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"AbstrakDespite the advancement of bone reconstruction in the past decade, large bone defect remains a challenge for orthopedic surgery. As mesenchymal stem cells (MSCs) emerges as one of the possible treatment of these defects, we evaluate the effect of its transplantation, particularly in combination with hydroxyapatite-calcium sulphate pellets. Methods: Twenty eight rabbits were randomly assigned into four different treatment groups. Each group received a different type of grafts (Autograft, hydroxyapatite-calcium sulphate [HA-CaSO4], HA-CaSO4 combined with marrow aspirate, or HA-CaSO4 combined with 2x106 MSCs). One centimeter long bone defects were created then immediately fixated with mini plate-screw and two cerclage wires. It was followed by the graft transplantation. Callus thickness was measured from the x-rays taken at 4, 8, 12 week after transplantation by two authors working independently. At the end of the study, histological staining along with osteocyte index were obtained by sacrificing the rabbits. These data were analyzed by one-way ANOVA test.Results: At the fourth week, callus thickness showed significant difference (p = 0.018). Although statistically insignificant, callus in MSCs group at the eighth week seemed to be thicker than any other groups of intervention (p = 0.546). The MSCs group also tend to have a higher osteocyte index at the follow-up weeks.Conclusion: MSC transplantation on bone defect results in faster callus formation and tends to generate a thicker callus."

"Latar Belakang. Terapi baku emas dalam penutupan defek septum ventrikel (DSV) adalah pembedahan. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSV yang bersifat relatif kurang invasif. Tujuan. Mengetahui perbandingan hasil penutupan DSV perimembran, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter dengan prosedur pembedahan. Metode. Penelitian retrospektif analitik dengan data berupa rekam medis pasien anak dengan DSV perimembran yang datang ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2010-Desember 2013. Hasil. Sebanyak 69 kasus anak dengan DSV perimembran masuk dalam penelitian, terdiri dari 39 kasus dengan prosedur pembedahan dan 30 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (89,7% vs 96,7%, p=0,271). Prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (46,7% vs 7,7%, p < 0,001). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (8 hari vs 3 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Tidak ada perbedaan total biaya antara prosedur transkateter dengan prosedur pembedahan (Rp. 55.032.636 vs Rp. 58.593.320 p = 0,923). Simpulan. Prosedur penutupan DSV perimembran secara transkateter mempunyai efektivitas dan biaya yang sama dengan prosedur pembedahan dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek.

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Background. Surgery has become standard therapy for ventricular septal defect (VSD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude VSD.

Objectives. To compare efficacy, complication, length of hospital stay, and total cost of perimembran VSD closure procedure between transcatheter closure and surgery.

Methods. A retrospective analysis was performed on children with perimembran VSD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2010-December 2031. The patients received transcatheter closure or surgical closure. Data were obtained from medical record.

Results. A total of 69 perimembran VSD cases were included in study, consisted of 39 cases underwent transcatheter closure and 30 cases underwent surgical closure. The efficacy of both procedur were not statistically different (89.7% vs 96.7%, p=0.271). However, surgery procedure had more complication than transcatheter closure (46.7% vs 7.7%, p < 0.001). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (8 days vs 3 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had median total cost Rp. 55.032.636 as compared with Rp. 58.593.320 for surgery procedure (p =0.923).

Conclusion. Perimembran VSD transcatheter closure had similar efficacy and costs with surgical closure. Complication rate was lower, and the length of hospital stay was shorter."

