Audiometri Subjektif pada Anak

Free Flap pada WajahMuhamad Sidik Hasanudin

Pembimbing Utama : dr. Shinta Fitri Boesoirie, M.Kes., Sp.T.H.T.K.L(K)

REFERATBagian Ilmu Kesehatan Telinga Hidung Tenggorok - Bedah Kepala LeherFakultas Kedokteran Universitas PadjadjaranRumah Sakit Dr. Hasan Sadikin-Bandung201511Pendahuluan2Mathes SJ, Levine J. Muscle Flaps and Their Blood Supply. Dalam: Thorne C, Grabb WC, Smith JW, Beasley RW, penyunting. Grabb and Smith's Plastic Surgery.Edisi ke 6. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.Lalwani A. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery.Edisi ke 3. New York: Mcgraw-hill; 2011.Jewett B. Local Cutaneous Flaps and Graft. Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.2Pendahuluan3Mathes SJ, Levine J. Muscle Flaps and Their Blood Supply. Dalam: Thorne C, Grabb WC, Smith JW, Beasley RW, penyunting. Grabb and Smith's Plastic Surgery.Edisi ke 6. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.Lalwani A. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery.Edisi ke 3. New York: Mcgraw-hill; 2011.Jewett B. Local Cutaneous Flaps and Graft. Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.3Epidemiologi4Hatcher JL, Bell EB, Browne JD, Waltonen JD. Disposition of elderly patients after head and neck reconstruction. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1236-41.Trivedi NP, Trivedi P, Trivedi H, Trivedi S, Trivedi N. Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India. Indian J Plast Surg. 2013;46(1):82-6.Tarsitano A, Pizzigallo A, Fantini MP, Marchetti C. Can microsurgical reconstruction after oral cancer improve patient-reported health-related quality of life? A 5-year experience. Journal of Medicine & The Person. 2008;6(1):14-9.Salvatori P, Paradisi S, Calabrese L, Zani A, Cantu G, Cappiello J, et al. Patients' survival after free flap reconstructive surgery of head and neck squamous cell carcinoma: a retrospective multicentre study. Acta Otorhinolaryngol Ital. 2014;34(2):99-104.Anatomi Kulit5

Fisiologi Flap Kulit6Girod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010

7Zona Perfusi. Memelihara fungsi sel dan kelangsungan hidupnya. Sistem peredaran darah pada makrosirkulasi, kapiler, interstisial, dan tingkat seluler. Zona I - IV penting untuk flap dapat bertahan hidup. Free Flap manipulasi zona IGirod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010Wound Healing8

Faktor yang Mempengaruhi LukaUsia. NutrisiInfeksiSirkulasi (hipovolemia) dan Oksigenasi. HematomaBenda asingIskemiaDiabetesKeadaan Luka. Obat (steroid, antikoagulan, antibiotikBrunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz's Principles of Surgery, Ninth Edition.Edisi ke 8. New York: McGraw-Hill Education; 2009.Klasifikasi Flap9Lokasilokal, regional, jauh (distant) FREE FLAPSuplai vaskular aksial RandomRotationalTranspositionAdvancementPostauricular interpolationDesain Flap dan metode gerakan jaringanPivotal flapRotationalTranspositionInterpolatedAdvancementUni-or bipedicled advancementV-Y or Y-V advancementIsland advancementHinge

Jewett B. Local Cutaneous Flaps and Graft. Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.10

Pemilihan Jenis FlapSTSG (Split-thickness Skin Graft), FTSG (Split-thickness Skin Graft), PML (Pectoralis Major Lateral Flap), LAT (Latisimus), SCAF (Subclavicula Anterior Flap), DP (Deltopectoral Flap), ALT (Anterolateral Thigh Flap), TFL (Tensor Faciae Latae), RFFF (Radial Forearm Free Flap),TPF (Temporoparietal Fascial Flap)

Erovic BM, Lercher P. Manual of Head and Neck Reconstruction Using Regional and Free Flaps.Edisi ke 1. Verlag-Wien: Springer Vienna; 2014.10Indikasi Rekonstruksi dengan menggunakan Free Flap pada Kepala dan Leher11Girod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010.Evaluasi Pre operatifukuran dan luas defek, lokasi donorjumlah dan jenis jaringan yang akan didapatkan, persarafan, keuntungan dari sisi fungsional, angka keberhasilan, lamanya operasi, kemampuan operator, dan faktor status kesehatan pasien secara menyeluruh12Girod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010.Yap LH, Butler CE. Principle of Microsurgery. Dalam: Thorne C, Grabb WC, Smith JW, Beasley RW, penyunting. Grabb and Smith's Plastic Surgery.Edisi ke 6. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.

