ULKUS DEKUBITUS

Irnawanti
22010117220095

Pembimbing :
dr. Dadi Garnadi, Sp.B
 Latar Belakang

Epidemiologi luka tekan bervariasi di beberapa

tempat. Di Amerika Serikat insiden berkisar antara
0,4% - 38% di unit perawatan akut, 2,2% - 23,9% di
unit long term care (perawatan jangka panjang), 0% -
7% di home care (perawatan di rumah). Fasilitas
perawatan akut di Amerika Serikat memperkirakan
2,5 juta luka tekan ditangani setiap tahunnya.

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 Make primer disease worse
Increase treatment cost

Make rehabilitation program Life treatening

take more times
 Definisi

Ulcus decubitus adalah luka yang terlokalisir pada kulit dan /

atau jaringan di bawahnya biasanya di atas penonjolan tulang,
sebagai akibat dari tekanan.

Ulkus dekubitus terjadi jika tekanan yang terjadi pada bagian

tubuh melebihi kapasitas tekanan pengisian kapiler dan tidak
ada usaha untuk mengurangi atau memperbaikinya sehingga
terjadi kerusakan jaringan yang menetap.

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 Faktor Risiko
Mobilitas dan aktivitas
Penurunan sensori persepsi

Kelembaban

Tenaga yang merobek (shear)

Pergesekan (friction)

Nutrisi

Usia

Tekanan arteriolar yang rendah

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Merokok

Temperatur kulit
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 Klasifikasi Luka Dekubitus
Menurut NPUAP ada perbandingan luka dekubitus
derajat I sampai derajat IV yaitu

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Derajat I: Eritema tidak pucat
pada kulit utuh, lesi luka kulit
yang diperbesar. Kulit tidak
berwarna, hangat, atau keras
juga dapat menjadi indikator.

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Derajat II: Hilangnya sebagian
ketebalan kulit meliputi
epidermis dan dermis. Luka
superficial dan secara klinis
terlihat seperti abrasi, lecet,
atau lubang yang dangkal.
Derajat III: Hilangnya seluruh
ketebalan kulit meliputi
jaringan subkutan atau
nekrotik yang mungkin akan
melebar kebawah tapi tidak
melampaui fascia yang
berada di bawahnya. Luka
secara klinis terlihat seperti
lubang yang dalam dengan
atau tanpa merusak jaringan
sekitarnya.
Derajat IV : Hilangnya seluruh
ketebalan kulit disertai destruksi
ekstensif, nekrosis jaringan;
atau kerusakan otot, tulang,
atau struktur penyangga
misalnya kerusakan jaringan
epidermis, dermis, subkutaneus,
otot dan kapsul sendi.
 Location of
ulcus decubitus

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 Protocol of therapy and prevention
of ulcus decubitus
1. Assesment of risk ulcus decubitus on patient

• We can use Norton scale to measure

risk factor of ulcus decubitus
• Norton scale is not considering about
nutritions factor, shearig, and have no
definition of fungtional parameter that
used.
 SKOR NORTON

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 Protocol of therapy and prevention
of ulcus decubitus
2. Preventing Plan
Skin Care
•1. Perform a head to toe skin assessment at least daily, especially checking pressure
points such as sacrum, ischium, trochanters, heels, elbows, and the back of the
head.
•2. Individualize bathing frequency. Use a mild cleansing agent. Avoid hot water and
excessive rubbing. Use lotion after bathing. For neonates and infants follow
evidence-based institutional protocols
•3. Establish a bowel and bladder program for patients with incontinence. When
incontinence cannot be controlled, cleanse skin at time of soiling, and use a topical
barrier to protect the skin. Select under pads or briefs that are absorbent and provide
a quick drying surface to the skin. Consider a pouching system or collection device
to contain stool and to protect the skin.
•4. Use moisturizers for dry skin. Minimize environmental factors leading to dry skin
such as low humidity and cold air. For neonates and infants follow evidence- based
institutional protocols
•5. Avoid massage over bony prominences.
 Protocol of therapy and
prevention of ulcus decubitus
2. Preventing Plan
Nutrition
•1. Identify and correct factors compromising protein/ calorie intake
consistent with overall goals of care.
•2. Consider nutritional supplementation/support for nutritionally
compromised persons consistent with overall goals of care.
•3. If appropriate offer a glass of water when turning to keep
patient/resident hydrated.
•4. Multivitamins with minerals per physician’s order.
 Protocol of therapy and
prevention of ulcus decubitus
2. Preventing Plan
Mechanical Loading and Support Surfaces
•1. Reposition bed-bound persons at least every two hours and chair-bound persons
every hour consistent with overall goals of care.
•2. Consider postural alignment, distribution of weight, balance and stability, and
pressure redistribution when positioning persons in chairs or wheelchairs.
•3. Teach chair-bound persons, who are able, to shift weight every 15 minutes.
•4. Use a written repositioning schedule.
•5. Place at-risk persons on pressure-redistributing mattress and chair cushion
surfaces.
•6. Avoid using donut-type devices and sheepskin for pressure redistribution.
•7. Use pressure-redistributing devices in the operating room for individuals
assessed to be at high risk for pressure ulcer development.
 Protocol of therapy and prevention
of ulcus decubitus
2. Preventing Plan
• 8. Use lifting devices (e.g., trapeze or bed linen) to move persons rather
than drag them during transfers and position changes.
• 9. Use pillows or foam wedges to keep bony prominences, such as knees
and ankles, from direct contact with each other. Pad skin subjected to
device related pressure and inspect regularly.
• 10. Use devices that eliminate pressure on the heels. For short-term use
with cooperative patients, place pillows under the calf to raise the heels
off the bed. Place heel suspension boots for long-term use.
• 11. Avoid positioning directly on the trochanter when using the side-lying
position; use the 30° lateral inclined position.
• 12. Maintain the head of the bed at or below 30° or at the lowest degree of
elevation consistent with the patient’s/resident’s medical condition.
• 13. Institute a rehabilitation program to maintain or improve
mobility/activity status.
 Protocol of therapy and
prevention of ulcus decubitus
3. Treatment

