MANAGEMENT OF SOFT TISSUE

EXTREMITY DEGLOVING INJURIES WITH

FULL-THICKNESS GRAFTS OBTAINED
FROM AVULSED FLAP
YOGI HERMAWAN
1711901061

PEMBIMBING
DR. AM DASMAR, SP.B
DR. RAMZI ASRIAL SP. B (K) V

ILMU BEDAH
RSUD BANGKINANG
DEFINISI

VULNUS ?
KLASIFIKASI LUKA

CLOSED WOUND OPEN WOUND

 CLOSED
WOUND

KONTUSIO

HEMATOMA
 OPEN
WOUND

LUKA TAJAM

VULNUS EXCORIATUM VULNUS SCISSUM VULNUS ICTUM

 LUKA TUMPUL

VULNUS
VULNUS LACERATUM VULNUS MORSUM
SCLOPECTERUM
Dirty or Infected Wound

Clean Contamined Wound

DERAJAT LUKA

Stadium 1  Luka Superficial

Stadium 2  Luka “Partial Thickness”

Stadium 3  Luka “Full Thickness”

Stadium 4  Luka Full Thickness

 MEMPENGARUHI
PENYEMBUHAN
LUKA
Umur Pasien

Berat Badan Pasien

Status Nutrisi

Dehidrasi

Suplai Darah Terganggu

Imunitas

Penyakit Kronis

Obat-Obatan
 FASE PENYEMBUHAN LUKA

FASE PROLIFERASI

FASE INFLAMASI FASE MATURASI

KLASIFIKASI PENYEMBUHAN LUKA

PENYEMBUHAN LUKA PRIMER

PENYEMBUHAN LUKA SEKUNDER

PENYEMBUHAN LUKA TERSIER

PENANGANAN LUKA ?
PERAWATAN LUKA UMUM

Perhatikan Keadaan Umum Pasien

Saat Terjadinya Perlukaan

Luka < 6 jam

Luka Terkontaminasi
Luka Terinfeksi

Profilaksis Tetanus

Medikamentosa ( Diberikan Profilaksis Infeksi Luka )

Pembukaan Jahitan
PERAWATAN LUKA KHUSUS

Perlukaan Perlukaan
Pembuluh Saraf
Darah Perifer

Perlukaan
Perlukaan
Thoraks
Tendon
Abdomen

Perlukaan Perlukaan
Daerah Daerah
Wajah Leher
BACKGROUND

BACKGROUND
 RESULTS

CONCLUSION
Type 3  Avulsion injuries to specific area
 Free ol local flaps

Reconstruction with the grafts Re-adaptation of the flap

MATERIALS AND METHODS

Degloving injuries 2010 - 2012

6 – 33 years (mean age: 16 years)

7 2

Ocuupati
Traffic onal
Accidents Accidents
Irrigation  physiological saline

Tetanus prophylaxis

Make the wound clean

A case of a foot avulsion. Post-operative 13th month result with defatting and adaptation
of the same flap to its original site.

Same technique applied for a hand avulsion. Post-operative 14th month results.
Defatting and transformation of the flaps to full thickness grafts.
RESULTS

7 patients the grafts were intact

1 patients lost 30% grafts

1 patients lost 10% grafts

8-12 months

Dressing after operate

Average
9 days on hospital
Discussion

Extremity avulsion  crucial to treatment

Tissue will be removed or protected ?

Degloving injuries caused by trauma

Today, microsurgical is protected to avulsed flap

Flaps might be another option for flap avulsed

Revascularization most important in degloving injuries

The avulsed flap in avulsion might be immediately

converted into a graft by removing its subcutaneous fat
Conclusion
tissue
T E R I MA KA S I H