Referat Rekonstruksi trauma jaringan lunak wajah .pptx

rekon

1. Referat Rekonstruksi trauma jaringan lunak wajah Pembimbing : Dr. d r. Ali Sundoro , S p .B.P.R.E ., S ubsp .K.M . (K) d r. Arif Tri Prasetyo , M.Ked.Klin ., S p .B.P.R.E ., S ubsp .K.M . (K)., S.H.

2. Introduction Reconstruction of soft tissue craniofacial trauma represents a challenging and common problem All wounds will benefit from cleansing, irrigation, conservative debridement and minimal tension closure. Some wounds will benefit from local or regional flaps for closure; and a few wounds will need tissue expansion, or free tissue transfer. Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48. Petropolis C, Antonyshyn. Primary repair of soft tissue injury and soft tissue defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 44-56.

3. Diagnosis and patient presentation Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

4. Systematic evaluation of the head and neck Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

5. Diagnostic studies Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

6. Treatment and surgical techniques: Anesthesia for treatment Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

7. Anesthesia for treatment (2) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

8. Anesthesia for treatment (3) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

9. Forehead, anterior scalp to vertex, upper eyelids, glabella (supraorbital, supratrochlear, infratrochlear nerves) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

10. Lateral Nose, Upper Lip, Upper Teeth, Lower Eyelid, most of medial cheek (infraorbital nerve) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

11. Lower lip and chin (mental nerve) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

12. EAR (auriculotemporal nerve, great auricular nerve, lesser occipital nerve, and auditory branch of the vagus (Arnold’s) nerve) Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

13. General treatment considerations The ultimate goal is to restore form and function with minimum morbidity Irrigation and debridement Starts by irrigating the wound with a bulb syringe, or a 60 cc syringe with an 18-G angio catheter attached to forcibly irrigate the wound. Abrasions Result from tangential trauma that removes the epithelium and a portion of the dermis leaving a partial thickness injury If dirt and debris are not promptly removed the dermis and epithelium will grow over the particulates and create a traumatic tattoo that is very difficult to manage later Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

14. Traumatic tattoo Two basic types of traumatic tattoo: from blast injuries and from abrasive injuries. Wounds treated within 24 hours show substantially better cosmetic outcome. Some of the treatment: surgical excision, microsurgical planning, dermabrasion, application of various solvents such as: diethyl ether, cryosurgery, electrosurgery, and laser treatment with carbon dioxide, argon lasers, Q-switched Nd:YAG laser, erbium-YAG laser, Q-switched alexandrite laser, and Q-switched ruby laser. Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

15. Simple lacerations When immediate closure is not feasible  the wound should be irrigated and kept moist with a saline and gauze dressing A few well placed absorbable 4-0 or 5-0 sutures will help align the tissue and relieve tension on the skin closure. The temptation to place numerous dermal sutures should be avoided  excess suture material in the wound will only serve to incite inflammation and impair healing. The skin should be closed with 5-0 or 6-0 nylon interrupted or running sutures; alternatively, 5-0 nylon or monofilament absorbable running subcuticular. Any suture that traverses the epidermis should be removed from the face in 4–5 days. Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

16. Complex lacerations When soft tissue is compressed between a bony prominence and an object  will burst or fracture resulting in a complex laceration pattern and significant contusion of the tissue. Contused and clearly nonviable tissue should be debrided. Tissue that is contused, but has potential to survive should usually be returned to anatomic position. Limited undermining may be used to decrease tension and achieve closure. Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

17. avulsions Avulsed injuries that remain attached by a pedicle will often survive, and the likelihood of survival depends on the relative size of the pedicle to the segment of tissue it must nourish If there is any possibility that the avulsed tissue may survive  repaired. If venous congestion develops  treated with medicinal leeches until the congestion resolves If tissue is truly missing such that primary repair cannot be accomplished then a more complex repair with an interpolation flap or other reconstruction may be needed Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

18. Secondary intention healing Some wounds with tissue loss may be best treated by secondary intention healing The advantages : simple, it does not require an operation, the wound contraction can work to the patient’s advantage, and in certain situations, the cosmetic result can rival other methods of closure. Most wounds can be dressed with a semi-occlusive dressing, or petrolatum ointment to prevent desiccation. Common complications include: pigmentation changes, unstable scar, excessive granulation, pain, dysesthesias, and wound contracture Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

19. SCALP Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

20. EYEBROW

21. EYELID Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

22. Lacerations of lid margin require careful closure to avoid lid notching and misalignment The technique = placement of several “key sutures” of 6-0 nylon at the lid margin to align the gray line and lash line. The conjunctiva and tarsal plate are repaired and then the “key sutures” may be tied. The sutures are left long. Subsequent skin sutures are placed starting near the lid margin and working away. As each subsequent suture is place and tied and long ends of the sutures nearer the lid margin are tied under the subsequent sutures to prevent the loose ends from migrating towards the eye and irritating the cornea Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

