PLASTIC SURGERY
PROF.BUCHARI KASIM,SpBP
DR.FRANK BIETRA BUCHARI,SpBP
MISUNDERSTANDING (1976) :
Assesment of patient :
N ature
G oal
E xpectation
L imitation
A lternative
R isks
SELECTION OF PATIENT
Minor Deformity
Max complaint
5
4
Psychosocial
3
Complaint
2
1 Major Deformity
Min complaint
0 1 2 3 4 5
Physical complaint
Rekonstruktif Aestetik
Jenis kasus :
1. Rural Plast. Surg.
2. Urban Plast. Surg.
( BK : 3rd Asean Congress of Plastic Surgery 1986 )
Ethiology :
1. Traumatic Injuries
2. Congenital Deformities
3. Neoplasm (Benign/Malignant)
4. Infection/Squele
5. Pure Aesthetic Complaints
PENERAPAN BEDAH PLASTIK
1. Ethiology Grade
{ D : e-burn gr@sulo }
ETIOLOGI
Anamnesis : Grade/Severity
SCALD I & II
FLAME II & III
ELECTRICAL III
CHEMICAL III
INHALATION respiratory
GRADE
Erythema
Blister
Pinprick ( - )
Grade 1-2
Thermal injury reaches epidermal
and dermal layers
The injured area is moist, with blister
formation
Grade 2-3
Progressive stasis zone necrosis and coagulation
necrosis of epidermis occur, dermis and deep layer
tissues of dermis are completely destroyed by
thermal injury. No blood flow can be found in the
necrotic area, the wound is pale
Electrical Burn
Cemical Burn
ESTIMATION OF BODY SURFACE AREA
Hands Palm = 1%
Lund & Browder Chart
Penilaian pada Anak:
Kepala : 14%
Tungkai kaki : 16%
Bagian lain sama dengan dewasa
Pada Bayi :
Kepala, lehar : 18%
Tungkai kaki : 14%
Bagian lain sama dengan dewasa
PATOFISIOLOGI
Increase
permeability
Interstitial tissue
Interstitial tissue
10 - 50 thn :
Grade 2 >15%
Grade 3 >3%
<10 & >40 thn :
Grade 2 10%
Grade 3
Wajah, tangan, kaki dan perineum
Melingkar pada daerah ekstremitas
Listrik
Trauma Inhalasi
Second and third degree burns >10% body surface area
(BSA) in patients <10 or >50 years old.
Second and third degree burns >20% BSA in other
groups.
Second and third degree burns with serious threat of
functional or cosmetic impairment that involve
face,hands, feet, genitalia, perineum, and major joints.
Third degree burns >5% BSA in any age group.
Electrical burns, including lightening injury.
Chemical burns with serious threat of functional
orcosmetic impairment.
Inhalation injury with burn injury.
Circumferential burns with burn injury.
Burn injury in patients with pre-existing medical
disordersthat could complicate management, prolong
recovery, or affect mortality.
Any burn patient with concomitant trauma (for example
fractures) in which the burn injury poses the greatest risk
of morbidity or mortality. However, if the trauma poses
the greater immediate risk, the patient may be treated in
a trauma center initially until stable, before being
transferred to a burn center.
MANAGEMENT
General/Medical Treatment :
Fluid Resusitation
Prevention infection
Local : Topical Antibiotic
Surgery :
a. Debridement
b. Excharatomy
c. Excicion + Grafting
d. Granulating Tissue + Grafting
PERTOLONGAN PERTAMA
ANAK :
2 CC X BB X % LUAS LB + KEBUTUHAN FAALI
KEBUTUHAN FAALI :
< 1 TAHUN : BB X 100 CC
1-3 TAHUN : BB X 75 CC
3-5 TAHUN : BB X 50 CC
The use of formal fluid resuscitation is
reserved for patients with burns involving
more than 15% to 20% TBSA.
The fluid administered should be lactated
Ringer (LR) solution is relatively hypotonic
and contains sodium, potassium,calcium
chloride, and lactate
It is important to remember that the
formula provides merely an estimate
of fluid requirements. Fluid should be
titrated to achieve a urine output of 30
cc/hr in adults and 1 cc/kg/per hour
in children
PERAWATAN LUKA
Inhalation burn
face neck
Respiratory distress
first 24 hours & 1-5 days
Intubation
TRAUMA INHALASI:
RIWAYAT TERBAKAR DIRUANG TERTUTUP
WAJAH DAN BIBIR OEDEMA
RAMBUT, ALIS MATA TERBAKAR
BULU HIDUNG TERBAKAR
ADA JELAGA KEHITAMAN DI LUBANG
HIDUNG
CURIGAI!!!!
I
Lakukan INTUBASI
Sistemic Antibiotic
Tetanus Prophylactic
Nutritional support :
Formula Curreri (24 hours caloric requirment)
Adult : 25 kilocal/kg BW + 40 kilocal % BSA
Child : 60-90 kilocal/kg BW + 35 kilocal % BSA
SURGERY
Debridement
Escharatomy
Prevention :
Position arm & leg
Thin
Grafting : STSG
Moderate
Silver Sulfadiazine
Cream in consentration of 1 %
Applied twice daily : open or close
Effective Gram + & Gram
Silver Nitrat (0,5 % solution)
Sulfanylon
COMPLICATION
Pulmonary Oedema
Gastrointestinal
33% Curling Ulcer
Infection : - Septichemi
- UTI
- Auricular chondritis
Late Complication
6 months 2 years
1. Contracture
2. Keloid
Burn injury destroys the bodys layer of
protection from the environment, and dressings
are needed to protect the body from infection
and minimize evaporative heat loss from the
body. The ideal dressing would be inexpensive,
easy to use, require infrequent changes, and
be comfortable.
Late complication Keloid
Finger contracture
Scald Burn (Grade 1-2)
3 minggu
GRADE 2
1,5 BULAN
Grade 3
3 bulan
GRADE 2
1,5 bulan
1 minggu 3 minggu 5 minggu
Mandibula
Maxilla
Zigoma
Nasal
1. MANDIBLE FRACTURE
Force mechanism
* Insp : - asimetri oedem !
* Palp : - bone continuity
- upper & lower jaw (MALLOCCLUSION + )
* Ro- : - Waters position (mento occip. view)
- Pan-oral view (PANOREX)
- CT Scan
* Th :
- Reduction & MM ficsation (wiring)
- Temporary fixation :
BARTONS BANDAGE
- Liquid/soft meal
- Oral hygiene
3. MAXILA FRACTURE
I. Maxila +
II. Maxila + III. Orbita +
Periform
Opertura Nasal Bone Nasal Bone
CRANIOFACIAL
UPPER LEVEL PIRAMIDAL NOE FX
DISJUNCTION
Nasal deformity
Avulsion Injuries
Hand Injuries