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Latar belakang: Bovine jugular vein (BJV) conduit telah menggantikan fungsi homograft untuk prosedur operasi rekonstruksi right ventricle outflow tract (RVOT). Penelitan ini bertujuan melihat kesintasan jangka panjang pasien yang dilakukan rekonstruksi RVOT menggunakan BJV conduit. Metode: Total 58 BJV conduit yang dimplantasi di satu pusat jantung pada tahun 2010 hingga 2016. Karakteristik pasien serta evaluasi ekokardiografi didapatkan dari rekam medis. Peneliti melakukan analisa kesintasan terhadap luaran kardiovaskular yang terjadi. Luaran kardiovaskular berupa stenosis, regurgitasi, endokarditis serta operasi ulang. Hasil: Kesintasan selama tujuh tahun, pasien usia dibawah 24 bulan dan diatas 24 bulan terhadap luaran kardiovaskular sebesar 74,1% dan 87,1%. Usia subjek dibawah 24 bulan meningkatkan risiko terjadinya luaran kardiovaskular sebesar 1,18 kali. Kesintasan selama tujuh tahun terhadap luaran kardiovaskular untuk BJV conduit ukuran 12-14 mm dan 16-22 mm adalah 77%, dan 87%. Penggunaan ukuran 12-14 mm BJV conduit, meningkatkan kejadian luaran kardiovaskular sebanyak 1,13 kali. Kesimpulan: Usia dibawah 24 bulan dan penggunaan ukuran BJV conduit 12-14 mm yang meningkatkan risiko terjadinya luaran kardiovaskular, maka perlu dipertimbangkan operasi paliatif pada pasien agar dapat menggunakan BJV conduit yang lebih besar dikemudian hari.

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Backgrounds: Bovine jugular Vein (BJV) conduit have replaced homograft function for right ventricle outflow tract (RVOT) reconstruction. This study purpose was to study long-term survival patient who undergo RVOT reconstruction with BJV conduit. Method: A total of 58 BJV conduit implanted in one heart center in 2010 until 2016. We gathered subject characteristic and echocardiography findings from medical record. We performed survival analysis based on cardiovascular events as the outcome which were stenosis, regurgitation, infective endocarditis, and re-operation. Result: The seven-year cardiovascular events were: patients less than 24 mo (74,1%), more than 24 mo (87,1%), BJV 12-14 mm in diameter (77%), 16-22 mm (87%). Age less than 24 mo and BJV conduit 12-14 mm in diameter increase risk of cardiovascular events 1,18 times and 1,13 times. Conclusion: Age less than 24 mo and BJV conduit 12-14 mm in diameter increasing risk of cardiovascular events. Thus, palliative surgery needs to be considered, allowing the use of conduit with a larger diameter. 

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"Pendahuluan: Masalah fungsional dan kosmetik semakin meningkat akibat adanya defek pada area craniofacial termasuk mandibula yang membentuk bagian bawah wajah. Rekonstruksi mandibula bertujuan memberikan kemungkinan maksimal dari hasil fungsional dan estetik. Hasil yang optimal dari fungsi rekonstruksi mandibula adalah salah satu tujuan dari penggunaan teknik flap bebas fibula. Dengan bantuan dari perkembangan system proses komputer dalam desain dan pembuatan, operasi craniomaxillofacial dapat dilakukan dengan bantuan komputer melalui berbagai bentuk dan variasi tujuan. Dalam rangka menelaah kualitas dari penelitian yang telah tersedia dan memberikan informasi untuk pengambilan keputusan, kajian mengenai perbadingan operasi dengan bantuan komputer (CAS) dengan metode konvensional freehand (CFS) menjadi penting untuk dilakukan. Metode: Pencarian pustaka sistematis dilakukan pada pusat data PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, dan Scopus, mencakup semua studi dengan data utama yang membandingkan hasil akurasi, efisiensi, komplikasi, dan fungsional diantara kelompok CAS dan CFS. Risiko bias studi dinilai menggunakan Newcastle-Ottawa Scale (NOS). Meta-analisis dilakukan melalui Review Manager. Hasil: Enam belas studi kohort memenuhi kriteria eligibilitas dari 355 studi pada pencarian awal. Studi dengan hasil yang sama (akurasi, efisiensi, komplikasi, dan fungsional) dibandingkan antara kelompok CAS dan CFS. Sebanyak 13 studi menunjukkan hasil signifikan secara statistik pada penilaian efisiensi: waktu ischemia lebih singkat (-34.84 menit, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), total waktu operasi lebih singkat (-70.04 menit, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), waktu rekonstruksi lebih singkat (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), dan lama rawat inap yang lebih singkat(-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) pada kelompok CAS dibanding kelompok CFS. Kesimpulan: Kajian sistematis dan meta-analysis menunjukkan hasil yang lebih baik pada kelompok CAS dibandingkan dengan CFS yang signifikan pada hasil efisiensi, Namun beberapa studi melaporkan berbagai analisis statistik dengan berbagai parameter untuk kategori hasil komplikasi, akurasi, dan fungsional. Seluruh studi sepakat bahwa CAS memberikan manfaat yang lebih dibandingkan CFS, walaupun CFS masih dapat menjadi pilihan.

