Hand Surgery in Indonesia.

The history of hand surgery in Indonesia began with the growing interest in performing a complicated hand surgery. Since the 1970s, hand surgery in Indonesia has made headway, especially when it comes to science and education. The development of hand surgery in Indonesia is not limited to a microsurgery area, but also covers more modern techniques, including reconstruction, minimal invasive surgery, arthroscopy, and various kinds of innovations and developments to overcome the high cost of health, especially medical devices in Indonesia. Voluntary visitations to help or take surgery procedures in many remote areas in Indonesia, such as Papua and Nusa Tenggara, have also contributed to the development of hand surgery. Currently, hand surgery in Indonesia is improving and growing significantly.

Utilizing Low-cost Vacuum-assisted Closure as Adjuvant Therapy in Soft Tissue Reconstruction for a Mangled Upper Extremity.

Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the closure of the defect can elevate the risk of infection. Adjuvant therapy becomes essential in the management of mangled injuries. We aim to present the use of low-cost vacuum-assisted closure (VAC) as an adjuvant therapy for mangled injuries. We reported the case of a 20-year-old man who sustained a mangled injury to his left forearm in a traffic accident 4 hours before admission. The mangled extremity severity score was 9; however, the patient declined amputation. Although the initial reconstruction was done, the flap could only cover vital structures. VAC was utilized to address the uncovered portion of the defect, to promote optimal granulation and prevent infection. The reconstruction proceeded with a skin graft and wrist arthrodesis. At 1-year follow-up, viable tissue was obtained but contracture occurred at the metacarpophalangeal and proximal interphalangeal joints. We intend to perform functional reconstruction at a later stage. Although the benefits of VAC in wound management are well established, reports regarding its advantages in mangled injury management remain relatively scarce. The high cost of VAC is a limiting factor, particularly in developing countries. This prompts the need for an affordable VAC innovation with comparable efficiency to the commercial model. Reverse Aqua Pump VAC, our innovative low-cost VAC, shows satisfactory outcomes in managing patients with mangled injuries with mangled extremity severity score indicating amputation.