13Alat-alat untuk melakukan opersi operasi mikrovaskular.

Burkey BB, Schmalbach CE, Coleman JR. Microvascular Flap. Dalam: Papel ID, penyunting. Facial Plastic and Reconstructive Surgery.Edisi ke 3. New York: Thieme; 2011.Penanganan Intraoperatif 14Girod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010.Yap LH, Butler CE. Principle of Microsurgery. Dalam: Thorne C, Grabb WC, Smith JW, Beasley RW, penyunting. Grabb and Smith's Plastic Surgery.Edisi ke 6. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.Gooneratne H, Lalabekyan B, Clarke S, Burdett E. Perioperative anaesthetic practice for head and neck free tissue transfer - a UK national survey. Acta Anaesthesiologica Scandinavica. 2013;57(10):1293-300.Operasi Mikrovaskular15

Yap LH, Butler CE. Principle of Microsurgery. Dalam: Thorne C, Grabb WC, Smith JW, Beasley RW, penyunting. Grabb and Smith's Plastic Surgery.Edisi ke 6. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007.Prinsip-prinsip umum dari teknik bedah mikrovaskular :Jahitan tegak lurus menembus melalui tunika adventitia ke intima.Hindari memegang atau memanipulasi tunika intima.Hindari melewati beberapa jahitan.Saat menarik jarum harus mengikuti lengkungan jarum dengan sempurna.Melebarkan dan memvisualisasikan bagian dalam pembuluh darah menggunakan larutan saline yang telah diberikan heparin. Gunakan forsep yang halus untuk membuka lumen pembuluh darah Lakukan anastomosis sebelum reperfusi.Lepaskan klem pada vena yang pertama.Memeriksa anastomosis dengan menggunakan ekor benang yang panjang. Lakukan penjahitan tambahan bila terjadi kebocoran pada jahitan. Hindari melakukan jahitan tambahan pada anastomosis yang rembesGunakan larutan saline hangat dan papaverine untuk menutupi anastomosis setelah reperfusi untuk melebarkan pembuluh darah dan relaksasi bila spasme.16Burkey BB, Schmalbach CE, Coleman JR. Microvascular Flap. Dalam: Papel ID, penyunting. Facial Plastic and Reconstructive Surgery.Edisi ke 3. New York: Thieme; 2011.Perawatan Pasca Operasi 17Lalwani A. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery. Edisi ke 3. New York: Mcgraw-hill; 2011.Fujioka M. Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers. ISRN Plastic Surgery. 2013;2013(1):1-5.Suh JD, Kim BP, Abemayor E, Sercarz JA, Nabili V, Liu JH, et al. Reirradiation after salvage surgery and microvascular free flap reconstruction for recurrent head and neck carcinoma. Otolaryngol Head Neck Surg. 2008;139(6):781-6.Novakovic D, Patel RS, Goldstein DP, Gullane PJ. Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol. 2009;1(33):1-5.Jenis Free Flap:18Jewett B. Local Cutaneous Flaps and Graft. Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014.19

