BEDAH PLASTIK

Plastic surgery is an art form of an exacting discipline Whose effectiveness often depends on a harmonious Blend of medical science and art.

Dr. Jan Tumatar Ngantung, SpB,SpBP. DIV. BEDAH PLASTIK, BAGIAN BEDAH FAKULTAS KEDOKTERAN UNSRAT MANADO

BUKU PEGANGAN
MASTERY of PLASTIC and RECONSTRUCTIVE SURGERY
Mimis Cohen (Ed). Little Brown & Co, New York

TEXTBOOK of PLASTIC SURGERY

William C. Grabb and James W. Smith. (Ed). Little Brown & Co, Boston

TEXTBOOK of SURGERY.
Sabiston D. C, Lyerly H.K. (Ed) W. B. Saunders Company. Philadelphia

PLASTIK (INDONESIA) PLASTICOS (YUNANI) PLASTIQUE / PLASTIC

(INGGRIS) : To Mold / To Form.

Definisi :

BEDAH PLASTIK
Bedah plastik adalah suatu ilmu, cabang dari ilmu bedah, yang mengerjakan operasi revisi atau merubah bentuk serta hubungannya dgn struktur sekitar, dari setiap bagian pada tubuh manusia dgn memperhatikan kebijakan utk menjadikan penampilan yg lebih baik / lebih sempurna, akan tetapi masih dlm batas2 tertentu yg bisa diterima, sesuai variasi umur dan etnisnya, pada kondisi tubuh yang sehat, baik phisik maupun mental.

LEARN TO MAKE WINGS

LEARN TO FLY

CAKUPAN BIDANG BEDAH PLASTIK

P. ESTETIK ` BEDAH PLASTIK AGING PROCESS NON AGING PROCESS CACAT TRAUMA (L.BAKAR / Maxilofacial Tr.) INFEKSI (NOMA) MUTILASI TUMOR BAWAAN LAHIR (Hypospadia, Sumbing) TRANSEXUAL

P. REKONSTRUKSI

PRINSIP2 DASAR BEDAH PLASTIK

ANALISA :
WHAT DO I HAVE (THE PROBLEM) WHAT DO I WANT (THE TARGET) HOW DO I GET THERE (THE WAY)

MODALITAS UTAMA
Aplikasi tehnik penjahitan, yg didasari oleh proses penyembuhan luka secara alamiah. Pemanfaatan jaringan tubuh. (aplikasi tandur alih kulit / jaringan / komponen tubuh tertentu) Pemanfaatan bahan dari luar tubuh (Aplikasi Implant) Aplikasi dressing yg baik.

APPLIKASI TEHNIK PENJAHITAN

APLIKASI TANDUR ALIH KULIT

APLIKASI IMPLANT

APLIKASI DRESSING

OPERASI PLASTIK
PLACING THE SCAR. PREPARING THE WOUND STIETCHCRAFT POST OPERATIVE CARE

PLACING THE SCAR.

RANDOM
LANGERS LINE

NATURAL LINE TERSEMBUNYI

WRINGKLES LINE GRS ANATOMI KLT GRS LIPATAN KLT

TERTUTUP BAJU
DLM BATAS RAMBUT

LANGERS LINE

PREPARING THE WOUND

Be harmfull. More conservative approaach on extensive wound. Clean wound.

STIETCHCRAFT

CABUT BENANG

INSTRUMEN

NEEDLE HOLDER DESECTING FORCEPS SCISSOR SKIN HOOK

INSTRUMEN DASAR BEDAH PLASTIK

ABSORBABLE SUTURES
Suatu benang steril dgn bahan yg terbuat dari collagen derivat dari mammalia yg sehat. Suatu bahan Synthetic dari polymer yg dapat diabsorbsi oleh jaringan mammalia hidup.
SUTURE COMPOSITION

- Surgical Gut Submucosa (sheep intestine) - Dexon Poly-glycolic acid - Vicryl Co-polymer of glycolide - Polydioxanone (PDS) Polyester of p-dioxane

NONABSORBABLE SUTURE
Suatu benang steril dgn bahan yg tahan thp degradasi oleh jaringan mammalia yg hidup
SUTURE COMPOSITION

- Surgical Silk Silkworms Spun. - Nylon (Ethylon) Polyamide Polymer - Polypropylene (Prolene) Polymer of Propylene - Ethibond Polyesther Fibers - Surgical Stainless Steel Iron, Nickel, Crom

COMPARISON OF SUTURE MATERIALS

SUTURE CAT GUT DEXON S VICRYL PDS SILK WIRE NYLON PROLENE ETYBOND ABSORPTION 1 MGG 2 MGG 3-4 MGG 3-6 BLN LONG-TERM PERMANENT LONG-TERM PERMANENT LONG-TERM STRENGTH FAIR GOOD GOOD EXCELLENT GOOD EXCELLENT EXCELLENT EXCELLENT EXCELLENT HANDLING FAIR FAIR FAIR FAIR to Good Excellent Poor GOOD FAIR to Good GOOD KNOT GOOD GOOD GOOD FAIR Excellent FAIR FAIR FAIR GOOD REACTION Moderate Min. to Mod. Min. to Mod. Minimal Mod.To High Minimal Minimal Minimal Moderate

JARUM

JARUM
EYE
NON SWAGED SWAGED LONGITUDINAL VERTICAL STRAIGHT CURVE FULL (1/2) HALF(1/4) ROUND (TAPER)