23. EARS - HEMATOMA

24. EARS - LACERATION Simple lacerations should be irrigated and minimally debrided. Known landmarks such as the helical rim, or antihelix should be reapproximated with a few “key” sutures. Repair with 5-0 or 6-0 nylon skin sutures. The closure should be accurate with slight eversion of the wound edges, using vertical mattress sutures if needed. Any inversion will persist after healing and result in unsightly grooves across the ear. Suturing the cartilage is detrimental, may lead to necrosis and increased risk of infection. If cartilage must be sutured, an absorbable 5-0 suture is best. Antibiotic A period of prophylactic: recommended  prevent suppurative chondritis , especially for lager injuries those with degloved or poorly perfused Postoperative: after repair of simple lacerations of the ear.

25. Nose Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

26. NOSE avulsion Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

27. Repair of parotid duct

28. Facial nerve injury

29. MOUTH AND ORAL CAVITY Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

30. THE LIPS

31. NECK Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48.

32. PRINCIPLES OF SECONDARY SOFT TISSUE CORRECTION

33. Sequence of Revision

34. Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

35. SOFT TISSUE CONTOUR AUGMENTATION Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

36. upper lid ptosis Examination should include: the degree of ptosis and levator excursion a complete cranial nerve examination. a Bell’s phenomenon When considering the options for ptosis correction, measurements play an important role in determining the choice of operation and the amount of levator advancement required. Mild ptosis  external levator resection & advancement, or Müllerectomy . Severe ptosis with maintained levator excursion  levator advancement Severe ptosis with absent levator function  a frontalis sling procedure. Secondary correction of severe injuries should be delayed until the scar has remodeled 6–12 months post injury

37. NASAL DEFORMITIES

38. Although small, an isolated defect to the soft triangle can be significantly disfiguring & challenging. The helical rim bears a striking resemblance to the alar rim and can be used as a composite graft for defects under 1 cm. Helical rim free flaps are useful for the largest defects containing alar, soft triangle, and columellar subunits. Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

39. SCAR REVISION Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

40. RESURFACING TECHNIQUES: Resurfacing of Scarred Tissues Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

41. TRAUMATIC TATTOOING

42. EXCISIONAL TECHNIQUES

43. TISSUE EXPANSION A powerful tool that allows for reconstruction with local and regional tissue when redundant tissues are not available. Provides the best match for colour and texture compared to the native tissues. Following expansion, changes typically reverse over several months in the epidermis and over 2 years in the dermis. The expander should be inflated enough to fill the dead space without putting undue tension on the surgical closure. Expansion is usually carried out over several weeks with injection intervals of 1 or 2 weeks. Complications of expansion include implant exposure, infection, deflation, and underlying bone resorption. Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64.

44. CONCLUSIONS

45. references Mueller RV. Facial trauma: soft tissue injuries. In: Chang J, Neligan P. Plastic Surgery 3 rd ed. Washington: Elsevier; 2013. p. 23-48. Petropolis C, Antonyshyn. Primary repair of soft tissue injury and soft tissue defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 44-56. Petropolis C, Fialkov J. Secondary reconstruction of facial soft tissue injury and defects. In: Dorafshar AH, Rodriguez ED, Manson PN. Facial trauma surgery from primary repair to reconstruction. New York: Elsevier; 2020. p. 355-64. Ebraihimi A, Kazemi HM, Nejadsarvari N. Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser. Trauma Mon. 2014;19(3): 1-7. Ghosh A. Primary one stage reconstruction in complex facial avulsion injury. World J Plas t Surg. 2017; 6(3). Hontscharuk R, Fialkov JA, Binhammer PA, et al. Primary orbital fracture repair: development and validation of tools for morphologic and functional analysis. J Craniofac Surg. 2012;23(4):1044–1049. Mazzola RF, Mazzola IC. History of fat grafting: from ram fat to stem cells. Clin Plast Surg. 2015;42(2):147–153. Kim S, Matic DB. The anatomy of temporal hollowing: the superficial temporal fat pad. J Craniofac Surg. 2005;16(5):760–763. Hamilton JR, Sunter JP, Cooper PN. Fatal hemorrhage from simple lacerations of the scalp. Forensic Sci Med Pathol . 2005;1:26772. Sanyaolu LN, Farmer SE, Cuddihy PJ. Nasal septal haematoma. BMJ. 2014;349:g6075.

46. THANK YOU