SHARP AND BLUNT TRAUMA

!!
RUBY!RIANA!A!
PLASTIC!SURGEON!

11/7/14! 1!
 Objec9ves!
Iden9fy!different!
Review!applicable!
considera9ons!
anatomy!and!
with!sharp!and!
physiology!
blunt!trauma!

Review!
management!of!
sharp!and!blunt!
trauma!
11/7/14! 2!
 Violence!and!Trauma!Study!

35%!of!violent! Overall!(GSW!&!
wounds!were! ST)!survival!rate!
from!stab!wounds! was!33%!

65%!survival!for!
stab!wounds!

11/7/14! 3!
 Mechanism!of!Injury!
Predictable+pa-ern+of+
injuries+based+on+forces+
applied+to+the+body+in+
trauma.!
Mechanism!of!injury!will!
help!you!assess!the!pa9ent,!
relay!important!informa9on!
to!the!hospital!and!key!you!
into!the!severity!of!your!
pa9ents!situa9on.!!+

It’s!elementary!my!dear!
Watson!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Remember!to!look!for!the!
CLUES!!!!

11/7/14! 4!
 How to describe a wound!

• The!nature!of!the!wound!(bruise,!lacera9on!or!
abrasion!etc).!
• The!wound!dimensions!(length,!width!and!
depth).!
• The!posi8on!of!the!wound!in!rela9on!to!fixed!
anatomical!landmarks!eg:!distance)from)the)mid)
line,!distance)below)the)clavicle…etc.!
• The!number!of!wounds.!
• The!margins!of!the!wounds!(Ragged!or!Everted)!
11/7/14! 5!
 Factors!affec9ng!wound!healing!

• Blood!supply.!
• Infec9ons.!
• Age!
• Site!of!wound.!
• Nutri9onal!status.!
• Inter!current!diseases.!
• Drugs:!cor9costeroids,!
immunosuppressive,!radiotherapy,!
chemotherapy.!

11/7/14! 6!
 WOUND!CLOSURE!
6 Flap bebas ( free flap )

5 Flap jauh

4 Flap lokal

3 Skin Grafting

2 Jahit primer / per primam

1 Sembuh sendiri/ per sekundam

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 Luka!tajam!

Luka!tumpul!
11/7/14! 9!
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 Stab+wounds+
•  Mechanism+
–  Sharp:+Tissue+disrup8on+
•  Extent+of+Injury+
–  Weapon+size,+length,+
sharpness,+penetra8on++
•  Severe+injury+
–  Chest+and+abdomen+
–  4++wounds+
–  (penetra8ng+injury+!+blunt+
trauma)+

11/7/14! 12!
 Airway!
!!!!Would!this!be!a!concerning!airway?!
!What!are!your!management!priori9es?!

11/7/14! 13!
11/7/14! 14!
 Don’t+
panic!!

11/7/14! 15!
Concepts+of+Ini8al+Assessment+!
Rapid+Primary+survey+!

Resuscita8on+!

Adjuncts+to+primary+survey+/resuscita8on+!

Detailed+secondary+survey+!

Adjuncts+to+secondary+survey+!

Reevalua8on+!

Defini8ve+care+!
11/7/14! 16!
 Ini8al+Assessment!

Primary+survey+and+
resuscita8on+of+vital+
func8ons+are+done+
simultaneously+–+++++++++
a+team+approach!

11/7/14! 17!
 Trauma+Team+
“Doin+it+24/7”!

!
• ED+Physicians!
• Anesthesiology!
• Surgeons!
• General+and+Trauma+and+Cri8cal+Care!
• Neurosurgery!
• Orthopedics!
• Medical+Students!
• Nurses!
• Radiology+Techs!
• Radiologists!
 Self-inflicted injuries!

!  Cuts are usually superficial, multiple and

parallel.
!  In right handed people most of injuries
are on the left side.
11/7/14! 19!
1)Throat+

! In slashing throat suicidal injury ,throwing

back the head, moves the carotid bundle
under the protection of the sternomastoid
muscles. So if the cut is confines to the front
of the neck, only the larynx or trachea may
be damaged!
11/7/14! 20!
1)Throat+
•  Stab!wounds!of!the!neck!are!UNCOMMON!in!
suicide.!

11/7/14! 21!
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 2)Wrist+

•  Deliberate cutting of the wrists is RARELY

effective as a sole method of suicide but it is
a COMMON injury!
11/7/14! 24!
3)Chest+

! Suicidal injury of the chest are almost

always stab wounds!
11/7/14! 25!
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 Defense Wounds!

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 Replanta9on!!
Decided,!usually!by!telephone,!are!suitable!for!
poten9al!replanta9on,!!
• ensure!that!hemorrhage!has!been!stopped!by!applica9on!
of!a!pressure!dressing!and!eleva9on,!and!that!fluid!
resuscita9on!has!been!ins9tuted!if!necessary.!!
• Tetanus!prophylaxis!may!be!required!and!broadjspectrum!
intravenous!an9bio9cs!are!begun.!!
• The!amputated!part!is!wrapped!in!sterile!gauze!
moistened!with!lactated!Ringer!solu9on,!sealed!in!a!
plas9c!bag,!and!placed!in!a!container!of!water!and!ice!at!a!
temperature!of39.2◦!F(4◦!C).!
11/7/14! 31!
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 Occlusive!Dressing!

11/7/14! 35!
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WOUND
Luka)tumpul):)oleh)karena)benda)
tumpul.)
Misal!:!
•  Luka!tusuk!tumpul!!!banyak!jaringan!
necrose!!!ingat!infeksi!anaerobe!
(tetanus)!:!kena!paku!
•  Luka!tembak!(Vulnus!sclopetum)!
!pelurunya!steril!karena!panas!
•  Luka!laserasi!(Vulnus!lacerosum)!–!
benturan!yang!luas,!terjadi!memar!
•  Luka!penetrasi!(Vulnus!penetratum).!Bila!luka!
menembus!rongga!tubuh.!Misal!:!peritoneum,!
pleura!
•  Luka!avulse!(Vulnus!avulsum)!–!terdapat!
lepasnya!sebagian!/!seluruh!jaringan.!Misal!:!
telinga!lepas!
•  Fractura!terbuka!
•  Luka!gigit!(bite)!serangga!/!anjing!/!ular!/!
orang!
 ring!
avulsion!
•  Suatu!keadaan!dimana!jaringan!kulit!&!
subku9s!atau!jaringan!yang!lebih!dalam!terj
elevasi!secara!paksa!sebagai!akibat!trauma!
keras!&!mendadak!
11/7/14! 45!
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 Macam+Penyembuhan+Luka+

First)Inten;on!=!primary!union!=!per!primam!

Second)Inten;on!=!second!union!=!per!
secundam!

Third)Inten;on!=!delayed!suture!=!per!ter9am!

Penyembuhan!dengan!carajcara!lain,!
misalnya!:!skin!grao!atau!flap.!!

11/7/14! 47!
 First!Inten9on!

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 Also!First!Inten9on!
•  !!

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 Secondary!Inten9on!

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 Thank+you+
11/7/14! 60!