PERAWATAN LUKA

DENGAN METODE
MODERN DRESSING

Ns. Ludi Maulana, S. Kep, CWCC, CSN

MAJOR LAYER OF THE SKIN
 MAJOR FUCTIONS

 Protection
 Absorpsi
 Sensation
 Sintesa
Vitamin D
 Thermoregul
ation
 Excretion
 JENIS LUKA
 LUKA AKUT
 Proses penyembuhan dgn fase
normal (Hemostasis-inflamasi-
proliferasi-
maturasi/remodelling)
 Setiap fase penyembuhan
berlangsung tanpa penundaan
 Penyembuhan terjadi dlm
waktu 3 minggu
 Remodelling tjd ditahun
berikutnya (Moreau, 2003)
 LUKA KRONIK
 Berawal dari luka akut
 Fase penyembuhan luka
tertunda
 Terhentinya proses
penyembuhan luka (Radikal
bebas meningkat, kerusakan
matriks extra seluler,
hilangnya Growth Factor)
BAGAIMANA MENGHADAPI LUKA ?
1. Primary Closure = dilakukan debridement dan
necrotomi, dijahit langsung.

PRYMARY HEALING (PENYEMBUHAN PRIMER)

2. Spontaneus Closure = Secondary wound
closure = dilakukan debridement, necrotomi
kemudian dibiarkan sembuh sendiri.

SECONDARY HEALING (PENYEMBUHAN

SEKUNDER)
3. Delayed primary closure = Dilakukan
debridement, necrotomi kmd dibiarkan saja. Beberapa
hari kemudian (3 – 4 hari) baru dijahit/ditautkan.

DELAYED PRIMARY HEALING (PENYEMBUHAN

PRIMER TERTUNDA ) = TERTIARY HEALING
 MOIST WOUND HEALING
 George D Winter (1962) : Proved that wounds that were
kept moist, healed better than those that were exposed
to the air.

THE FATHER OF MOIST

WOUND HEALING
Schematic Diagram of the
Phases of Wound Healing
CELLS OF WOUND HEALING
WOUND BED PREPARATION
KAPAN LUKA DIKATAKAN KRONIK ?
……………………….

CONTOH LUKANYA ?
………………………..

BISA SEMBUH ?
………………………

BAGAIMANA MERAWATNYA ?
………………………..
KARAKTERISTIK LUKA KRONIK
 Delayed healing yang berulang
 Faktor sistemik & lingkungan sangat
berperan (wound severity) : penyakit
penyerta
 Faktor lokal penting diperhatikan (wound
burden) : infeksi, benda asing, jaringan
nekrosis
 Contoh luka : DM / leg ulcer, PU, Luka
kanker
BISA
SEMBUH ?????
 MANAJEMEN LUKA KRONIK

BENDA ASING TIME LEMBAB

ETIOLOGI

WOUND BED PREPARATION

TOPIKAL THERAPY
JARINGAN SAFE AUTOLISIS
NEKROSIS DEBRIDEMENT SUPPORT
INFEKSI PENYEMBUHAN
 WOUND BED PREPARATION
 T : Tissue management

 I : Inflammation & Infection control

 M : Moisture Balance

 E : Epithelial edge advancement

(Falanga, 2004)
WOUND BED PREPARATION
WBP (TIME)
BISA
SEMBUH ?????
 ASSESMENT
WOUND ASSESMENT :
 Holistic assessment  Location ( LETAK LUKA )

 Stage ( 1- 4 )
 Etiology
 Wound base ( DASAR LUKA :

RYB )
 Duration of the  Type of tissue ( EPITELISASI –

wound / age GRANULASI – SLOUGH )

 Dimention ( PENGUKURAN LUKA )

 Exudates ( CAIRAN LUKA )

 Factor that impede  Odor ( BAU TIDAK SEDAP )
healing  Wound edge ( TEPI LUKA )

 Periwound skin ( KULIT SEKITAR

LUKA )
 Sign of infection( TANDA

INFEKSI )
 Wound pain ( NYERI )
STADIUM LUKA 1- 4
 PENGUKURAN LUKA / DIMENTION

 Panjang X lebar X
kedalaman

 Ada tidaknya
undermining / goa,
yang diukur sesuai
dengan arah jarum
jam.
CARA PENDOKUMENTASIAN UNDERMINING
CARA PENDOKUMENTASIAN UNDERMINING
 CAIRAN LUKA - WHAT IS IT?

Blood Inflammation

Chronic wound fluid Product of infection

WOUND DRESSING
 THE IDEAL WOUND DRESSING SHOULD PROVIDE THE
OPTIMUM ENVIRONMENT TO MEET THE TREATMENT
OBJECTIVE AND PROTECTION FROM FURTHER INJURY
CHARACTERISTIC RATIONALE

 Promotes moist wound  Dry wound bed inhibits wound

healing*
 Manages excess exudate
 Provides thermal insulation
 Impermeable to micro-
organisms
 Causes minimal trauma on
removal
 Cost effective
 Available in hospital and
community
healing
 Prevent maceration and further
wound breakdown
 Reducing temperature at wound
bed reduces fibroblast activity
 Prevents damage and reduces
pain
 Prevent exit and entry of
organisms
 Makes best use of available
resources
 Accessible to all careers
 DRESSING SELECTION

 What is the action of this dressing?

 When should it be used?
 Are there any contra-indications to its use?
 Do I know the method of application and removal?
 Is a secondary dressing required ?
 If yes which dressing is appropriate ?

The application of an inappropriate secondary

dressing may adversely affect the ability of the
primary dressing to function correctly.
 TUJUAN PEMILIHAN
BALUTAN
1. Membuang jaringan mati, benda asing dan partikel
2. Balutan dapat mengontrol kejadian infeksi /
melindungi luka dari trauma dan invasi bakteri
3. Mampu mempertahankan kelembaban
4. Mempercepat proses penyembuhan luka,
5. Absorbs cairan luka
6. Nyaman digunakan, mengurangi nyeri,
7. Proteksi periwound
8. Kontrol bau.
 DRESSING PROCESS

AUTOLYSIS
DEBRIDMENT :
MEMPERTAHANKA MEMBUANG
MEMPERCPT
N KELEMBABAN / JARINGAN MATI, PROSES
MOISTURE BENDA ASING PENYEMBUH
BALANCE YANG TIDAK
DIBUTUHKAN AN LUKA
TUBUH
HISTORY

 Sebelum th 1980 an, kassa masih

menjadi unggulan balutan
 Setelah th 1980, perubahan
dramatis dgn berbagai jenis
balutan yg mendukung konsep
MOISTURE
BALANCE
 Saat ini lebih dari 3500 jenis
balutan ada di dunia
 DRESSING / BAHAN BALUTAN
Gauze / kassa
Island dressing
Transparent film
Hidrogels
Hydrokoloid
Hydrocelullosa
Calsium alginate
Collagen
Polyurethane foam
Hydrophobic
Silver / Cadexomere
Zink cream
Fixasi
 CARA MEMBALUT LUKA

BALUTAN BALUTAN
PRIMER SEKUNDER

BALUTA
N LUKA
 DRESSING

CONVENTIONAL DRESSING EVIDENCE BASE DRESSING

WOUND
ASSESMENT
35
PROGRESS LUKA
THANK YOU