!!
RUBY!RIANA!A!
PLASTIC!SURGEON!
11/7/14! 1!
Objec9ves!
Iden9fy!different!
Review!applicable!
considera9ons!
anatomy!and!
with!sharp!and!
physiology!
blunt!trauma!
Review!
management!of!
sharp!and!blunt!
trauma!
11/7/14! 2!
Violence!and!Trauma!Study!
35%!of!violent! Overall!(GSW!&!
wounds!were! ST)!survival!rate!
from!stab!wounds! was!33%!
65%!survival!for!
stab!wounds!
11/7/14! 3!
Mechanism!of!Injury!
Mechanism!of!injury!will!
Predictable+pa-ern+of+ help!you!assess!the!pa9ent,!
injuries+based+on+forces+ relay!important!informa9on!
applied+to+the+body+in+ to!the!hospital!and!key!you!
trauma.! into!the!severity!of!your!
pa9ents!situa9on.!!+
It’s!elementary!my!dear!
Watson!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Remember!to!look!for!the!
CLUES!!!!
11/7/14! 4!
How to describe a wound!
• The!nature!of!the!wound!(bruise,!lacera9on!or!
abrasion!etc).!
• The!wound!dimensions!(length,!width!and!
depth).!
• The!posi8on!of!the!wound!in!rela9on!to!fixed!
anatomical!landmarks!eg:!distance)from)the)mid)
line,!distance)below)the)clavicle…etc.!
• The!number!of!wounds.!
• The!margins!of!the!wounds!(Ragged!or!Everted)!
11/7/14! 5!
Factors!affec9ng!wound!healing!
• Blood!supply.!
• Infec9ons.!
• Age!
• Site!of!wound.!
• Nutri9onal!status.!
• Inter!current!diseases.!
• Drugs:!cor9costeroids,!
immunosuppressive,!radiotherapy,!
chemotherapy.!
11/7/14! 6!
WOUND!CLOSURE!
6 Flap bebas ( free flap )
5 Flap jauh
4 Flap lokal
3 Skin Grafting
11/7/14! 7!
11/7/14! 8!
Luka!tajam!
Luka!tumpul!
11/7/14! 9!
11/7/14! 10!
11/7/14! 11!
Stab+wounds+
• Mechanism+
– Sharp:+Tissue+disrup8on+
• Extent+of+Injury+
– Weapon+size,+length,+
sharpness,+penetra8on++
• Severe+injury+
– Chest+and+abdomen+
– 4++wounds+
– (penetra8ng+injury+!+blunt+
trauma)+
11/7/14! 12!
Airway!
!!!!Would!this!be!a!concerning!airway?!
!What!are!your!management!priori9es?!
11/7/14! 13!
11/7/14! 14!
Don’t+
panic!!
11/7/14! 15!
Concepts+of+Ini8al+Assessment+!
Rapid+Primary+survey+!
Resuscita8on+!
Adjuncts+to+primary+survey+/resuscita8on+!
Detailed+secondary+survey+!
Adjuncts+to+secondary+survey+!
Reevalua8on+!
Defini8ve+care+!
11/7/14! 16!
Ini8al+Assessment!
Primary+survey+and+
resuscita8on+of+vital+
func8ons+are+done+
simultaneously+–+++++++++
a+team+approach!
11/7/14! 17!
Trauma+Team+
“Doin+it+24/7”!
!
• ED+Physicians!
• Anesthesiology!
• Surgeons!
• General+and+Trauma+and+Cri8cal+Care!
• Neurosurgery!
• Orthopedics!
• Medical+Students!
• Nurses!
• Radiology+Techs!
• Radiologists!
Self-inflicted injuries!
11/7/14! 21!
11/7/14! 22!
11/7/14! 23!
2)Wrist+
11/7/14! 27!
11/7/14! 28!
11/7/14! 29!
11/7/14! 30!
Replanta9on!!
Decided,!usually!by!telephone,!are!suitable!for!
poten9al!replanta9on,!!
• ensure!that!hemorrhage!has!been!stopped!by!applica9on!
of!a!pressure!dressing!and!eleva9on,!and!that!fluid!
resuscita9on!has!been!ins9tuted!if!necessary.!!
• Tetanus!prophylaxis!may!be!required!and!broadjspectrum!
intravenous!an9bio9cs!are!begun.!!
• The!amputated!part!is!wrapped!in!sterile!gauze!
moistened!with!lactated!Ringer!solu9on,!sealed!in!a!
plas9c!bag,!and!placed!in!a!container!of!water!and!ice!at!a!
temperature!of39.2◦!F(4◦!C).!
11/7/14! 31!
11/7/14! 32!
11/7/14! 34!
Occlusive!Dressing!
11/7/14! 35!
11/7/14! 36!
11/7/14! 37!
WOUND
Luka)tumpul):)oleh)karena)benda)
tumpul.)
Misal!:!
• Luka!tusuk!tumpul!!!banyak!jaringan!
necrose!!!ingat!infeksi!anaerobe!
(tetanus)!:!kena!paku!
• Luka!tembak!(Vulnus!sclopetum)!
!pelurunya!steril!karena!panas!
• Luka!laserasi!(Vulnus!lacerosum)!–!
benturan!yang!luas,!terjadi!memar!
• Luka!penetrasi!(Vulnus!penetratum).!Bila!luka!
menembus!rongga!tubuh.!Misal!:!peritoneum,!
pleura!
• Luka!avulse!(Vulnus!avulsum)!–!terdapat!
lepasnya!sebagian!/!seluruh!jaringan.!Misal!:!
telinga!lepas!
• Fractura!terbuka!
• Luka!gigit!(bite)!serangga!/!anjing!/!ular!/!
orang!
ring!
avulsion!
• Suatu!keadaan!dimana!jaringan!kulit!&!
subku9s!atau!jaringan!yang!lebih!dalam!terj
elevasi!secara!paksa!sebagai!akibat!trauma!
keras!&!mendadak!
11/7/14! 45!
11/7/14! 46!
Macam+Penyembuhan+Luka+
First)Inten;on!=!primary!union!=!per!primam!
Second)Inten;on!=!second!union!=!per!
secundam!
Third)Inten;on!=!delayed!suture!=!per!ter9am!
Penyembuhan!dengan!carajcara!lain,!
misalnya!:!skin!grao!atau!flap.!!
11/7/14! 47!
First!Inten9on!
11/7/14! 48!
11/7/14! 49!
Also!First!Inten9on!
• !!
11/7/14! 50!
Secondary!Inten9on!
11/7/14! 51!
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Thank+you+
11/7/14! 60!