Wound Management & Wound Bed Preparation

8/10/2019 Wound Management & Wound Bed Preparation

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LAPISANLAPISAN KULIT

Epidermis

Dermis

Hypodermis


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FISIOLOGI KULIT

Pelindung terhadap substansi

berbahaya

Fungsi thermoregulasi (berkeringat,

evaporasi, radiasi)

Sensasi (nyeri, sentuhan, panas-dingin) Eksresi dan absorbsi

PT. ENSEVAL MEDIKA PRIMA


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LUKA

(GLOBAL WOUND ACADEMY) :

A WOUND IS GENERALLY DEFINED AS

PATHOLOGICAL STATE IN WICH TISSUE ARE

SEPARATED FROM EACH OTHER /ORDESTROYED

UMUM :

TERPUTUSNYA

KONTINUITAS/KETERSAMBUNGAN KULIT

KARENA SUATU SEBAB.



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TYPE OF WOUND

Estimated healing time (waktu penyembuhan).

Aetiology (penyebab).

Depth of the wound (kedalaman luka).

Condition of the wound (kondisi luka).



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WOUND TYPE

HEALING TIME PREDICTABLE

(WAKTU PENYEMBUHAN)

AKUT: SESUAI TAHAPAN & WAKTU PENYEMBUHAN

KRONIK: KEGAGALAN DALAM TAHAPAN & WAKTU

PENYEMBUHAN



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JENIS LUKAETIOLOGI

ULCERATIF

TRAUMATIC

SURGICAL



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Arterial

DiabeticVenous

Aetiology - Ulcers



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Superficial burn

from an electric fire

Minor laceration

during pre-operative

shaving

Aetiology - Minor Trauma



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Aetiology - Major Trauma



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Aetiology - Surgery



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JENIS LUKA

DEPTH

SHALLOW/SUPERFISIAL WOUND (EPIDERMIS)

PARTIAL THICKNESS (EPIDERMIS-DERMIS)

FULL THICKNESS (SAMPAI FASIA)

DEPTH (SAMPAI OTOT)



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ShallowPenetrating Epidermis and Basement Membrane



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Partial ThicknessEpidermis \ Some Dermis



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Full ThicknessEpidermis \ Dermis



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CavityEpidermis / Dermis / Underlying Structures



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Infected



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NecroticYellow, wet slough Black, dry eschar



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Exuding



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PROSES PENYEMBUHAN

LUKA Bioseluler

Biokimia

Respons vaskuler Saling

Aktivitas seluler terkait

Bahan kimia



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TAHAP PENYEMBUHAN LUKA

1. Fase Haemostasis :perdarahan, kons tr iksi vasku lar,

c lott ing , platelet agregasi

Segera setelah inju ry

2. Fase Inf lamasi :

vasodilastasi vaskular,

phagocytos is ,mulai d i lepaskan

faktor pertumbuhan

2-3 hari setelah in jur y 1 m inggu



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TAHAP PENYEMBUHAN LUKA

3. Fase Prol i feras i :

Migrasi f ib rob last, Sintesa colagen,

angiogenesis, prol i ferasi sel,

granu lasi, epitel isasi

Hari 3 m inggu ke 2

4. Fase Maturasi dan remodel l ing :

pematangan jar ingan baru

21 hari setelah inju ry

GRANULASI

EPITELISASI



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Primary intention

healing

Secondaryintention healing

(luka kronik)

Tertiary intention

healing (skngraft)

Types of Surgical Healing



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Luka sembuh

Pengertian :

Terciptanya kontinuitas lapisan kulit serta

adanya kekuatan jar. parut yang mampumelakukan fungsi / aktifitas yang normal



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Faktor-Faktor Yang Mempengaruhi

Penyembuhan Luka

Penyembuhan luka proses yg kompleks


1. Faktor Internal

1. Usia

2. Status Nutrisi

3. Oksigenasi dan Perfusi Jaringan (vaskulasrisasi)4. Status Imunologi

5. Penyakit Penyerta

2. Faktor Eksternal

Pengobatan

Radiasi

Stress Psikologis

Trauma Jaringan

Infeksi


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KONSEP MODERN

MANAJEMEN PERAWATAN

LUKA KRONIK

MOIST WOUND HEALING

WOUND BED PREPARATION



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Konsep modern

Dimulai 45 tahun y.l (1961)