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Background: Major functional and cosmetic problems will arise from defects in craniofacial regions, including mandible which constructs the shape of lower third of the face. The aim of mandibular reconstruction is to achieve the best possible functional and aesthetic outcomes. The optimal return of mandibular bone function is one of the reconstruction goals using free fibular flap (FFF). With aid of the evolving computer processing system for design and manufacturing, craniomaxillofacial surgery can be conducted with computer-aided surgery in many forms and varied proposes. In order to evaluate the quality of available article and to provide information for decision-making, review of comparison between computer-aided surgery (CAS) and conventional freehand surgery (CFS) need to be evaluated.

Methods: A systematic search was conducted on PubMed, ProQuest, Cochrane Library, EBSCOhost, Wiley Library, Science Direct, and Scopus, including all studies with primary data that compared accuracy, efficiency, complication, and functional outcomes between CAS and CFS group. Risk of bias for included studies were assessed based on Newcastle-Ottawa Scale. Meta-analysis was performed in Review Manager.

Results: Sixteen cohort studies were included that meet the eligibility criteria from initial searches of 355 studies. Studies with the same outcome (accuracy, efficiency, complication, and functional) are compared in CAS and CFS group. Thirteen studies demonstrated statistically significant efficiency outcomes: shorter ischemia time (-34.84 minutes, 95% CI: -40.04 to -29.63; p<0.00001; I2=94%), shorter total operative time (-70.04 minutes, 95% CI: -84.59 to -55.49; p<0.00001; I2=77%), shorter reconstruction time (-41.86 minutes, 95% CI: -67.15 to -16.56; p=0.001; I2=93%), and shorter length of hospital stay (-2.98 days, 95% CI: -4.35 to -1.61; p=0.0001; I2=7%) in CAS group than CFS group.

Conclusion: Systematic review and meta-analysis demonstrated higher outcomes CAS group compared to conventional group significantly in efficiency outcomes. However, some studies performed diverse statistical analysis on several parameters for outcomes category such as complications, accuracy, and functional. All studies agreed that CAS group has higher benefits than conventional method, although the conventional method is still an option."