20FlapArteryVeinNerveRekonstruksiFlap FasiokutaneousLengan bawah radialRadialisVena radialis atau sefalikaSaraf kutaneous antebrakialis medial dan lateral Rongga mulut, lidah, palatum, hidung, wajah, scalp, bibir, faring, laring, faringoesofagealLengan bawah ulnarisUlnarisVena ulnaris atau sefalikaSaraf kutaneous antebrakialis medial dan lateralRongga mulut, lidah, palatum, hidung, wajah, scalp, bibir, faring, laring, esofagus servikalLengan atas lateralRadialis kolateral posterior Radialis kolateral postSaraf kutaneous posterior Rongga mulut, lidah, palatum, faring Paha lateralDeep femoralVena femoralisKutaneous femoralis lateral Rongga mulut, lidah, palatum, faringSkapular-paraskapularSubskapularSubskapular-Rongga mulut, lidah, palatum, faring, wajah, bibirFlap MiokutaneousRektus abdominisEpigastrik inferior profunda Epigastrik inferior profundaInterkostalis Dasar tengkorak, total glosektomiLatisimusSubskapularSubskapularTorakodorsalDasar tengkorak, scalpFree Flap yang Sering Digunakan pada Kepala dan LeherGirod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010.21FlapArteryVeinNerveRekonstruksiFlap OsteokutaneousFibulaPeronealPeronealKutaneous lateralRekonstruksi mandibulaRadiusRadialisRadialis or sefalikakutaneous antebrakialis medial dan lateralRekonstruksi mandibula dan mid-faceSkapulaSubskapularSubskapular-Rekonstruksi mandibula dan mid-faceKrista iliakaSikumfleksus iliaka profunda Sikumfleksus iliaka profunda-Rekonstruksi mandibula dan mid-faceFlap lain-lainJejunumCabang mesenterik superiorCabang mesenterik superior-Rekonstruksi faringoesofagealOmentumGastroepiploicGastroepiploic-Scalp Temporal-parietalSuperficial temporalSuperficial temporal-Tulang dan kartilago Free Flap yang Sering Digunakan pada Kepala dan Leher(lanjutan...)Girod DA, Tsue TT. Free Tissue Transfer. Dalam: Flint PW, Cummings CW, penyunting. Cummings Otolaryngology Head & Neck Surgery.Edisi ke 5. Philadelphia: Mosby/Elsevier; 2010.Sering digunakan untuk merekonstruksi kepala dan leher. Tipis, fasia yang lentur. memiliki potensi untuk memiliki rekonstruksi saraf reanastomosis saraf kutaneus. Umumnya digunakan untuk menutup defek intraoral, faring, dan defek kulit kepala dan leher22Fasia dan Fasiokutaneus Free Flap Flap Radius Lengan Bawah (Radial Forearm Flap) Flap Lengan Lateral (Lateral Arm Flap) Flap Paha Leteral (Lateral Thigh Flap) Flap Paha Anterolateral (Anterolateral Thigh Flap)Flap Fasia Temporoparietal (Temporoparietal Fascial Flap)Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil

23Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil24Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. PhilKarsinoma sel basal yang luas meliputi maksila kiri dan hidung. Penutupan defek menggunakan flap lengan bawah lateral25

25Tamimy MS, Rashid M, Islam MZ, Sarwar S-u-R, Aman S, Aslam A. A comparison of free transfer of radial forearm and anterolateral thigh flaps for head and neck reconstruction. European Journal of Plastic Surgery. 2009;32(2):95-102.26

Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil27Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. PhilKarsinoma sel skuamosa yang luas pada mandibula kiri. Dilakukan penutupan defek menggunakan flap paha anterolateral28

Tamimy MS, Rashid M, Islam MZ, Sarwar S-u-R, Aman S, Aslam A. A comparison of free transfer of radial forearm and anterolateral thigh flaps for head and neck reconstruction. European Journal of Plastic Surgery. 2009;32(2):95-102.29

Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil30Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil

Flap Fasia Temporoparietal (Temporoparietal Fascial Flap)31Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil

Flap Rektus Abdominis

32Flapmuskulokutaneus (Musculocutaneous Flap)Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil33

Flap rectus vertical. Flap rectus abdominis transversus bagian tengah dan bawah. Flap rectus toracoumbilikal. Flap gabunganr rectus torakoumbilikal dan vertical. Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil34Karsinoma sel skuamosa aurikula, mandibula dan skull base lateral. Free flap diambil dari rektus abdominis.

Flap Latissimus Dorsi 35 untuk merekonstruksi kulit kepala, tetapi kurang baik untuk defek dengan ukuran besarFlap GrasilisKegunaan utama mengembalikan fungsi fasial, dimana revaskularisasi dan reinervasi untuk mengembalikan aktivitas otot.

Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. PhilFlap Fibular Osteokutaneus (Fibular Osteocutaneous Flap)36Composite Free Flap

Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. Phil37

Flap osteokutaneous fibula pada rekonstruksi mandibulaWehage IC, Fansa H. Complex reconstructions in head and neck cancer surgery: decision making. Head & Neck Oncology. 2011;3(1):14-5.Osteocutaneous and Osteomusculocutaneous Iliac Crest Flaps38

Chepeha DB. Microvascular Free Flaps in Head and Neck Reconstruction Dalam: Johnson JT, Rosen CA, Bailey BJ, penyunting. Bailey's Head and Neck Surgery - Otolaryngology.Edisi ke 5. PhilSimpulan39Terima kasih40