For Better Life Quality

WOUND
MANAGEMENT

Wound & Surgery

MEDICAL CONSUMABLE DEPARTMENT

LAPISAN LAPISAN KULIT

Epidermis
Dermis

Hypodermis

FISIOLOGI KULIT
Pelindung terhadap substansi
berbahaya
Fungsi thermoregulasi (berkeringat,
evaporasi, radiasi)
Sensasi (nyeri, sentuhan, panas-dingin)
Eksresi dan absorbsi
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LUKA
(GLOBAL WOUND ACADEMY) :
A WOUND IS GENERALLY DEFINED AS
PATHOLOGICAL STATE IN WICH TISSUE ARE
SEPARATED FROM EACH OTHER /OR
DESTROYED
UMUM :
TERPUTUSNYA
KONTINUITAS/KETERSAMBUNGAN KULIT
KARENA SUATU SEBAB.
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TYPE OF WOUND
Estimated healing time (waktu penyembuhan).
Aetiology (penyebab).
Depth of the wound (kedalaman luka).
Condition of the wound (kondisi luka).

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WOUND TYPE
HEALING TIME PREDICTABLE
(WAKTU PENYEMBUHAN)
AKUT : SESUAI TAHAPAN & WAKTU PENYEMBUHAN
KRONIK : KEGAGALAN DALAM TAHAPAN & WAKTU
PENYEMBUHAN

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JENIS LUKA
ETIOLOGI
ULCERATIF
TRAUMATIC
SURGICAL

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Aetiology - Ulcers
Arterial

Venous

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Diabetic

Aetiology - Minor Trauma

Minor laceration
during pre-operative
shaving

Superficial burn
from an electric fire

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Aetiology - Major Trauma

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Aetiology - Surgery

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JENIS LUKA
DEPTH

SHALLOW/SUPERFISIAL WOUND (EPIDERMIS)

PARTIAL THICKNESS (EPIDERMIS-DERMIS)
FULL THICKNESS (SAMPAI FASIA)
DEPTH (SAMPAI OTOT)

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PT. ENSEVAL MEDIKA PRIMA

Shallow
Penetrating Epidermis and Basement Membrane

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Partial Thickness
Epidermis \ Some Dermis

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Full Thickness
Epidermis \ Dermis

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Cavity
Epidermis / Dermis / Underlying Structures

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JENIS LUKA
KONDISI
INFEKSI
NECROTIC
EXUDATING

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Infected

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Necrotic
Yellow, wet slough

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Black, dry eschar

Exuding

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PROSES PENYEMBUHAN
LUKA
Bio seluler
Bio kimia
Respons vaskuler
Aktivitas seluler
Bahan kimia

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Saling
terkait

TAHAP PENYEMBUHAN LUKA

1. Fase Haemostasis :
perdarahan, konstriksi vaskular,
clotting, platelet agregasi
Segera setelah injury

2. Fase Inflamasi :
vasodilastasi vaskular,
phagocytosis,mulai dilepaskan
faktor pertumbuhan
2-3 hari setelah injury 1 minggu
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TAHAP PENYEMBUHAN LUKA

3. Fase Proliferasi :
Migrasi fibroblast, Sintesa colagen,
angiogenesis, proliferasi sel,
granulasi, epitelisasi
Hari 3 minggu ke 2
GRANULASI

4. Fase Maturasi dan remodelling :

pematangan jaringan baru
21 hari setelah injury
EPITELISASI
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WARNA JARINGAN
1. Jaringan baik (Viable tissue)
a. Merah cerah
Granulasi
b. Merah muda/pink
Epitelisasi
2. Jaringan tidak baik (Non Viable Tissue)
a. Kuning
Slough
b. Hitam
Eschar

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Types of Surgical Healing

Primary intention
healing
Secondary
intention healing
(luka kronik)
Tertiary intention
healing (skngraft)
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Luka sembuh
Pengertian :
Terciptanya kontinuitas lapisan kulit serta
adanya kekuatan jar. parut yang mampu
melakukan fungsi / aktifitas yang normal

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Faktor-Faktor Yang Mempengaruhi

Penyembuhan Luka
Penyembuhan luka

proses yg kompleks

1.

Faktor Internal
1. Usia
2. Status Nutrisi
3. Oksigenasi dan Perfusi Jaringan (vaskulasrisasi)
4. Status Imunologi
5. Penyakit Penyerta

2.