"[Pendahuluan:
Hydrofiber merupakan materi balutan luka yang memiliki kemampuan absorbsi dan memberikan suasana lembab yang baik, namun belum diketahui potensi kemampuannya sebagai hemostat. Penelitian ini bertujuan untuk melihat potensi kemampuan hemostasis hydrofiber.
Metode:
Studi eksperimental in-vitro dan in-vivo menggunakan kontrol dan randomisasi dilakukan pada 7 ekor tikus (in-vitro) dan 14 ekor tikus (in-vivo) Rattus novergicus strain Sprague-Dawley yang sehat dengan berat 200-300 gram. Pada penelitian in-vitro didapatkan 32 sampel darah 1mL. Pada 16 sampel kelompok perlakuan ditambahkan 5mg hydrofiber; 16 sisanya berfungsi sebagai kontrol. Waktu koagulasi dihitung dan dianalisis menggunakan independent t-test. Pada penelitian in-vivo subjek dikelompokkan menjadi 3 grup yang masing-masing terdiri dari 9 buah luka dan ditutup dengan hydrofiber, alginat atau kasa lembab salin. Selisih berat darah yang diserap tiap balutan dihitung dan dianalisis menggunakan uji Kolmogorv-Smirnov, sedangkan selisih luas area perdarahan dihitung dengan uji Anova (p<0.05)
Hasil:
Dari penelitian in-vitro didapatkan hasil tidak terdapat perbedaan antara waktu koagulasi sampel darah dengan hydrofiber dibandingkan dengan tanpa hydrofiber [p=0.119 (CI -7.47-62.28)]. Sedangkan pada penelitian kedua didapatkan hasil tidak terdapat perbedaan pada selisih berat [p=0.163 (CI 31.41-54.83)] dan selisih luas (p=0.788 (CI 2.83-3.28)] antara kelompok hydrofiber, alginate, dan kasa lembab salin.
Diskusi:
Hydrofiber tidak memiliki perbedaan dalam hal hemostasis bila dibandingkan dengan alginat dan kasa lembab salin yang sudah lama diketahui memiliki kemampuan hemostasis; dapat disimpulkan bahwa hydrofiber berpotensi memiliki kemampuan hemostasis., Background:
Hydrofiber is a highly absorbent dressing with its ability to promote wound healing. Because of its structure similarity with alginate, hemostatic property of hydrofiber is being questioned. This study was aimed to explore hemostatic property of hydrofiber.
Methods:
In-vitro and in-vivo experimental study was performed in healthy Sprague- Dawley rats weighing 200-300 gram. A number of 32 blood samples were collected from 7 animals for in-vitro study; 16 samples were added with hydrofiber, while the rest functioned as control. Coagulation time between hydrofiber and control were analyzed using independent t-test. The in-vivo study involved 27 deep dermal wounds that were divided into 3 groups where each group of wounds was covered with hydrofiber, alginate, and saline gauze dressing respectively. Amount of blood that was absorbed by each dressing were analyzed using Kolmogorv-Smirnov test, while bleeding surface area after dressing were analyzed with Anova test (p<0.05)
Results:
There is no significant difference in terms of coagulation time between hydrofiber and control [p 0.119 (CI -7.47-62.28)]. The amount of blood that was absorbed by each dressing [p 0.163 (CI 31.41-54.83)] and the bleeding surface area after dressing [p 0.788 (CI 2.83-3.28)] were also not significantly different between hydrofiber, alginate, and saline soaked gauze.
Conclusion:
Hydrofiber shows potential hemostasis property, as it has no difference in its profile of coagulation time and amount of absorbed blood with the profiles shown by alginate and saline soaked gauze.]"

"Defek tulang luas belum memiliki solusi memuaskan walaupun dengan kemajuan teknik operasi dan agen biologis terbaru. Penggunaan sel punca mesenkimal (SPM) menunjukkan proliferasi dan diferensiasi minimal pasca implantasi. Sekretom dapat menjadi alternatif SPM sebagai produk siap pakai dengan efek osteoinduktor yang poten. Penelitian ini bertujuan untuk mengetahui efek sekretom pada penyembuhan defek luas tulang panjang pada tikus Sprague Dawley (SD) secara radiologis dan histologis. Sebanyak 60 ekor tikus SD dibagi menjadi 5 kelompok yaitu kontrol, SPM, sekretom, SPM+sekretom, dan SPM+sekretom+BMP-2. Setelah 2 dan 4 minggu, dilakukan pemeriksaan radiologis dengan skor RUST (Radiographic Union Score for Tibial) dan histomorfometri dengan Image J (total kalus, area penulangan, tulang rawan, fibrosis, dan void). Pada berbagai pasase dan waktu, BMP-2 hanya terdapat dalam kadar yang sangat kecil di dalam sekretom. Pemberian sekretom lebih superior pada kelompok lain secara radiologis dan histomorfometris pada setiap waktu. Pemberian sekretom mengandung banyak faktor pertumbuhan dan sitokin yang dapat mempercepat dan meningkatkan penyembuhan tulang. Implantasi SPM xenogenik dapat memperpanjang proses inflamasi pada dan kombinasinya dengan sekretom memberikan efek toksistas terhadap penyembuhan tulang Sekretom, baik digunakan secara tunggal maupun kombinasi dengan SPM dan BMP-2 merupakan agen osteoinduktor baru yang poten dalam perbaikan tulang pada model tikus dengan defek tulang luas.

