FISIOLOGI PENYEMBUHAN

LUKA
 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

Home WORK : Why MOIST ?

JUSTIFIKASI
1. Fibrinolisis : fibrin cepat hilang pada suasana lembab
oleh netrofil dan sel endotel

2. Angiogenesisi : proses akan lebih terangsang pada suasana lembab

3. Infeksi : lebih rendah dibandingkan suasana kering ( 2.6 % vs 7.1 % )

4. Percepatan pembentukan sel aktif : invasi netrofi yang diikuti oleh

makrophag, monosit dan limfosit ke daerah luka akan berfungsi
lebih dini.

5. Pembentukan growth factor : lebih cepat pada suasana lembab

* EGF, FGF dan Interleukin1 dikeluarkan oleh makrophag
untuk proses angiogenesis dan pembentukan str. Korneum
* Platelet-derived Growth Factor (PDGF) dan Transforming
Growth Factor-beta (TGF-beta) dibentuk oleh platelet untuk
proses proliferasi fibroblast.
TYPES OF WOUND HEALING
1. Healing by First Intention

2. Healing by Second
Intention

3. Healing by Third
Intention
Schematic Diagram of the
Phases of Wound Healing
FISIOLOGI PENYEMBUHAN LUKA

Fase Penyembuhan Luka

Fase Koagulasi
Fase Inflamasi
Fase Proliferasi
Fase Remodeling
FISIOLOGI PENYEMBUHAN LUKA
(CONT’)

Proses Penyembuhan Luka

Penyembuhan Penyembuhan
Primer Sekunder

Melalui fase koagulasi,

Melalui aproksimasi inflamasi, proliferasi
tepi luka yang baik dan remodeling yang
lebih panjang
FISIOLOGI PENYEMBUHAN LUKA
(CONT’)
Faktor-faktor yang Mempengaruhi Proses
Penyembuhan Luka

Faktor
Faktor Lokal
Sistemik
• Diabetes
• Usia
• Obat-
• Oksigenasi • Hormonal
obatan
• Infeksi • Stress
• Alkohol
• Nutrisi
• Merokok
• Obesitas
CELLS OF WOUND HEALING.
 INFLAMMATORY STAGE
 Tanda : kemerahan, panas,
nyeri dan bengkak
 Last approximately 4 to 5
days
 Permulaan terjadinya proses
penyembuhan luka :
aktifitas platelet untuk
STOP perdarahan dan
triggers the immune
response
 24 jam pertama saat terjadi
perlukaan, neutrophils,
monocytes and macrophages
mengontrol pertumbuhan
bakteri dan membuang jaringan
mati ( mempersiapkan dasar
luka )
 Characteristic red color and
warmth is caused by the
capillary blood system
increasing circulation & laying
foundation for epithelial growth
PROLIFERATION STAGE
 Begins within 24 hours of  Formation of new capillaries
the initial injury and may that generate and feed new
continue for up to 21 days tissue

 It is characterized by three  Granulation tissue is the

events: beefy red tissue that bleeds
 Epithelialization easily
 Granulation
 Collagen synthesis
PROLIFERATION : EPITHELIAZATION
 Formation of an epithelial
layer that seals and protects
the wound from bacteria and
fluid loss
 It is essential to have a moist
environment to foster
growth of this layer
 It is a very fragile layer that
can be easily destroyed with
aggressive wound irrigation
or cleansing of the involved
area
PROLIFERATION : COLLAGEN
SYNTHESIS
 Creates a support matrix for
the new tissue that provides
it with its’ strength

 Oxygen, iron, vitamin C, zinc,

magnesium & protein are
vital for collagen synthesis

 This stage is the actual

rebuilding and is influenced
by the overall patient
condition of the wound bed
 MATURATION
 FINAL stage of wound
healing
 Begins around day 21 and
may continue for up to 2
years
 Collagen synthesis continues
with eventual closure of the
wound and increase in
tensile strength
 Tensile strength reaches only
about 80% of pre-injury
strength