Highlights Zygomatic complex fractures can involve surrounding structures and cause serious ophthalmic and aesthetic complications. Radiological investigations is very useful in diagnosing and planning the reconstruction surgery. The goal of fracture reconstructions is to restore the appearance and skeletal anatomy before injury instead of bone healing. Immediate reconstruction is recommended to prevent more complications. 3-D model reconstruction can provide better accuracy but takes longer time.

Total loss of columella causes significant aesthetic and functional deformities due to its important functions which provides assistance and extension to the nose pointer. Noma is described as one of the developed sources of total columellar loss, and is also contagious, with the ability to intensely damage facial tissues and immediate structures. However, the condition is predominantly suffered in Africa, with an estimation of 20 instances per 100,000 individuals. Furthermore, the reformation of a columellar disorder offers a complex process, due to the structural features of the location. A 24-year-old female patient with total columellar loss caused by Noma. We performed a two stage reconstruction. First, we used double nasolabial flaps to create a new columella. Second, we inserted costal cartilage and dermofat graft to support it. The double nasolabial flap demonstrated 100% survival. Both nasal airway and the final appearance showed functionally and cosmetically remarkable results. The nasolabial angle projected better than the preoperative measurement. The patient was satisfied. The patient was followed up until a year after surgery. The double nasolabial flaps combined with costal cartilage graft is one of the best surgical options to obtain astonishing columellar reconstruction.

Objective: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. Design: Observational cohort study. Setting: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. Patients, Participants: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. Interventions: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. Main Outcome Measure(s): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. Results: While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. Conclusion: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

Highlights:1. Decubitus ulcers can be caused by prolonged immobilization and constant pressure on the body.2. Decubitus ulcer patients were dominated by females, aged 46-65 years old, and the most common comorbidity history was patients with limb weakness. AbstractIntroduction: Continuous pressure on the area of the skin, especially in areas with bone protrusion can cause decubitus ulcers. Decubitus ulcers can occur to anyone, both children and adults, male or female, especially in people who experience daily immobility in a bed or wheelchair. Many treatments are performed in order to prevent decubitus ulcers to not becoming a more dangerous condition. This study aimed to determine the profile of pressure ulcers in Dr. Soetomo General Hospital Surabaya.Methods: This was a cross-sectional descriptive retrospective study. Secondary data were collected from 25 medical records of pressure ulcer patients in the Outpatient Clinic Department of Plastic Surgery Dr. Soetomo General Hospital Surabaya from January to December 2018. The data such as age, gender, risk factors, comorbidities history, and management were taken. The calculation was performed using Microsoft Excel.Results: The majority of patients with pressure sores at the Outpatient Clinic Department of Plastic Surgery Dr. Soetomo General Hospital Surabaya from January to December 2018 were dominated by female patients aged 46-65 years old (24%), with the most common risk factor being immobilization (96%). Patients’ history showed that most patients with decubitus ulcers suffered from a weakness in the limbs (13%). The most common treatment was wound bed preparation (46%) and education (46%).Conclusion: Pressure ulcers most often occurred in women aged 41-65 years or the elderly. Most patients experienced immobilization as a risk factor for pressure ulcers. These patients were dominated by those who had a history of illness with limb weakness. The therapy applied to patients with pressure sores was the preparation of wound beds and education to the patient.

Background: Fractures of the hard palate are infrequent. They are found in less then 10% of patients with midfacial fractures. They practically never occur in isolation and are usually part of alveolar process fractures or more complex midfacial fractures of the Le Fort type. Treatment of palatal fractures is planned and performed with the goal of restoring the transverse width of the palate, the anteroposterior projection of the maxillary arch, and the patient’s pretraumatic occlusal plane, as well as maintaining horizontal stability of the midface.Case Presentation: Reporting patient female 17 years old with panfacial fracture due to traffic accident. There was slight epidural haemorrhage on frontal area. The fractures are on upper face, midface, and lower face including the hard palate. We performed open reduction internal fixation on palate to correct the arch of the upper jaw. The other fracture site can be corrected easier. The approaches that we done are bicoronal, subsilier, and intraoral. The patient was successfully treated using bottom-up and outside-in sequence by accessing all facial injuries. Postoperatively, radiograph examination revealed good reduction and fixation of titanium plates, and physical examination revealed good functional and aesthetic outcomes.Conclusion: Palate fractures are relatively uncommon and are associated with significant rates of malocclusion and wound complications. These injuries are typically managed with plate fixation of the alveolar ridge with variable approaches to the palatal vault

Latar Belakang. TGF-β merupakan growth factor yang paling dominan dalam peningkatan sintesis kolagen, memiliki peran utama pada penyembuhan luka dengan menstimulasi fibroblas sehingga menimbulkan penyembuhan dan berperan serta dalam pembentukan parut, baik itu parut normal maupun abnormal seperti parut hipertrofik dan keloid. Penelitian ini bertujuan untuk mengukur kadar TGF-β pada fase penyembuhan luka.Metode. Penelitian eksperimental ini menggunakan randomized post test only control group design. Dua belas luka akut kulit tikus dirandomisasi menjadi dua kelompok, dimana kelompok 1 diambil spesimen pada hari ke-5 dan kelompok 2 pada hari ke-21 dan dilakukan pemeriksaan ELISA untuk mengukur kadar TGF-.Hasil. Pengukuran kadar TGF-β pada luka akut kulit tikus didapatkan jumlah yang meningkat secara signifikan dari hari ke-5 (fase inflamasi) ke hari ke-21 (fase proliferasi) dengan nilai p = 0,003. Kesimpulan. Terjadi peningkatan kadar TGF- pada akhir fase proliferasi atau awal fase remodelling. Hal ini menyebabkan peningkatan proliferasi fibroblas untuk mensintesis kolagen yang nantinya dapat menjadi parut hipertrofik dan keloid.

BACKGROUND: Skin wounds are a major challenge, such as full-thickness wounds that need a long time to heal. However, the addition of erythropoietin can accelerate the wound healing process. AIM: This study was aimed to determine the effect of topical erythropoietin administration on vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and epithelialization in the wound healing process. METHODS: This was randomized controlled trial. Full-thickness wounds were created on the back of each white rat. No treatment was administered in the control group (n=16), and topical erythropoietin was applied in the treatment group (n=16). The rats were euthanized on day 3 and day 6 post-surgery, respectively. The expression levels of VEGF, EGF, and microscopic epithelialization rate were examined. RESULTS: The level of EGF expression in the treatment group increased significantly on day 3 by 2.84 times compared to the control group and on day 6 increased to 4.89 times compared to the control group (p < 0.001). The level of VEGF expression in the treatment group on day 3 increased 2.18 times compared to the control group and on day 6 increased to 2.65 times compared to the control group (p < 0.001). Meanwhile, epithelialization in the treatment group on day 3 increased 1.3 times compared to the control group and on day 6 increased up to 7.62 times compared to the control group (p < 0.001). CONLUSION: Topical administration of erythropoietin could increase the expression of VEGF, EGF, and epithelialization in both early inflammatory and proliferative phases.

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