Herlyn-Werner-Wunderlich (HWW) syndrome is difficult to diagnose. We report our first experience of fistula repair in HWW syndrome in Hasan Sadikin General Hospital Indonesia. A 12 years old girl presented with urinary retention, and was consulted to urology because the urethral meatus could not be found. MRI showed two separate uteri, cervices, and vaginas. Complete separation of vagina and urethra was done. After 2 years follow up, the patient had no complaint. HWW syndrome should be suspected in cases with pelvic pain or urinary retention during menarche period among teenagers and neonatal cases with any renal malformation.

Burn injury is a common type of trauma which causes significant morbidity and mortality. Wound healing following burns can be complicated by the formation of hypertrophic scars and the occurrence of post-inflammatory hyperpigmentation (PIH). Neodymium:yttrium aluminum garnet (Nd:YAG) laser might become one of the treatments of choice for hypertrophic scars and PIH. We report a case of post-burn hypertrophic scars and hyperpigmentation in a 20-year-old man. The patient was consulted from the Department of Plastic Surgery and Reconstruction after scar revision. He was treated with 1064 nm long-pulsed Nd:YAG laser therapy, spot size 6 mm, fluence 55 J/cm², pulse duration 3 millisecond (ms), for three sessions with one month interval, followed by 1064 nm Q-switched (QS) Nd:YAG, spot size 4 mm, fluence 2.5 J/cm², frequency 2 Hz for two sessions with one month interval. Clinical improvement was observed after five sessions, characterized by scar thinning as assessed using Vancouver scar scale and increased skin tone brightness also reduced redness assessed using a spectrophotometer with no significant side effects. The management of post-burn facial scars and hyperpigmentation remains a challenge. Aside from surgery, the treatment strategy for hypertrophic scar is laser, one of which is the long-pulsed Nd:YAG laser which reduces the production of collagen. In hyperpigmented lesions, QS Nd:YAG laser destructs the melanosome. Combination of 1064 nm long-pulsed and QS Nd:YAG laser therapy provide significant improvement. These therapeutic strategies can be considered as a treatment option for post-burn hypertrophic scars and hyperpigmentation.

Rhinophyma is characterized by progressive enlargement of the nasal skin, which is considered to be an advanced stage of phymatous rosacea. Esthetic disfigurement makes surgical treatment necessary for this condition. Hypertrophic scars are the consequence of alterations in the skin’s healing process following surgical interventions. Laser may be the treatment of choice in hypertrophic scars. We reported a case of hypertrophic scars following excisional surgery and full-thickness skin grafting due to rhinophyma in an 18-year-old male who was consulted from the Department of Plastic Surgery and Reconstruction. The 1064 nanometer (nm) Q-switched Neodymium: Yttrium Aluminum Garnet (QS Nd:YAG) with 4 mm spot size, 1.5 J/cm2 and 1 Hz was applied to the hypertrophic scars for three sessions within one month interval. Clinical improvement was observed as indicated by the patient’s Vancouver scar scale score and spectrophotometry result, and no side effects were found. Nd:YAG laser is a non-ablative device that targets hemoglobin, water, and melanin. Any thermal effects on dermal tissue containing blood vessels could result in reduced blood flow through the capillaries in the dermal papillae. QS Nd:YAG-induced selective photothermolysis was responsible for collagen breakdown and reduced collagen production in hypertrophic scars. The 1064 nm QS Nd:YAG laser gave good results in this case although more treatment sessions may be recommended and a longer follow-up is necessary in order to assess the stability of the result.