BODY

TRIANGLE (CUTTING)
FLAT SIDE

POINT

CONVENTIONAL CUTING REVERSE CUTTING SPATULLA BLUNT

TEN PRINCIPLES
I. Understand a normal appearance, acquire a sense of beauty. It is important to identify what looks normal and what looks beautiful. II. Feel the sense of harmony among body structures Normal or beautiful means also that there are harmony between structures. III. Understand that it is difficult to beautify something that is already beautiful. One should know ones capability and should be frank to the patient. IV. Choose and decide the most effective and efficient methode. Should always keep up recent developments and inventions. V. Postpone work you can postpone. Understand the natural history of healing process (do not rush). VI. Respect the patients wish. The final decision is made by the patient. VII. Give respect to tissue. Work Cautiously and gently, use the finest material (do not do more harmful). VIII. Replace / reconstruct displaces / destroyed structered in their anatomical site. IX. Make the scar less conspicuous. Either due to very fine or hidden in special anatomical site. X. Share the devicit. If one wants to reconstruct a defect from adjucent tissue, it is enough to share the defisit

THE GOLDEN LAW

THE GOLDEN LAW

GASPAR TAGLIACOZZI (1597)

WE RESTORE, REPAIR AND MAKE WHOLE THOSE PARTS.WHICH NATURE HAS GIVEN, BUT WHICH FORTUNE HAS TAKEN AWAY NOT SO MUCH THAT THEY MAY DELIGHT THE EYE, BUT THAT THEY MAY BUSY UP THE SPIRIT AND HELP THE MIND OF THE AFFLICTED.

TERIMA KASIH

IMPLANT MATERIAL
Dr. Jan Tumatar Ngantung, SpB, Sp.BP.

DIVISI BEDAH PLASTIK BAGIAN BEDAH FK UNSRAT MANADO

IMPLANT
FUNCTION :
TO INSERT. EMBEDDED. FIXATION. PROSTHESIS.

TYPE.
EXOGENOUS. AUTOGENOUS.

BAHAN AUTOGENOUS
SIFAT dari AUTOGENOUS IMPLANT:
DIBUTUHKAN OPERASI TAMBAHAN. DIBUTUHKAN WAKTU TAMBAHAN. KEMUNGKINAN DIRESORBSI. PROBLEM PERGESERAN YANG BERLANJUT. TERSEDIA DALAM BENTUK TERBATAS.
Cartilage. Fat. Dermis Muscle.

CONTOH : Bone. Fascia.

BAHAN EXOGENOUS

SIFAT dari EXOGENOUS IMPLANT :

TAK BERUBAH SECARA PHISIK OLEH SOFT TISSUE. TAK BERUBAH SECARA KIMIAWI TAK MUDAH BEREAKSI TAK TIMBUL ALERGI / HYPERSENSITIVITAS / INFLAMASI BUKAN BAHAN YANG CARSINOGENIK. NON MAGNETIK DAN TAK BERKARAT. MUDAH DIBENTUK. MUDAH DISTERILKAN.

CONTOH :
METAL TEXTILE PLASTIC FLUID RUBBERY (VITALIUM, TITANIUM) (PROPLAST, TEFLON) (POLY URETHANE) (COLLAGEN, SILICONE) (COLLAGEN, SILICONE SOLID)

SILIKON
Asalnya adalah bahan silikat (silicon-dioxyde). Jenisnya : Industrial grade & Medical grade silicone. Medical grade silicone ada yang cair, gel, sheet/ bag, solid (soft / medium / hard), tergantung pd panjangnya rantai samping, makin panjang makin solid. Medical grade silicone cair ada yg injectable (MDX-4), ada pula yg non injectable (DC-360). Bedanya hanya pada very high purity. Sejak 1970 sudah dilarang penggunaannya utk disuntikan dlm jaringan tubuh manusia, karena banyak sekali menyebabkan reaksi inflamasi yg khronis membentuk silikonoma.

SIFAT2 SILIKON
Stabil terhadap panas. Reaksi tubuh minimal. Tidak melekat. Tidak diserang oleh tubuh (inert). Stabil terhadap waktu. Versatile.

MAMMARY IMPLANT

SALINE FILLED (PROFILE, SMOOTH SURFACE, VALVE)

MAMMARY IMPLANT

SILICONE GEL FILLED (ROUND, TEXTURE SURFACE)

MAMMARY IMPLANT

SALINE FILLED (PROFILE, TEXTURE SURFACE, VALVE)

ROUND TISSUE EXPANDER

RECTANGEL TISSUE EXPANDER

CRESCENT TISSUE EXPANDER

SILICONE BLOCK

SOLID SILICONE BLOCK

NASAL IMPLANT

SOLID SILICONE BLOCK

BELOW NASAL BASE OF THE FACE

SOLID SILICONE BLOCK

CHIN / MANDIBULAR AUGMENTATION

TESTICULAR IMPLANT

OTOPLASTY IMPLANT

SILASTIC ROD (TENDON SPACER)

SILICONE SHEET

SILICONE REACTION

INERT ?

REMOVAL OF THE RUPTURE SILICONE IMPLANT

KOLAGEN
Suatu produk protein yg merupakan serat jar ikat antar sel. Berasal dari jaringan kulit sapi (bovine collagen / zyderma). Yang dijinkan pemakaiannya untuk manusia sesuai FDA : - Zyderm I (3,5 % collagen sapi). - Zyderm II (6,5 % collagen sapi). - Zyplast (3,5% human collagen). - Atello-collagen (1%, 2%, 3,5%, 6,5% human collagen). Penggunaan utk rejuvenasi kulit, bukan utk augmentasi. Harus melalui prosedure test kulit (minimal 2 bln). Implan collagen akan diserap dlm 3 bln. Reaksinya ada yg cepat ada yg lambat, ada yg ringan dan ada yg berat.

TERIMA KASIH