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Critical sized defect (CSD) has been a problem despite advanced surgical techniques and new biologic agent. Recent literatures have shown that bone marrow derived Mesenchymal Stem Cell (BM-MSC) proliferate and differentiate only in a small amount upon implantation. Meanwhile secretome which previously was considered as waste product during MSC culture, may now presents considerable advantages over living cells in terms of potency, manufacturing, storage, cost, and potential as a ready-to-go osteoinductor agent. The study aimed to determine the effect of secretome in the healing of CSD SD (Sprague Dawley) rat by radiographic and histologic analysis. A total of 60 SD-rat were divided into 5 groups including, control (normal saline), MSC, secretome, MSC+secretome, MSC+secretome+BMP-2. After 2 and 4 weeks, RUST (Radiographic Union Score for Tibia) and histomorphometric (callus, osseous, cartilage, fibrous and void area) evaluation using Image J are compared. Secretome group is superior to other group significantly in all parameters at all time. Implantation of xenogenic MSC might prolong the inflammation phase of bone healing while the MSC+secretome group suggest the toxicity effect decreasing the bone formation area. Secretome, whether used solely or combined with BM-MSC and BMP-2, is a novel, potent bone-healing agent for CSD in rat models."

"ABSTRAK Latar Belakang: Simple bone cyst (SBC) adalah tumor tulang jinak, berisi cairan.Tujuan utama terapi SBC adalah mendapatkan penyembuhan tulang, mencegahfraktur patologis, dan manajemen gejala khususnya nyeri. Terdapat berbagaimetode pengobatan SBC, namun saat ini masih kontroversial karena angkakesembuhan dan tingkat invasi operasi. Terapi injeksi perkutaneus steroidmerupakan metode operasi dengan tingkat invasi rendah sehingga penyembuhantulang dan luaran fungsional lebih baik. Metode: Total terdapat 10 pasien (6 laki-laki, 4 perempuan, rerata usia13 tahun)SBC yang terbagi dalam dua kelompok. 5 pasien (proksimal femur 3; proksimalhumerus 1; calcaneus 1) dilakukan terapi injeksi perkutaneus steroid dan 5 pasien(proksimal femur 2; proksimal humerus 2, radius 1) terapi kurease denganhidroksiapatit. Injeksi perkutaneus steroid dilakukan sebanyak tiga kali denganinterval waktu tiap satu bulan. Rerata follow up adalah 12-26 bulan. Evaluasipenyembuhan tulang dinilai secara radiologi dengan kriteria Chang dkk. Luaranfungsional dinilai berdasarkan skor MSTS.Hasil: Penyembuhan tulang komplit didapatkan pada kedua kelompok, namunsolid union lebih cepat terjadi pada kelompok terapi injeksi perkutaneus steroid. Luaran fungsional didapatkan nilai yang lebih baik pada kelompok injeksiperkutaneus steroid terutama pada bulan ke-3 (55%) dan ke-6 (84%) pasca operasiberdasarkan skor MSTS dibandingkan terapi kuretase dengan hidroksiapatit(bulan ke-3 47% dan ke-6 69,3%). Simpulan: Terapi injeksi perkutaneus steroid masih tetap menjadi pilihan utamametode terapi SBC dengan solid union lebih cepat, tingkat prosedur operasi invasi rendah, lebih mudah, efektif, dan aman.ABSTRACT Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The maingoals of the therapy are to get the bone healing, prevent pathological fractures, andmanagement of pain symptom. There are various methods of the SBC treatment, howeverstill remains controversial because of their healing rate and invasiveness of surgery.Steroid injection therapy is a surgical procedure with a low level of invasiveness so thatbetter bone healing and functional outcomes.Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were dividedinto two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1)performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2proximal humerus, radius 1) performed curretage with hydroxyapatite therapy.Percutaneous steroid injection was performed three times at intervals of each month. Themean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed byChang criteria and the functional outcome by MSTS score.Results: Complete bone healing was found in both group, but solid union occurred fasterin steroid injection theraphy group. The functional outcomes found better value in thesteroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) thancurettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) postoperation based on MSTS score.Conclusions: Percutaneus steroid injection therapy is still the main choice of SBCtreatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe."