Konsep dasar :

perawatan berbasis suasanalembab

MOIST WOUND HEALING

Dr. George Winter



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Dr. Winter

Science of wound

healing

Smith & Nephew

Polymer filmTechnology

The First Advanced Dressing

1971



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Dr. George Winter

Healing of Skin Wounds andthe Influence of Dressings on

the Repair Process

Published Nature journal

1971

MOIST WOUND HEALING



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CONCLUSION

Covering a wound with a water-vapor proof film, had

a profound effect on the pattern of healing, orientating

the migrating epidermis over the original wound

surface instead of through the dermis

(Menutup luka dengan suatu transparant film yang

dapat menahan uap air, mempunyai efek pertumbuhan

jaringan pada luka)



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S. Randolph May

(1984)

Penelitian terhadap OPSITE FILM pada superfisial &

partial thickness wound :

-Bacterial barrier

-Gas permeability

-Moisture pavour and water proof

-Maintain Temperature

Conclusion :

Memperkuat teori dari Dr. George Winter


Dr Mary Dyson


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Dr. Mary Dyson

(1987)

Conclusion :

Wound in which a moist environtment has beenmaintained .heal more rapidly and in a more orderly

manner than do dry wounds, both epidermal and

dermal repair being accelerated.

(Luka yang diperlakukan tetap dalam kondisilembabLEBIH CEPAT SEMBUH daripada luka dalam

kondisi kering.

Membandingkan konsep moist wound healing dan Drywound healing pada dermal wound



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A NEW concept

Wound Bed Preparation



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Dr. Vincent Falanga,MD, FACP

The wound must be

prepared within the basetissue and the

environment primed in

order to ensure thehealing process can

progress in a timely

fashion




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R. GarySibbald, Md, Frcpc

Debridement, bacterial

balance and moist

interactive healingmust all

be optimised as integral

parts of preparing the

wound bed.




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T.I.M.E

T - TISSUE VIABILITY

I - INFLAMATION/INFECTION

M - MOISTURE IMBALANCE

E - EDGE OF THE WOUND


Tissue Viability


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Tissue Viability

Viable Tissue -- Bright Red (granulating), Pink

(epithelialising)

Non Viable Tissue -- Black (necrotic), Yellow

(slough)

Removing -- Debridement

Debridement -- Surgically, Enzymatic,

Autolytic, Mechanic.

Product -- Intrasite Gel


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WOUND MANAGEMENT

T - TISSUE VIABILITY

LIHAT KONDISI JARINGAN

Viable/Baik (merah

cerah, pink)

Non Viable/Tidak

Baik (Kuning, Hitam)

Debridement

INTRASITE GEL

(Autolisys Debridement)

INTRASITE GEL


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Inflamation And Infection

Mikroorganismeyg merugikan Infeksi danmenghambat

penyembuhan luka

Sign -- Redness, exudate, odour, Inflamation,

tenderness, bleed easily

Use topikal antiseptic or antimicrobial

Product -- Acticoat


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WOUND MANAGEMENT

I - INFLAMATION/INFECTION

LIHAT TANDA INFEKSI

ADATIDAK

ADA

-ACTICOATLangsung

absorbance

dressing


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Moisture and Exudate

Management

Suasana lembab paling ideal dalam

penyembuhan luka

Kaji exudate level

Use Absorbence Dressing

Product :

Allevyn

Allevyn Plus Cavity


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WOUND MANAGEMENT

M - MOISTURE IMBALANCE

LIHAT TINGKAT/LEVEL EKSUDAT

Gunakan Absorbance Dressing

Eksudate

Ringan

Eksudate

sedang

Eksudate

produktif/banyak

MELOLIN MELOLIN/ALLEVYN ALLEVYN

HIDROCELULLAR

FOAM


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Edge Of The Wound

Luka menutup dari tepi dan dasar luka

Gangguan di tepi luka Oedema, Infeksi,

Callus dll) akan menghambat penyembuhan

luka

Evaluasi Luka PENTING


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WOUND MANAGEMENT

E - EDGE OF THE WOUND

LIHAT TEPI DAN DASAR LUKA

Adakah oedema, callus,

Cavity/Undermaining ?

