penyembuhan luka

1. PENYEMBUHAN LUKA, PRINSIP
PERAWATAN LUKA

2. Apa itu Luka ?
• Luka adalah suatu gangguan dari kondisi normal pada kulit
• Luka adalah kerusakan kontinuitas kulit, mukosa membrane dan tulang
atau organ tubuh lain.
• Ketika luka timbul, efek yang akan muncul adalah :
a. Hilangnya seluruh atau Sebagian fungsi organ.
b. Respon stress simpatis
c. Perdarahan serta pembekuan darah
d. Kontaminasi bakteri
e. Kematian sel

3. Luka berdasarkan waktu penyembuhan
 Luka Akut : luka dengan masa penyembuhan sesuai
dengan konsep penyembuhan yang telah
diharapkan
 Luka Kronis : Luka yang mengalami kegagalan
dalam proses penyembuhan, dapat karena faktor
eksogen dan endogen.

4. Introduction
 Normal healing of acute skin wound :
- through 4 distinct, but overlapping phases
Diegelmann, RF , Evans, MC , WOUND HEALING: AN OVERVIEW OF ACUTE, FIBROTIC AND DELAYED H
Frontiers in Bioscience 9, 283-289, January 1, 2004

5. Pathophysiology
Hemostasis
• begins immediately after the injury
• vascular constriction
• the formation of a platelet thrombus
• propagation of the coagulation cascade
• termination of clotting
• removal of the clot by fibrinolysis
01.
Proliferation
• Occurs 3 to 21 days after injury and
involves processes of angiogenesis,
granulation tissue production, collagen
deposition, and epithelialization.
03.
Inflamation
• Inflammatory cells migrate to the wound site
after platelet activation during the first several
days following injury.
• Mast cells release vasoactive cytokines
• increase capillary permeability and promote
local dilation to aid the migratory process
02.
Maturation
• final stage of wound healing is the maturation
phase, and includes collagen cross-linking,
remodeling, and wound contraction.
04.

8. INFLAMMATORY PHASE
( lag phase or substrate phase ) 0-48 hrs
 Clinical signs:
Rubor , Calor, Tumor, Dolor, Functio
Laesa

9. PROLIFERATIVE PHASE
(Fibroplasia phase) day 2 - ~ 6
weeks
 Clinical signs:
 Disappearance of inflammatory signs,
 Reduction of swelling,
 Reduction of wound size (contraction),
itching
 Key-elements:
 Net collagen synthesis,
 Increase in wound tensile strength,
 Scar formation

10. PROLIFERATIVE PHASE
 Wound Contraction
 “ Wounds heal from side to side but
contract from end to end ”
 Highest rate of contraction from days 10-21
 Collagen Deposition

11. MATURATION AND RE-MODELLING
PHASE
3 weeks to 1-2 years
 Type III collagen is replaced by type I
collagen,
 Duration of phase dependent upon :
 patient age (decreased age - increased duration),
 racial differences,
 type of wound, body location
 duration of inflammatory phase
 Collagenases act to resorb necessary fibers
that have been deposited randomly - initially
collagen deposition = collagen resorption, but
eventually resorption is greater than

13. CHRONIC WOUND
 Etiology Fail to heal :
1. Infection / inflammation
2. Recurrent trauma
3.Inadequate O2 & blood supply
4. Underlying chronic diseases
5. Inadequate medical care :
- socio-economic or psychosocial
limitations
 Chronic Wound :
- Arrest to heal
- Failure to progress normally over a 30 day
period
Smith AP.S., Etiology Of The Problem Wound
in Sheffield PJ, Fife CE, Wound Care Practice, 2nd ed, 2007

14. Normal Healing Process
Tissue is viable No Foreign Bodies
Free From Excessive Bacterial Contamination
Ideal Local Conditions
Prasetyono TOH. General concept of wound healing: revisited.
Med J Indones.2009; 19(.)