"Latar Belakang: Rekonstruksi pada defek tulang kritikal masih merupakan tantangan yang besar untuk seorang ahli bedah plastik rekonstruksi. Selama ini, baku emas untuk menangani kasus defek tulang tersebut adalah menggunakan autologous bone graft, namun terdapat beberapa kekurangannya seperti morbiditas pada lokasi donor, pemanjangan waktu operasi, donor yang terbatas, dan pemajangan waktu rawat. Mencoba mengatasi kekurangan tadi, muncullah rekayasa jaringan tulang yang memberikan hasil yang menjanjikan dalam regenerasi jaringan tulang biologis yang baru. Beberapa penelitian hewan sebelum, menunjukkan bahwa implantasi secara ortotopik dan ektopik dapat memberikan hasil yang cukup baik dalam regenerasi tulangMetode: Telaah sistematis dilakukan pada Pubmed/MEDLINE, Cochrane Library, dan WHO ICTRP, termasuk semua studi dengan data primer untuk rekayasa jaringan tulang menggunakan kalsium fosfat sebagai bahan rangka, studi pada defek tulang kritikal, baik uji klinis acak terkontrol maupun tidak pada manusia dan hewan. Luaran yang dinilai adalah pembentukan tulang baru yang membandingkan implantasi secara ortotopik (intraperiosteum) dan ektopik (intramuskular). Studi ini menggunakan SYRCLE’s tools untuk menilai risiko bias studi pada hewan.Hasil: Didapatkan lima studi hewan yang memenuhi kriteria eligibilitas dari total 80 studi yang diinklusi pada telaah ini. Dicantumkan karakteristik demografis dari masing-masing studi. Studi yang memiliki luaran klinis yang sama (% area tulang dan % kontak) dibandingan antara implantasi ortotopik dan ektopik. 2 studi menunjukkan bahwa implantasi secara intramuskular menggunakan kerangka yang sudah ditambahkan BMSC memberikan hasil yang baik pada pembentukan jaringan tulang baru. Kerangka kosong tidak menunjukkan adanya pembentukan tulang. Penambahan BMP-2 sebagai factor pertumbuhan dapat meningkatkan osteogenisitas baik pada implantasi ortotopik maupun ektopik.Kesimpulan: Implantasi ortotopik dapat menginduksi pembentukan tulang baru lebih baik daripada implantasi ektopik. Menggunakan kerangka yang ditambahkan BMSC serta BMP-2 pada implantasi intramuskular memberikan hasil yang baik untuk pembentukan tulang baru. Rekayasa jaringan tulang memungkinkan untuk dilakukan dengan implantasi secara ortotopik maupun ektopik

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Background: Critical bone defect reconstruction remains a major challenge in plastic reconstructive surgery. While autologous bone graft is still considered as the gold standard for treating critical bone defects, there are disadvantages like donor site morbidity long operative time, donor limitation, and extended hospital stay. In order to resolve them, bone tissue engineering has emerged in reconstruction medical studies, for they give promising result in regenerating new biological bone tissue. Previous animal studies have shown that implantating orthotopically and ectopically gave promising result in bone regeneration.

