peran prostaglandin E2 (PGE2), trombosit (immature platelet fraction, IPF), dan vascular endothelial growth factor (VEGF) pada penutupan DA secara fungsional dan anatomis pada NCB belum banyak diteliti. Patofisiologi terjadinya DAP dapat memengaruhi tata laksana farmakologi dini yang belum terstandardisasi pada NCB. Penggunaan obat antiinflamasi nonsteroid seperti ibuprofen dimungkinkan dapat menghambat jalur sintesis prostaglandin dengan efek samping minimal.Tujuan: Mengkaji peran prostaglandin E2, VEGF, IPF, dan efek pemberian ibuprofen oral dalam proses penutupan DA pada NCB.Metode: Penelitian dilakukan di rumah sakit (RS) Sanglah Denpasar, RS Prima Medika Denpasar, dan RS Umum Daerah Wangaya Denpasar, dalam periode Maret sampai Agustus 2015. Penelitian terdiri dari 2 desain, pertama desain potong lintang pada pasien dengan DAP dan tanpa DAP secara consecutive sampling dan desain kedua uji klinis acak terkontrol ganda pada pasien DAP usia ≥ 48 jam. Pasien dengan DAP kemudian dimasukkan dalam uji klinis, dilakukan randomisasi untuk diberikan perlakuan ibuprofen oral dosis hari pertama 10 mg/kg, hari kedua dan ketiga 5 mg/kg atau plasebo. Pemantauan hemodinamik dan efek samping obat dilakukan selama pemberian perlakuan. Pemeriksaan ekokardiografi, PGE2, VEGF, IPF, dan kreatinin dilakukan pada hari pertama dan keempat pascapemberian perlakuan.Hasil: Terdapat 64 subjek yang diteliti pada desain pertama dan 32 subjek pada desain kedua. Rerata kadar PGE2 lebih tinggi pada kelompok dengan DAP dibanding tanpa DAP, sedangkan rerata kadar VEGF dan IPF tidak berbeda. Ibuprofen oral tidak terbukti menurunkan diameter DA pascaperlakuan, tidak terdapat perbedaan rerata diameter pada kedua kelompok. Terdapat hubungan positif sedang terhadap perubahan kadar PGE2 dengan perubahan diameter DAP pascaperlakuan. Tidak terdapat perubahan hemodinamik atau efek samping akibat pemberian ibuprofen oral atau plasebo pada NCB dengan DAP.Simpulan: Tingginya kadar PGE2 terbukti berperan dalam patensi DA pada NCB. Ibuprofen oral dosis 10 - 5 - 5 mg/kgBB tidak mengecilkan diameter DAP.

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Background: Serious morbidity impact due to patent ductus arteriosus (PDA) in full-term neonates remains high. The functional role of prostaglandin E2 (PGE2), platelet (immature platelet fraction, IPF), and vascular endothelial growth factor (VEGF) has not been studied in the closure mechanism of ductus arteriosus (DA). Understanding of pathophysiology of PDA may influence early pharmacological treatments, which have not been standardized in full-term neonates. The use of non-steroidal anti-inflammatory drugs such as ibuprofen can be beneficial as a pharmacological agent in enhancing the closure of PDA with minimal adverse effects.

Objectives: To evaluate the role of prostaglandin E2, VEGF, IPF, and the effect of oral ibuprofen in the process of DA closure in full-term neonates.

Methods: This study was conducted in Sanglah General Hospital, Prima Medika Hospital, and Wangaya Hospital Denpasar. The study consisted of two designs, the first was cross-sectional design in subjects with and without PDA using consecutive sampling and the second was double blind randomized controlled trial in full-term infant aged ≥ 48 hours. Subjects with PDA were randomized to oral ibuprofen and placebo administration, in which ibuprofen was given consecutively 10 - 5 - 5 mg/kg. All subjects underwent echocardiography, PGE2, VEGF, and IPF assays. Hemodynamics monitoring was evaluated during trial and adverse effect due to ibuprofen was recorded by measuring urine volume and plasma creatinine level.