15. Types of Wound Healing
1. Primary intention
2. Secondary intention
3. Tertiary intention

16. Primary intention
 involves epidermis and dermis without total
penetration of dermis healing by process of
epithelialization
 When wound edges are brought together so that
they are adjacent to each other (re-approximated)
 Minimizes scarring
 Most surgical wounds heal by primary intention
healing
 Wound closure is performed with sutures
(stitches), staples, or adhesive tape
 Examples: well-repaired lacerations,well reduced
bone fractures,healing after flap surgery

17. Secondary intention
 The wound is allowed to granulate
 Surgeon may pack the wound with a gauze or
use a drainage system
 Granulation results in a broader scar
 Healing process can be slow due to presence of
drainage from infection
 Wound care must be performed daily to
encourage wound debris removal to allow for
granulation tissue formation
 Examples:gingivectomy,gingivoplasty,tooth
extraction sockets, poorly reduced fractures.

18. Tertiary intention
 (Delayed primary closure or secondary suture):
 The wound is initially cleaned, debrided and
observed, typically 4 or 5 days before closure.
 The wound is purposely left open
 Examples:healing of wounds by use of tissue
grafts.

19. GENERAL PRINCIPLES OF WOUND
CARE
 Local Bioburden Management / Infection Control
 Wound Debridement
 Surgical / sharp debridement
 Mechanical Debridement
 Chemical or Enzymatic Debridement
 Autolytic Debridement

20. Concept of Wound Bed
Preparation
 Debridement of nonviable tissue and denatured
extracellular matrix (ECM),
 Control of bacterial burden and inflammation,
 Establishing optimal moisture balance,
 Stimulation of epidermal cell migration at the
wound edge.

21. Wound Bed Preparation
 Aim :
 Optimal Wound Healing Environment :
 Well vascularized Wound Bed
 Stable Wound Bed
 Minimal Exudate
Structured & Systematic Approach :
Removal of Barriers

22. Wound Problems = Barriers
1. Necrotic tissue
2. Bacterial Infection
3. Exudate
 Debridement
 Bacterial Load
Management
 Moisture Control

23. Surgical Debridement
 Sharp debridement uses a scalpel, scissor or
other instrument to cut devitalized tissue
 The fast & most efficient method
 The preffered method in rapidly developing
inflammation of the body’s connective tissue &
general infection ( Sepsis )
 Carried out by physician :
 Bedsite or in Operating theatre

24. Surgical Debridement :
General Consideration
Bedside
 Minor sized,
Superficial
 No anasthesia or
Local anasthesia
 Control of hemostatic
<
 Effectiveness <
 Low cost
Operating theatre
 Deep
 General anasthesia
 Good lightning for
best assessment &
evaluation
 Control of hemostatic
>
 Effectiveness >
 High cost

25. Mechanical Debridement
 Saline-moistened dressing is allowed to dry
overnight and adhere to the dead tissue.
As the dressing is removed, the devitalized tissue
is pulled away.
 One of the oldest methods of debridement.
 Painful since the dressing adhered to non-vital as
well as vital tissue.
 Not selective: good and bad tissue
 an unacceptable debridement method for
clean
wounds where a new layer of healing cells is
already developing.

26. Vapor Gauze
Scab
Exudate Epidermis
Dermis
Fat
Dry dead skin
Gauze
Detaching
Epithelial cell
Detached with
Gauze dressing
Epithelial cell
Moving below
dry skin

27. Moist
Environment
Waterproof Contaminants
WOUND HEALING’S
CONCEPT
Moist
Environment
Waterproo
f
Contaminants
Modern Dressing

28. TYPES OF WOUNDS &
COLOUR’S SYMBOLS
Black
Necrotic tissue
Yellow
Slough
Green
Infection
Red
Granulation
Pink
Epithelialization

