BEDAH PLASTIK

Dr. Jan Tumatar Ngantung, SpB,SpBP.

DIV. BEDAH PLASTIK, BAGIAN BEDAH FAKULTAS KEDOKTERAN

UNSRAT MANADO

Plastic surgery is an art form of an exacting disciplineWhose effectiveness often depends on a harmonious

Blend of medical science and art.

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

BUKU PEGANGAN

PLASTIK (INDONESIA)

PLASTICOS (YUNANI)

PLASTIQUE / PLASTIC (INGGRIS)

: To Mold / To Form.

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 kebijak-an utk menjadikan penampilan yg lebih baik / lebih sempurna, akan tetapi masih dlm ba-tas2 tertentu yg bisa diterima, sesuai variasi umur dan etnisnya, pada kondisi tubuh yang sehat, baik phisik maupun mental.

Definisi :

LEARN TO MAKE WINGS

LEARN TO FLY

CAKUPAN BIDANG BEDAH PLASTIK

● AGING PROCESS ● P. ESTETIK

` ● NON AGING PROCESS● BEDAH PLASTIK

● CACAT ● TRAUMA (L.BAKAR /

Maxilofacial Tr.)

● P. REKONSTRUKSI ● INFEKSI (NOMA) ● MUTILASI TUMOR ● BAWAAN LAHIR (Hypo-

spadia, Sumbing) ● TRANSEXUAL

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.

APLIKASI TANDUR ALIH KULIT

APPLIKASI TEHNIK PENJAHITAN

APLIKASI IMPLANT

APLIKASI DRESSING

OPERASI PLASTIK

● PLACING THE SCAR. ● PREPARING THE WOUND● STIETCHCRAFT● POST OPERATIVE CARE

PLACING THE SCAR.● RANDOM

● LANGER’S LINE

● NATURAL LINE ● WRINGKLE’S LINE

● GRS ANATOMI KLT

● TERSEMBUNYI ● GRS LIPATAN KLT

● TERTUTUP BAJU

● DLM BATAS RAMBUT

LANGER’S LINE

PREPARING THE WOUND

● Be harmfull.● More conservative approaach

on extensive wound.● Clean wound.

STIETCHCRAFT

CABUT BENANG

INSTRUMEN DASARBEDAH PLASTIK

NEEDLE HOLDER DESECTING FORCEPS SCISSOR SKIN HOOK

INSTRUMEN

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 degra-dasi 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

SUTURE ABSORPTION STRENGTH HANDLING KNOT REACTION

CAT GUT 1 MGG FAIR FAIR GOOD Moderate

DEXON “S” 2 MGG GOOD FAIR GOOD Min. to Mod.

VICRYL 3-4 MGG GOOD FAIR GOOD Min. to Mod.

PDS 3-6 BLN EXCELLENT FAIR to Good FAIR Minimal

SILK LONG-TERM GOOD Excellent Excellent Mod.To High

WIRE PERMANENT EXCELLENT Poor FAIR Minimal

NYLON LONG-TERM EXCELLENT GOOD FAIR Minimal

PROLENE PERMANENT EXCELLENT FAIR to Good FAIR Minimal

ETYBOND LONG-TERM EXCELLENT GOOD GOOD Moderate

COMPARISON OF SUTURE MATERIALS

JARUM

JARUM● EYE ● NON SWAGED

● SWAGED

● STRAIGHT● BODY ● LONGITUDINAL ● CURVE ● FULL (1/2)

● HALF(1/4)

● VERTICAL ● ROUND (TAPER) ● TRIANGLE

(CUTTING) ● FLAT SIDE

● POINT ● CONVENTIONAL CUTING ● REVERSE CUTTING

● SPATULLA ● BLUNT

TEN PRINCIPLESI. 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 patient’s 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 SPI-

RIT AND HELP THE MIND OF THE AFFLICTED.”

TERIMA KASIH

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

DIVISI BEDAH PLASTIK

BAGIAN BEDAH FK UNSRAT

MANADO

IMPLANT MATERIAL

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.

CONTOH : Bone. Cartilage. Dermis

Fascia. Fat. Muscle.

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 (VITALIUM, TITANIUM) TEXTILE (PROPLAST, TEFLON) PLASTIC (POLY URETHANE) FLUID (COLLAGEN, SILICONE) RUBBERY (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 menye-babkan 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