FISIOLOGI PENYEMBUHAN LUKA

woc ec l i n i c

a Professional Nurse Lead Service for People with Stomas, Wounds or IncontinenceI j in No. 1196/ 503/ Dinkes/ BAK/ XI I / 2007

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

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 the initial injury and may continue for up to 21 days

It is characterized by three events: Epithelialization Granulation Collagen synthesis

Formation of new capillaries that generate and feed new tissue

Granulation tissue is the beefy red tissue that bleeds easily

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

5 HARI PASCA PERLUKAAN

REFFERENCE Idral Darwis.2008.Perawatan luka

diabet.WOCARE publishing. Indonesia Aida S.D. Suriadiredja.2007. History of wound

healing and moist wound healing. Indonesian ETNEP paper.(not publication)

Carville Kerylin.1998. Wound care manual. Silver chain foundation.Australia

Bryant Ruth.2007. Acute and chronic wound. Mosby.USA