Results: From March to August 2015, there were 64 subjects recruited for the first design and 32 subjects in the second design. The mean level of PGE2 was higher significantly in the group with PDA than non PDA group, while the mean levels of VEGF and IPF showed no difference. In the second design, oral ibuprofen showed no effect in reducing DA diameter after treatment. There were no differences in mean diameter of DA in both groups before and after treatments. There was moderate positive relationship between levels of PGE2 and the change of PDA diameter. There were neither hemodynamic changes nor adverse effect due to the administration of oral ibuprofen or placebo.

Conclusions: A high level of PGE2 appears to play a pivotal role in DA patency of full-term neonates. Administration of oral ibuprofen in 10 - 5 - 5 mg/kg schedule could not induce PDA closure in full-term neonates."

"Latar Belakang:Kanker payudara merupakan kanker dengan jumlah tertinggi pada perempuan di dunia. Meningkatnya angka ketahanan hidup pasien kanker payudara, membuat meningkatnya insiden terjadinya limfedema diakibatkan komplikasi dari Modified Radical Mastectomy(MRM). Belum diketahui apakah ada pengaruh dilakukannya flap jaringan di daerah diseksi kelenjar getah bening pada kanker payudara dengan perbaikan aliran limfe pada daerah tersebut. Tujuan dari penelitian ini adalah mengetahui adanya regenerasi limfatik pada flap jaringan pasien kanker payudara pasca mastektomi dan diseksi aksila.Metode Penelitian: dilakukan penelitian menggunakan desain kuasi eksperimen pada semua pasien kanker payudara yang dilakukan Modified Radical Mastectomy (MRM) dan diseksi aksila dengan menggunakan flap untuk mengurangi kejadian limfedema pasca operasi. Data diambil pada periode januari 2018 sampai Mei 2019Hasil : Terdapat 32 pasien kanker payudara pasca tindakan MRM dan diseksi aksila (16 pasien dengan flap dan 16 pasien tanpa flap). Dari 16 pasien yang dilakukannya flap, terdapat 14 pasien yang mengalami regenerasi limfatik (87,5%) dan 2 pasien yang tidak mengalami regenerasi limfatik (12,5%) pasca pemasangan flap jaringan pada pasien MRM. Terdapat hubungan antara penggunaan flap (p = 0,049 dengan OR 95%CI 5,43 (2,22-32,2)) dan usia (p = 0.042 dengan OR 95%CI0,2 (0,03-0,95))terhadap regenerasi limfatik.Kesimpulan : Terdapat hubungan yang berbeda bermakna antara flap jaringan dengan tanpa flap pada daerah diseksi kelenjar limfe dengan regenerasi limfatik pada daerah tersebut. Tidak terdapat hubungan berbeda bermakna antara komorbid, riwayat radiasi, indeks masa tubuh, stadium TNM, terhadap regenerasi limfatik.

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Background : Breast cancer is the most common cancer in women in the world. Increased survival rates of breast cancer patients, making the increased incidence of lymphedema caused by complications from Modified Radical Mastectomy (MRM). It is not known yet whether there is an effect of doing tissue flap in the area of ​​lymph node dissection in breast cancer with improved lymph flow in the area. The purpose of this study was to determine the presence of lymphatic regeneration in tissue flap of breast cancer patients after mastectomy and axillary dissection.

Research Method : Conducted a study using quasi-experimental design in breast cancer patients with MRM and axillary dissection alone or by using a flap to reduce the incidence of postoperative lymphedema. Data is taken from January 2018 to Mei 2019.

Results : There were 32 breast cancer patients after MRM and axillary dissection (16 patients with flaps and 16 patients without flap). Of the 16 patients who were replaced by flaps, 14 patients needed lymphatic regeneration (87,5%) and 2 patients who did not need lymphatic regeneration (12,5%) after tissue flaps procedure in MRM patients. There is a relationship between the use of flap (p = 0.049 with OR 95% CI 5,43 (2,22-32,2)) and age (p = 0.042 with OR 95% CI 0,2 (0,03-0,95)) to lymphatic regeneration.

Conclusions : There is a significantly different relationship between tissue flaps and without flaps in the area of ​​lymph node dissection with lymphatic regeneration in the area. There is no significant difference between comorbidities, radiation history, body mass index, TNM stage, and lymphatic regeneration."