Faktor Eksternal

Pengobatan

Radiasi

Stress Psikologis

Trauma Jaringan

Infeksi

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KONSEP MODERN
MANAJEMEN PERAWATAN
LUKA KRONIK
MOIST WOUND HEALING
WOUND BED PREPARATION

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MOIST WOUND HEALING

Konsep modern
Dimulai 45 tahun y.l (1961)
Konsep dasar :
Dr. George Winter

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perawatan berbasis suasana

lembab

The First Advanced Dressing

1971
Dr. Winter
Science of wound
healing

Smith & Nephew

Polymer film
Technology

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MOIST WOUND HEALING

Dr. George Winter
Healing of Skin Wounds and
the Influence of Dressings on
the Repair Process
Published Nature journal
1971

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CONCLUSION
Covering a wound with a water-vapor proof film, had
a profound effect on the pattern of healing, orientating
the migrating epidermis over the original wound
surface instead of through the dermis
(Menutup luka dengan suatu transparant film yang
dapat menahan uap air, mempunyai efek pertumbuhan
jaringan pada luka)

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S. Randolph May
(1984)
Penelitian terhadap OPSITE FILM pada superfisial &
partial thickness wound :
- Bacterial barrier
- Gas permeability
- Moisture pavour and water proof
- Maintain Temperature

Conclusion :
Memperkuat teori dari Dr. George Winter
PT. ENSEVAL MEDIKA PRIMA

Dr. Mary Dyson

(1987)
Membandingkan konsep moist wound healing dan Dry
wound healing pada dermal wound
Conclusion :
Wound in which a moist environtment has been
maintained .heal more rapidly and in a more orderly
manner than do dry wounds, both epidermal and
dermal repair being accelerated.
(Luka yang diperlakukan tetap dalam kondisi
lembabLEBIH CEPAT SEMBUH daripada luka dalam
kondisi kering.
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A NEW concept
Wound Bed Preparation

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WOUND BED PREPARATION

Dr. Vincent Falanga, MD, FACP
The wound must be
prepared within the base
tissue and the
environment primed in
order to ensure the
healing process can
progress in a timely
fashion

WOUND BED PREPARATION

R. Gary Sibbald, Md, Frcpc
Debridement, bacterial
balance and moist
interactive healing must all
be optimised as integral
parts of preparing the
wound bed.

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Wound Bed Preparation

Bertujuan untuk menghilangkan hambatan lokal dalam
penyembuhan luka :
1. SLOUGH

Jaringan yang tidak baik

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2. EXCESS CHRONIC
EXUDATE

3. BACTERIAL
IMBALANCE

Eksudate yang berlebihan Beban baktetri yang tinggi

T.I.M.E

T
I
M
E

- TISSUE VIABILITY
- INFLAMATION/INFECTION
- MOISTURE IMBALANCE
- EDGE OF THE WOUND

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Tissue Viability
Viable Tissue -- Bright Red (granulating), Pink
(epithelialising)
Non Viable Tissue -- Black (necrotic), Yellow
(slough)
Removing -- Debridement

Debridement -- Surgically, Enzymatic,

Autolytic, Mechanic.

Product -- Intrasite Gel

WOUND MANAGEMENT
T - TISSUE VIABILITY
LIHAT KONDISI JARINGAN

Viable/Baik (merah
cerah, pink)

INTRASITE GEL

Non Viable/Tidak
Baik (Kuning, Hitam)

Debridement
INTRASITE GEL
(Autolisys Debridement)

Inflamation And Infection

Mikroorganisme
yg merugikan

Infeksi dan
menghambat
penyembuhan luka

Sign -- Redness, exudate, odour, Inflamation,

tenderness, bleed easily

Use topikal antiseptic or antimicrobial

Product -- Acticoat

WOUND MANAGEMENT
I

- INFLAMATION/INFECTION
LIHAT TANDA INFEKSI

TIDAK
ADA

ADA
-ACTICOAT

Langsung
absorbance
dressing

Moisture and Exudate

Management
Suasana lembab paling ideal dalam
penyembuhan luka
Kaji exudate level
Use Absorbence Dressing

Product :
Allevyn
Allevyn Plus Cavity

WOUND MANAGEMENT
M - MOISTURE IMBALANCE
LIHAT TINGKAT/LEVEL EKSUDAT
Gunakan Absorbance Dressing

Eksudate
Ringan

Eksudate
sedang

MELOLIN

MELOLIN/ALLEVYN

Eksudate
produktif/banyak
ALLEVYN
HIDROCELULLAR
FOAM

Edge Of The Wound

Luka menutup dari tepi dan dasar luka
Gangguan di tepi luka (Oedema, Infeksi,
Callus dll) akan menghambat penyembuhan
luka