Orbital cellulitis is uncommon sequelae of the spread of odontogenic infection to adjacent maxillary sinuses or to distant sites such as the orbits. Once it happened, the spread of such infection can be of serious complication such as complete blindness or even more serious and life threatening situations as cavernous sinus thrombosis, intra-cranial abscess, or even death. This paper aimed to expose the guideline treatment of orbital cellulitis as a complication of odontogenic infection. It reported one case of orbital cellulitis in the emergency unit of Hasan Sadikin hospital Bandung, with complaints of pain, swelling at cheek and periorbital region, and the history of toothache. The treatment include incision drainage, extraction of tooth, and parenteral administration of antibiotic and analgesic. Odontogenic infections are derived from dental infection and can potentially spread rapidly to be ascending infection like orbital cellulitis. Odontogenic infection and orbital cellulitis should be adequately treated with incision drainage, extraction of tooth and parenteral administration of antibiotic, steroid and analgesic. Without immediate treatment, odontogenic infection can lead to ascending infection. Orbital cellulitis due to spreading of odontogenic infection is a rare case. In this case report, the patient had a significant improvement due to immediate and proper treatment.

Arterialized venous flap, like any other flap, will undergo an ischemic reperfusion injury during its transfer process. To overcome this, ischemic preconditioning can be done to provide protection and enhanced flap survival. One of the reliable parameters of flap survival is its temperature. However, there was no recorded data regarding AVF's temperature or its monitoring. This research aimed to demonstrate the temperature effect of ischemic preconditioning on arterialized venous flap. Male Wistar Rats were randomly divided into 4 groups, consisting of 6 negative control groups, 8 positive control group (PS) rats that underwent an anastomosis of the superficial epigastric artery to the superficial epigastric vein, 8 experimental rat group 1 (EX1) that underwent 3 cycles of 5 minutes pre-anastomosis clamping with 3 cycles of 5 minutes each, and 8 experimental rats' group 2 (EX2) with 3 cycles of 10 minutes. Flap's temperature was observed preoperatively and postoperatively from day 1 to day 7, day 14, and day 21 with an android-based thermal camera and recorded in Celsius degrees. All the flaps (N= 26) were vital. The temperature drop was seen in all anastomosed flaps compared to the negative control (30.37 vs. 25.08 vs. 23.77 vs. 25.27, p<0.05). A significant increase in temperature occurred on days 4 to 6 in Ex1 (33.62±1.820, 33.62±1.820, 32.40±1.627; p<0.05). As in the temperature trend, Ex2 is shown to have a stable temperature from day 2 until 21. This study has recorded an increase in temperature in the early days of the creation of the arterialized venous flap at various timings of ischemic preconditioning. The flap's monitoring was easily observed with a thermal camera that can be implemented in humans.

Background: Permanent pacemaker implantation in pediatric patients with severe malnutrition presents a unique surgical challenge due to the absence of a viable subcutaneous protective envelope. In this population, standard device fixation frequently results in recurrent wound dehiscence and device extrusion, often necessitating lead abandonment or epicardial placement. This study evaluates the efficacy of a dual-modality salvage technique integrating a Polytetrafluoroethylene (PTFE) mesh barrier with vascularized fasciocutaneous tissue coverage. Case presentation: We present the case of a 3-year-old male with congenital complete atrioventricular block and severe acute malnutrition, defined by a Weight-for-Height Z-score of less than -3 SD. The clinical course was complicated by three consecutive implant failures over an 8-month period, including two thoracic and one abdominal extrusion, characterized by aseptic pressure necrosis. To salvage the cardiac hardware, a novel sealed-device technique was employed. The pulse generator was encapsulated in a non-absorbable PTFE mesh to minimize the coefficient of friction and placed in a sub-fascial plane. Simultaneously, a random-pattern fasciocutaneous rotation flap was harvested to provide robust, vascularized coverage. Biochemical analysis revealed severe hypoalbuminemia (2.1 g/dL) and anemia pre-operatively. Conclusion: At the 12-month follow-up, the surgical site demonstrated complete physiological integrity with no recurrence of erosion, seroma, or infection. The combination of PTFE encapsulation to mitigate mechanical shearing forces and a fasciocutaneous flap to restore perfusion offers a durable salvage strategy for refractory device extrusion in cachectic pediatric patients.