KELAINAN KONGENITAL LIMFEDEMA PARUT (HIPERTROFIK & KELOID ...
Transcript of KELAINAN KONGENITAL LIMFEDEMA PARUT (HIPERTROFIK & KELOID ...
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KELAINAN KONGENITAL
LIMFEDEMA
PARUT (HIPERTROFIK & KELOID)
KONTRAKTUR
KULIAH ILMU BEDAH PLASTIK
Prof. Dr. David S Perdanakusuma, dr., SpBP-RE(K)
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Kelainan Kongenital
Craniofacial : CLP, Facial Cleft, Mycrotia
Hand : Syndactily, Polydactily, Macrodactily
Genital : Hypospadia, Vaginal increta
General : Nevus, Hemangioma,
Lymphangioma,Neurofibroma
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CLP
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Facial Cleft
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Microtia Daun telinga kurang terbentuk/kecil
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Terapi : operasi 3 tahap
Tahap 1
Menanam rangka dari tulang rawan (inserting cartilagenous)
Umur 7 tahun
Tahap 2
Elevasi flap yang didalamnya terdapat tulang rawan
(Elevation ear)
Tahap 3
Menyempurnakan kekurangan operasi sebelumnya
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Congenital Hands
1:600 children
Classification
1. Failure of Formation cleft hand, radial club hand
2. Failure of Differentiation
Syndactyly, camptodactyly
3. Duplication Polydactyly, mirror hand
4. Overgrowth Macrodactyly
5. Undergrowth Madelung’s deformity
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Polydactyly
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Hypospadia Meatus uretra eksterna terletak lebih proksimal dari yang normal
Tipe:
- glans
- corona
- penile
- penoskrotal
- skrotal
- perineal
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Klinis :
Penis bengkok
Terdapat chordee
Preputial dorsal berlebih
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Terapi :
Tahap I : release chordee
Tahap II : uretroplasty
Operasi satu tahap : release chordee + uretroplasty
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Hemangioma
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Hemangioma : kelainan pembuluh darah bawaan yang
tidak ikut aktif dalam peredaran darah umum.
Bukan neoplastik
Punya kecenderungan membesar
Merupakan mesodermal excess dari jaringan vaso
formative
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Macam-macam
Hemangioma Hemangioma kapiler
Hemangioma kavernosum
Hemangioma campuran
VASCULER MALFORMATION
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Terapi
Regresi spontan tanpa terapi
Pembedahan
Injeksi skleroting agent
Ligasi pembuluh darah
Kortikosteroid
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Nevus
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Limfedema
Oedema yang terjadi karena terganggunya aliran limfe
Primer
Sekunder : karena infeksi (filaria), pembedahan,
metastase tumor dan radiasi
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Terapi
Elastic compression
Operasi :- Charles : debulked + skingrafting
- Kondoleon : excising strips of
underlying muscle fascia
- Thompson : buried dermal flap
- Lymphangioplasty
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Scar/Parut Cacat alami akibat proses penyembuhan luka
Penyembuhan Luka :
Inflamasi
Proliferasi
Remodelling/Maturasi PARUT
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Parut Baik dan Tidak Baik
Kategori
Baik Tidak Baik
Lokasi Diantara 2 estetik unit Berada di dalam 2 estetik unit
Susunan Sejajar RSTLs Tegak lurus/berlawanan
RSTLs
Kedalaman Dangkal Dalam
Warna Sesuai warna kulit Hiperpigmentasi/
hipopigmentasi
Elevasi Rata Elevasi/cekung
Patologi Tidak ada Hipertrofik/keloid
Regio Rata, tidak mobil (paha,
lengan atas)
Mobil di area tekukan (siku,
lutut)
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Problem Parut
Parut Hipertrofik
Keloid
Kontraktur : linier dan difus
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HYPERTROPHIC SCARS KELOID
TIMBUL SEGERA SETELAH
PEMBEDAHAN
BELUM TIMBUL SETELAH BEBERAPA
BULAN
ADA MATURASI TIDAK ADA MATURASI
TERBATAS PADA DAERAH LUKA TUMBUH MELEWATI BATAS LUKA
UKURAN LESI SESUAI DENGAN
CEDERA
CEDERA MINIMAL BISA MENIMBULKAN
LESI BESAR
TIMBUL KARENA PERGERAKAN
TIDAK TERGANTUNG GERAK
BIASANYA MENYEBERANG
PERMUKAAN YANG BISA BERTEKUK
(JOINT, ABDOMEN, DLL)
AREA PREDILEKSI, JARANG
MENYEBERANG PERSENDIAN
ADA PERBAIKAN DENGAN
PEMBEDAHAN
PEMBEDAHAN SERING MEMBUAT
MENJADI LEBIH BURUK
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normal scar
Hypertrophic
scar
keloid
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PENCEGAHAN
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1. Menghormati jaringan
2. Hindari dead space
3. Hindari hematoma
4. Hindari kematian jaringan yang berlebih
5. Elektrokoagulasi yang halus
6. Mencegah kekeringan
7. Desinfektan tidak iritasi
8. Absorbable suture minimal
9. Adaptasi yang baik
10.Jahitan penunjang non absorbale suture
11.Simpul jangan terlalu kencang
12.Suasana lembab (moist)
13.Jahitan diangkat setelah kuat
14.Imobilisasi
Teknik Pembedahan Yang Baik
Mencegah terjadinya infeksi
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Surgery or trauma
Good surgical technique and wound management reduce the risk of scarring
Silicone gel sheeting
Silicone gel sheeting
Standard counselling
Hypoallergenic taping or silicone gel sheeting
Risk of scarring
Patient concerned?
yes risk risk Increased No risk PREVENTION OF SURGICAL / TRAUMA SCARRING
2nd line:inj.KS
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TERAPI
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Pembedahan
Inj. Kortikosteroid
Silicone Gel Sheeting
Pressure Therapy
Radio Therapy
Laser Therapy
Cryotherapy
Adhesive Microporous Hypoallergenic Paper Tape
Miscellaneous Therapies : # Vit E,Onion extract cream,Allantoin,Sulfomucopolysacharide gel,Glycoaminoglycan gel, Cream Centella asiatica
# Topical Retinoic Acid,Colchicine,Antihistamin sistemic
# Cyclosporine, intralesional verapamil
Emerging Evidence: Interferon, 5-fluorouracil,Bleomycin inj
Anti TGF beta (riset)
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PEMBEDAHAN
Eksisi (total or intra keloid)
W plasty , Z plasty
Scar Excision + Skingrafting
Local Flap
Tissue Expantion
Free Tissue Transfer
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Eksisi total Eksisi intralesi W-plasty
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Excision & Z- plasty
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Tissue Expansion
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Pembedahan : Rekurensi tinggi (45-100%)
Injeksi Kortikosteroid : respon bervariasi sekitar
50-100%, rekurensi rata-rata 9-50%
Efek samping 63% : atrofi kulit, telangiektasi
Radiotherapy : respon rata-rata 10-94 %, rekurensi
rata-rata 50-100%
Cryotherapy : respon rata-rata 51-74%
Polyurethane : tidak menunjukkan evidence of
efficacy dan evidence effectiveness
KELOID
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Kontraktur
Kelainan berupa kontraksi yang menetap akibat regangan parut
sehingga menyebabkan gangguan / terbatasnya gerak
Biasanya terjadi pada : leher, axilla, siku, lutut, pergelangan, jari
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Penanganan Kontraktur
Kombinasi:
Pressure Therapy
Serial Casting or Splinting
Surgery : Release contracture, Skin grafting,
Flap
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Intrinsic Splint
Airplane Splint
Neck Splint
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