1. Clean the wound regularly

For non-contaminated wounds, sterile water or 0.9% solution is the
cleansing agent of choice. In situations where there is a high risk of
wound infection, it is an indication for the use of an antiseptic solution

2. Debridement wounds from any necrotic tissue on the wound

 The indications for the operative
procedure include, but are not
limited to, the following:
• Removal of the source of sepsis, defined as systemic inflammatory
response syndrome (SIRS) in the presence of infection. (Diagnostic criteria
for SIRS include any two of the following: temperature 38 or 36°C, heart
rate > 90 bpm, respiratory rate ≥ 20 breaths/min or PaCO2 ≤ 32 mmHg or
mechanical ventilation, and white blood cell count ≥ 12,000/μl or ≤ 4,000/μl
or ≥ 10% band forms
• Removal of local infection to decrease bacterial burden, to reduce the
probability of resistance from antibiotic treatment, and to obtain accurate
cultures
• Collection of deep cultures taken after debridement from the tissue left
behind to evaluate persistent infection and requirements for systemic
antibiotic treatment
• Stimulation of the wound bed to promote healing and prepare for a skin
graft or flap
 Protocol of therapy and
prevention of ulcus decubitus

3. Treatment

Anticipate Infection
Need culture and resistant test.
If needed, we can use sistemic antibiotic for example penicillins,
cephalosporins, aminoglycosides, fluoroquinolones
 Protocol of therapy and
prevention of ulcus decubitus
3. T re atm e n t
Wound care based on the stage

Grade Wound care

Avoid Massage or pressure on the area of ​the lesion. Use a

hydrocolloid dress or a film dressing. If there is no use of beige
I skin to keep skin moist. Make body position changes; tilted right
and left every 2 hours. Provide adequate nutrition and vitamins;
A, D, E. Provide support using a pillow

Same action as degree one. Coupled using a bandage that is

II semipermeable to prevent dryness and keep the tissue well. Or
use bandage tang its moist.
 Protocol of therapy and
prevention of ulcus decubitus
3. T re atm e n t
Wound care based on the stage

III If there is necrosis do debridement, and

clean it with normal copy. Keep the
wound environment moist when the
tissue is dry. Use a hydrocolloid
bandage, if any. Avoid stressing and
assessing risk factors. Give antibiotic
treatment in case of infection.

IV Same with grade III

4. Stim ulate and as s is t the fo rm atio n o f granulatio n and e pithe lial tis s ue .
To accelerate the formation of granulation and epithelial tissue in decubitus
ulcers so as to speed healing can be given:
• Topical ingredients for example: 2% salicylic salicy ointment, zinc preparation
(ZnO, ZnSO4).
• Hyperbaric Oxygen; besides having bacteriostatic effects on a number of
bacteria, also has a proliferative epithelial effect, adds granulation tissue and
improves the vascular state.
• 8. Surgic al treatm e nt
For grade III and IV
To close the wound there are some treatment that can be done :
-The primary closure
consists of excision of the edge of the ulcer and the conversion of
the wound into an elliptical shape. The wound is then closed layer
by layer to immobilize the dead space. The edges of the skin are
reunited and sewn. Sometimes, drain is required.
- Skin Flap and Skin Graft
 Komplikasi
• Osteomielitis
• Sepsis
• amputasi
 TERIMA KASIH
Mohon arahan dan bimbingannya…

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