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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 discipline

Whose effectiveness often depends on a harmonious

 Blend of medical science and art.

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MASTERY of PLASTIC and RECONSTRUCTIVE SURGERYMimis Cohen (Ed). Little Brown & Co, New York

  TEXTBOOK of PLASTIC SURGERYWilliam 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

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PLASTIK (INDONESIA)

PLASTICOS (YUNANI)

PLASTIQUE / PLASTIC

(INGGRIS)

: To Mold / To Form.

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BEDAH PLASTIK

Bedah plastik adalah suatu ilmu, cabang dariilmu bedah, yang mengerjakan operasi revisiatau merubah bentuk serta hubungannya

dgn struktur sekitar, dari setiap bagian padatubuh manusia dgn memperhatikan kebijak-an utk menjadikan penampilan yg lebih baik / lebih sempurna, akan tetapi masih dlm ba-tas2 tertentu yg bisa diterima, sesuai variasiumur dan etnisnya, pada kondisi tubuh yangsehat, baik phisik maupun mental.

Definisi :

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LEARN TO MAKE WINGS

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LEARN TO FLY 

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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

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PRINSIP2 DASARBEDAH PLASTIK

 ANALISA : 

● WHAT DO I HAVE (THE PROBLEM)

● WHAT DO I WANT (THE TARGET)

● HOW DO I GET THERE (THE WAY)

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MODALITAS UTAMA

● Aplikasi tehnik penjahitan, yg didasarioleh proses penyembuhan luka secaraalamiah.

● Pemanfaatan jaringan tubuh. (aplikasitandur alih kulit / jaringan / komponentubuh tertentu)

● Pemanfaatan bahan dari luar tubuh

(Aplikasi Implant)

● Aplikasi dressing yg baik.

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APLIKASI TANDUR ALIH KULIT

APPLIKASI TEHNIK PENJAHITAN

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APLIKASI IMPLANT

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APLIKASI DRESSING

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OPERASI PLASTIK

●   PLACING THE SCAR.● PREPARING THE WOUND

● STIETCHCRAFT

● POST OPERATIVE CARE

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PLACING THE SCAR.

●  RANDOM

● LANGER’S LINE 

● NATURAL LINE ● WRINGKLE’S LINE 

● GRS ANATOMI KLT

● TERSEMBUNYI ● GRS LIPATAN KLT● TERTUTUP BAJU

● DLM BATAS RAMBUT

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LANGER’S LINE 

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PREPARING THE WOUND

● Be harmfull.● More conservative approaach

on extensive wound.

● Clean wound.

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STIETCHCRAFT

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CABUT BENANG

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INSTRUMEN DASAR

BEDAH PLASTIK

 NEEDLE HOLDER

DESECTING FORCEPS

SCISSOR

SKIN HOOK

INSTRUMEN

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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

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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

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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

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JARUM

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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 

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TEN PRINCIPLES

I. 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 structuresNormal 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 toshare the defisit 

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THE GOLDEN LAW

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THE GOLDEN LAW

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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.”

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TERIMA KASIH

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

DIVISI BEDAH PLASTIK

BAGIAN BEDAH FK UNSRAT

MANADO

IMPLANT MATERIAL

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IMPLANT   FUNCTION :

TO INSERT.

EMBEDDED.

FIXATION.

PROSTHESIS.

  TYPE. EXOGENOUS.

AUTOGENOUS.

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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.

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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)

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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 veryhigh purity.

Sejak 1970 sudah dilarang penggunaannya utk disuntikan

dlm jaringan tubuh manusia, karena banyak sekali menye-babkan reaksi inflamasi yg khronis membentuk silikonoma.

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SIFAT2 SILIKON

Stabil terhadap panas.

Reaksi tubuh minimal. Tidak melekat.

Tidak diserang oleh tubuh (inert).

Stabil terhadap waktu.

Versatile.

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MAMMARY IMPLANT

SALINE FILLED (PROFILE, SMOOTH SURFACE, VALVE)

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MAMMARY IMPLANT

SILICONE GEL FILLED (ROUND, TEXTURE SURFACE)

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MAMMARY IMPLANT

SALINE FILLED (PROFILE, TEXTURE SURFACE, VALVE)

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ROUND TISSUE EXPANDER

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RECTANGEL TISSUE EXPANDER

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CRESCENT TISSUE EXPANDER

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SILICONE BLOCK

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SOLID SILICONE

BLOCK

NASAL IMPLANT

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SOLID SILICONE BLOCK

BELOW NASAL BASE OF THE FACE

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SOLID SILICONE BLOCK

CHIN / MANDIBULAR AUGMENTATION

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TESTICULAR IMPLANT

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OTOPLASTY IMPLANT

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SILASTIC ROD (TENDON SPACER)

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SILICONE SHEET

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SILICONE REACTION

INERT ?

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REMOVAL OF THE RUPTURESILICONE IMPLANT

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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.

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TERIMA KASIH