Indonesian plastic surgeons’ attitude during early period of the COVID-19 pandemic

Background@#This study aims to report how the practice of plastic surgeons and their attitude was during the first measure period of coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#A survey study was held among members of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons during week 5 after the first report of COVID-19. A 10 multiple-choice questions (MCQs) and 1 essay covered key questions on the area of surgery and operating room, clinics, internal meeting, and consultation. The only open-ended question relates to the last MCQ addresses a future “flipped” medical practice. @*Results@#Response rate was 45.6% among 228 members, with 89.4% did no practice or limited their service to emergency and urgent cases only. Only 1.9% kept their official meeting as usual, while the majority modified it. The practice in the operating theatre and clinic were also altered to comply with the measures; with 21.2% from the total respondents only allowed patients with exposure to come for visit after taking 14 days of self-quarantine. Teleconsultation was practiced by 50% of the respondents, while 41.3% agreed and 10.6% disagreed upon the future “flipped” medical practice. @*Conclusion@#In general plastic surgeons have made supportive actions during the pandemic. Surgery was performed with all precautions at the utmost as a reflection of high alert of viral infection. Teleconsultation has been embraced via existing social media. Agreement upon the future “flipped” medical practice is reasonable. All in all, the actions were considered as most relevant.

Laboratory Study on Injection Force Measurement on Syringe and Needle Combinations

@#Background: This study aimed to measure the least initial and maintenance forces of syringe and needle combinations to provide a reference for local anesthetic injection. Methods: An experimental study was conducted in our Physics Laboratory during September 2015. A series of syringes sized 1 mL, 3 mL, 5 mL, 10 mL and 20 mL were paired with the original needles, 27G, 27G spinal and 30G. Each combination was tested three times using a compression testing Instron 5940 Series to measure initial and maintenance forces. Statistical analysis was performed using One-way ANOVA. Results: The lowest initial force was shown by the combination of 1 mL syringe and 27G spinal needle. However, the 1 mL syringe showed no significant difference across the needles [F(3, 8) = 3.545; P < 0.068]. The original and 27G needle showed mean difference 0.28 (95%CI: −0.19, 0.75; P = 0.420). The lowest maintenance force was measured in the combination of 1 mL syringe and its original 26G needle. On the contrary, both the highest initial and maintenance forces were shown by the combination of 10 mL syringe and 30G needle. Conclusion: The 1 mL syringe with original 26G needle shows the best combination.

Achilles tendon reconstruction with a half-width Achilles graft and wrap-around fascial flap

A 70-year-old man complained imbalance while walking, inability to perform ankle flexion, and could not stand on tip-toe 3 months after injury. The ankle looked swollen with loss of Achilles contour and obvious gait disturbance. Magnetic resonance imaging shows a 5-cm Achilles tendon gap. Subsequently, surgery was performed to solve the neglected Achilles tendon rupture. Patient was put under general anesthesia with a regional block. Using a non-tourniquet technique, a reconstructive procedure was performed using a half-width autologous Achilles tendon graft, which was attached to the calcaneal prominence with wire in a double strand Bunnell fashion. As for the proximal stump, double core Bunnell/modified Kessler suturing was carried out to suture the graft to Achilles stump. To increase the vascularization, an ipsilateral gastrocnemius fascial flap with a distally based-pedicle was harvested to wrap around the tendon graft. At a 6-month follow-up, the patient was able to stand on tip-toe and had also regained a normal gait.

The safety of one-per-mil tumescent infiltration into tissue that has survived ischemia

BACKGROUND: The aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation. METHODS: Forty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension (TcPO₂) was measured before and after infiltration, and changes in TcPO₂ were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation. RESULTS: Thirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. TcPO₂ readings showed significant decreases (P<0.05) following both one-per-mil tumescent (99.9±5.7 mmHg vs. 37.2±6.3 mmHg) and normal saline (103±8.5 mmHg vs. 48.7±5.9 mmHg) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis. CONCLUSIONS: One-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.