Evaluasi Luka

PENTING

WOUND MANAGEMENT
E - EDGE OF THE WOUND
LIHAT TEPI DAN DASAR LUKA

Adakah oedema, callus,

Cavity/Undermaining ?
Tidak Ada

Ada
ALLEVYN PLUS CAVITY
VISITRAK

Patient Assesment

Overal
evaluation

Treat Cause

Wound Diagnosis

Wound bed
preparation

Addres Patient Concerns

Prepare Wound Bed

Bacterial
Balance

Management

Exudate

Cellular

Biochemical

Of Necrosis

Management

Dysfungtion

Balance

Antimikrobial
therapy

Debridement

Absorptive
products

Prepared wound

Conventional
And/or advanced
therapy

Grafts

Wound Healing
factors

Bio-enginered
products

Healing wound

Moist Wound
Healing

PT. ENSEVAL MEDIKA PRIMA

LANGKAH PERAWATAN

ASSESMENT
PENCUCIAN DAN DEBRIDEMANG
PEMILIHAN TOPIKAL THERAPI
KULTUR LUKA

PT. ENSEVAL PUTERA MEGATRADING

PENGKAJIAN

Usia
Medikasi
Penyakit penyerta
Nutrisi
Hambatan lokal
(TIME), warna
dasar luka

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PENCUCIAN LUKA
Tujuan:

1. Meningkatkan, memperbaiki dan

mempercepat proses penyembuhan luka.
2.

Menghindari terjadinya infeksi.

3.

Membuang jaringan nekrosis dan sisa

balutan.

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Cairan Pencuci Luka

Paling mudah dicari

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NaCl 0,9 %

DEBRIDEMANG
Necrosis:
Kematian sel yang
disebabkan oleh penurunan
proses enzymatic tubuh
Debridement /
Debridemang :
Membuang jaringan
nekrosis dari
permukaan luka

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Tujuan dari pemilihan balutan

membuang jaringan mati, benda asing dan partikel
balutan dapat mengontrol kejadian infeksi /
melindungi luka dari trauma dan invasi bakteri
mampu mempertahankan kelembaban,
mempercepat proses penyembuhan luka,
absorbs cairan luka
nyaman digunakan,
steril dan
cost effective.

PT. ENSEVAL PUTERA MEGATRADING

Sebelum Memilih Balutan,

Pertimbangkan ..

Frekuensi mengganti balutan

Jumlah eksudat
Ada tidaknya goa / undermining / cavity
Orang yang akan mengganti balutan

PT. ENSEVAL PUTERA MEGATRADING

Wound Dressings
Untuk pertamakalinya
balutan yang
mempertahankan
kelembaban
digunakan pada tahun
1970s
Saat ini lebih dari
3500 jenis balutan ada
di dunia

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Melolin-Gauzes / kasa
Primary dressing / balutan
yang menempel di luka
Secondary dressing / balutan
penutup
Mengisi jaringan mati
berongga
Cleansing material
Mechanical debridement
Carrier for medication

Transparent Films-Opsite
Polyurethane or copolyester composition
Waterproof and gas
permeable
Superficial wounds dg
jumlah eksudat minimal
Promote autolysis
debridemang pada
jaringan nekrotik
Permit evaluation of
wound progress
Can tear healthy skin if
improperly removed
Occlusion may reduce
pain

 Jenis topical therapy

yang dapat membantu
proses peluruhan
jaringan nekrotik oleh
tubuh sendiri ( support
autolisis debridement ).
Partial or full thickness
wounds, minor burns (
radiasi / ekspose panas )
Conformable
No residue in wounds
INTRASITE GEL

Hydrogels

Foams-Allevyn
Hydrophylic
polyurethane
No residue or breakdown
Highly absorbent,
conformable
With or without adhesive
borders
Partial & full thickness
wounds
Safe to use with clinical
infected wounds
May help to control
hypergranulation tissue

Absorbent Wound Fillers-Allevyn

Cavity
Various compositions as gels,
strands, beads, foam pillows
Varying levels of absorption
Useful with deep cavity
wounds
Can absorb while at the same
time promoting moist wound
healing

Closure Techniques

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Other Surgical Techniques

Muscle
Flap

Skin Graft

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Drainage
Tube

Complications - Infection
Typically ~10% surgical wound infection
rate

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Complications - Haematoma

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Complications - Dehiscence

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Fistula & Sinus

Fistula - organ to organ
- organ to skin
Sinus - blind sac to skin

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Incisional Hernia

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Post-Operative Dressing criteria

Professor Scales Criteria:

- High MVP

Non-sensitising

Non-adherent

Good adhesion

Absorbent

Sterile

Waterproof

Low Cost

Bacterial Barrier

Non-flammable &
non-toxic

Conformable
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PERAWATAN LUKA AKUT

Prinsip STERIL
Cairan pencuci luka : antiseptik (iodine atau NaCl 0,9 %)
Gunakan balutan yang ideal (sesuai dengan kriteria)

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Materials

Wound cleansing pack

Gloves
Cleansing solution
Dressings
Dressing retention device
Clean work area

Preparing the patient

Wash hands
Position patient
Loosen retention devices

Preparation of equipment

Preparation of work area

Preparation of the wound

Wound Cleansing

Dressing the wound

Final Stage