29. INDICATIONS OF MODERN
DRESSINGS

30. Scab Formation Necrosis Granulation Epithelialization
Red → Black Yellow Red Pink
Degree I
Degree II
Degree III
Degree IV
Polyurethane Film
Hydrogel
Polyurethane Foam
Hydrocolloid, Thin Polyurethane Foam
Alginate, Polymer Bead, Cavity Filler
The Choice of Wound Dressings
Kinds & Properties of Wound Dressing

32. Hidrogel
 Dapat membantu proses peluruhan
jaringan nekrotik oleh tubuh sendiri.
 Berbahan dasar gliserin/air yang dapat
memberikan kelembaban
 Digunakan sebagai dressing primer dan
memerlukan balutan sekunder (pad/kasa
dan transparent film)
 Topikal ini tepat digunakan untuk luka
nekrotik/berwarna hitam/kuning dengan
eksudat minimal atau tidak ada.

33. Film Dressing
 Jenis balutan ini lebih sering
digunakan sebagai secondary
dressing dan untuk luka - luka
superfi sial dan noneksudatif atau
untuk luka post-operasi.
 Terbuat dari polyurethane film
yang disertai perekat adhesif; tidak
menyerap eksudat.
 Indikasi: luka dengan epitelisasi,
low exudate, luka insisi.
 Kontraindikasi: luka terinfeksi,
eksudat banyak.

34. Hydrocolloid
 Balutan ini berfungsi mempertahankan luka dalam
suasana lembab, melindungi luka dari trauma dan
menghindarkan luka dari risiko infeksi, mampu
menyerap eksudat tetapi minimal; sebagai dressing
primer atau sekunder, support autolysis untuk
mengangkat jaringan nekrotik atau slough.
 Terbuat dari pektin, gelatin, carboxymethylcellulose,
dan elastomers.
 Indikasi: luka berwarna kemerahan dengan
epitelisasi, eksudat minimal.
 Kontraindikasi: luka terinfeksi atau luka grade III-IV.

35. Calcium Alginate
 Digunakan untuk dressing primer dan masih
memerlukan balutan sekunder. Membentuk
gel di atas permukaan luka; berfungsi
menyerap cairan luka yang berlebihan dan
menstimulasi proses pembekuan darah.
 Terbuat dari rumput laut yang berubah
menjadi gel jika bercampur dengan cairan
luka.
 Indikasi: luka dengan eksudat sedang
sampai berat.
 Kontraindikasi: luka dengan jaringan nekrotik
dan kering.
Tersedia dalam bentuk lembaran dan
pita, mudah diangkat dan
dibersihkan.

36. Foam/absorbant dressing
 Balutan ini berfungsi untuk menyerap
cairan luka yang jumlahnya sangat
banyak (absorbant dressing),
sebagai dressing primer atau
sekunder.
 Terbuat dari polyurethane; non-
adherent wound contact layer, highly
absorptive.
 Indikasi: eksudat sedang sampai
berat.
 Kontraindikasi: luka dengan eksudat
minimal, jaringan nekrotik hitam.

37. Dressing Antimicrobial
 Balutan mengandung silver 1,2% dan
hydrofi ber dengan spektrum luas
termasuk bakteri MRSA (methicillin-
resistant Staphylococcus aureus).
 Balutan ini digunakan untuk luka kronis
dan akut yang terinfeksi atau berisiko
infeksi.
 Balutan antimikrobial tidak disarankan
digunakan dalam jangka waktu lama dan
tidak direkomendasikan bersama cairan
NaCl 0,9%.

38. Antimicrobial Hydrophobic
 Terbuat dari diakylcarbamoil chloride,
nonabsorben, non-adhesif.
 Digunakan untuk luka bereksudat
sedang – banyak, luka terinfeksi, dan
memerlukan balutan sekunder.

39. Medical Collagen Sponge
 Terbuat dari bahan collagen dan sponge.
 Digunakan untuk merangsang percepatan
pertumbuhan jaringan luka dengan
eksudat minimal dan memerlukan balutan
sekunder

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TERIMA KASIH