AdaTidak Ada

ALLEVYN PLUS CAVITY

VISITRAK

Patient Assesment


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Patient Assesment

Treat Cause Wound Diagnosis Addres Patient Concerns

Prepare Wound Bed

Exudate

Management

Cellular

Dysfungtion

Biochemical

Balance

Management

Of Necrosis

Bacterial

Balance

Antimikrobial

therapy

Debridement Absorptive

products

Grafts Wound Healing

factors

Bio-enginered

products

Moist Wound

Healing

Healing wound

Overal

evaluation

Wound bed

preparation

Prepared wound

Conventional

And/or advanced

therapy


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LANGKAH PERAWATAN

ASSESMENT

PENCUCIAN DAN DEBRIDEMANG

PEMILIHAN TOPIKAL THERAPI

KULTUR LUKA

PT. ENSEVAL PUTERA MEGATRADING


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PENGKAJIAN

Usia

Medikasi

Penyakit penyerta Nutrisi

Hambatan lokal

(TIME), warnadasar luka


PENCUCIAN LUKA


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PENCUCIAN LUKA

Tujuan:

1. Meningkatkan, memperbaiki danmempercepat proses penyembuhan luka.

2. Menghindari terjadinya infeksi.

3. Membuang jaringan nekrosis dan sisabalutan.



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Cairan Pencuci Luka

Paling mudah dicari NaCl 0,9 %



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DEBRIDEMANG

Debridement /

Debridemang :

Membuang jaringan

nekrosis dar ipermukaan luka

Necrosis:Kematian sel yang

disebabkan oleh penurunan

proses enzymatic tubuh


T j d i ilih b l t


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Tujuan dari pemilihan balutan

membuang jaringan mati, benda asing dan partikel

balutan dapat mengontrol kejadian infeksi /melindungi luka dari trauma dan invasi bakteri

mampu mempertahankan kelembaban,

mempercepat proses penyembuhan luka,

absorbs cairan luka

nyaman digunakan,

steril dan

cost effective.



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Sebelum Memilih Balutan,

Pertimbangkan ..

Frekuensi mengganti balutan Jumlah eksudat

Ada tidaknya goa / undermining / cavity

Orang yang akan mengganti balutan



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Wound Dressings

Untuk pertamakalinyabalutan yangmempertahankankelembaban

digunakan pada tahun1970s

Saat ini lebih dari3500 jenis balutan ada

di dunia


Melolin-Gauzes / kasa


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Melolin Gauzes / kasa

Primary dressing / balutanyang menempel di luka

Secondary dressing / balutanpenutup

Mengisi jaringan matiberongga

Cleansing material Mechanical debridement

Carrier for medication


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HydrogelsJenis topical therap


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Hydrogels Jenis topical therapyyang dapat membantu

proses peluruhan

jaringan nekrotik olehtubuh sendiri ( support

autolisis debridement ).

Partial or full thicknesswounds, minor burns (

radiasi / ekspose panas )

Conformable No residue in wounds

INTRASITE GEL

Foams-Allevyn


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Foams Allevyn

Hydrophylicpolyurethane

No residue or breakdown

Highly absorbent,conformable

With or without adhesive

borders Partial & full thickness

wounds

Safe to use with clinical

infected wounds May help to controlhypergranulation tissue

Ab b d ill All


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Absorbent Wound Fillers-Allevyn

Cavity

Various compositions as gels,

strands, beads, foam pillows

Varying levels of absorption

Useful with deep cavity

wounds

Can absorb while at the sametime promoting moist wound

healing


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Other Surgical Techniques


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Other Surgical Techniques

Skin Graft

Muscle

Flap

Drainage

Tube


Complications Infection


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Complications - Infection

Typically ~10% surgical wound infectionrate



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Complications - Dehiscence


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Complications - Dehiscence


Fistula & Sinus


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Fistula & Sinus

Fistula - organ to organ

- organ to skin

Sinus - blind sac to skin


Incisional Hernia


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Incisional Hernia



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Non-sensitising

Good adhesion Sterile

Low Cost

Non-flammable &non-toxic

Post-Operative Dressing criteria

- High MVP

Non-adherent

Absorbent

Waterproof

Bacterial Barrier

Conformable

Professor Scales Criteria:



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PERAWATAN LUKA AKUT

Prinsip STERIL

Cairan pencuci luka : antiseptik (iodine atau NaCl 0,9 %)

Gunakan balutan yang ideal (sesuai dengan kriteria)


M i l


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Materials

Wound cleansing pack

Gloves

Cleansing solution

Dressings

Dressing retention device

Clean work area


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Preparing the patient

Wash hands Position patient

Loosen retention devices


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Preparation of equipment

P ti f k


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Preparation of work area

P i f h d


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Preparation of the wound

Wound Cleansing


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Wound Cleansing

Dressing the wound


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Dressing the wound


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Final Stage

Wound Management & Wound Bed Preparation

Documents

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