Methods: A systematic search was done on PubMed/MEDLINE, Cochrane Library, and WHO ICTRP, including all studies with primary data for bone tissue engineering using calcium phosphate as scaffold materials, studies in critical bone defects, RCT or non RCT in human studies or animal studies. Studies with outcome of new bone formation comparing orthotopic (intraperiosteum) implantation and ectopic (intramusculuar) implantation. We used SYRCLE’s tools for assessing risk of bias of animal studies.

Results: Five animal studies meet the eligibility criteria from a total of 80 studies are included for this review. Characteristics demography of each study are stated. Studies with the same outcome (bone area% and contact%) are compared in orthotopic and ectopic implantation. Two studies showed that intramuscular implantation using BMSC-seeded scaffold give promising result of new bone formation. However empty scaffold did not show any bone formation. Adding BMP-2 for growth factor can improved osteogenecity both in orthotopic implantation and ectopic implantation

Conclusion: Orthotopic implantation can induced new bone formation better than ectopic implantations. Using BMSC-seeded and addition of BMP-2 for intramuscular implantation give good result of new bone formation. Both orthotopic and ectopic (intramuscular) implantation are possible for bone tissue engineering"

"ABSTRAK

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Latar belakang : Rekonstruksi defek jaringan tulang merupakan tantangan utama yang dihadapi ahli bedah mulut dan maksilofasial. Elemen dasar yang dibutuhkan dalam suatu rekayasa jaringan adalah sel, scaffold matriks serta molekul stimulan growth factors . Bagaimana sifat mekanik dari scaffold kitosan/hidroksiapatit/kolagen produksi BATAN, Jakarta, belum pernah diteliti. Tujuan : Menganalisa sifat mekanik scaffold kitosan/hidroksiapatit/kolagen produksi BATAN, Jakarta, sebelum dan setelah direndam dalam simulated body fluid selama 8 hari. Metode : Menyediakan scaffold komposit kitosan/hidroksiapatit/kolagen, kemudian merendam scaffold didalam simulated body fluid pada suhu 37 0C, selama 8 hari. Kemudian masing ndash; masing scaffold diangkat dan dikeringkan pada suhu ruang pada hari 0, 2, 4, 6, 8. Untuk diuji kekuatan tekan dan kekuatan tarik. Data yang diperoleh diolah dan dianalisa. Hasil : Variasi nilai kekuatan tekan dan kekuatan tarik dapat dihubungkan dengan beberapa hal , ukuran spesimen yang tidak seragam, komposisi scaffold, ukuran pori scaffold yang tidak sama dan adanya degradasi dari kandungan polimer. Kesimpulan : Scaffold kitosan/hidroksiapatit/kolagen tidak memiliki kekuatan tarik dan kekuatan tekan sebelum dan setelah perendaman masing ndash;masing hari dengan simulated body fluid.

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ABSTRACTBackground The reconstruction of bone tissue defect is a major challenge for the oral and maxillofacial surgeon. The basic elements needed in a tissue engineering is a cell, scaffold matrix and stimulant molecules growth factors . How mechanical properties the scaffold of chitosan hydroxyapatite collagen production BATAN, Jakarta, has never been in research. Purpose Analyze the mechanical properties the scaffold of chitosan hydroxyapatite collagen from BATAN, Jakarta, before and after immersion in simulated body fluid for 8 days. Method Provides a composite scaffold of chitosan hydroxyapatite collagen, then soaking the scaffold in SBF at 37 0 C, for 8 days. Then each scaffold is removed and dried at room temperature on the day of 0, 2, 4, 6, 8. To test the compressive strength and tensile strength. The data obtained were processed and analyzed. Results Variations in the value of the compressive strength and tensile strength can be attributed to several things, the size of the specimen which is not the same, the composition of the scaffold, scaffold pore size is not the same and the degradation of the content polimer. Summary Scaffold chitosan hydroxyapatite collagen does not have differences the tensile strength and compressive strength before and after immersion with simulated body fluid."