Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
KOLEGIUM BEDAH
INDONESIA
Introduction
Normal healing of acute skin wound :
- through 4 distinct, but overlapping phases
Key-elements:
Net collagen synthesis,
Increase in wound tensile strength,
Scar formation
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
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
1. Trauma
2. Surgery
3. Burn
4. Severe arterial insufficiency
5. Edema with venous insufficiency
6. Prolonged pressure
7. Intermittent trauma without protective
sensation &
poor perfusion
WOUND HEALING &
PROBLEM
Most wounds heal through a normal healing
sequences,
regulated by integrated actions of chemokines,
cytokines, growth factors & proteases
Synergy
PROBLEM
WOUND
( Warriner, 2003)
Local Factors Affecting
Wound Healing
NONHEALIN
G
Warriner, 2003) WOUND
Systemic Factors Affecting
Wound Healing
Type of damage
Local
Factors
Extent of damage
2. Secondary intention
3. Tertiary intention
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
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.
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.
GENERAL PRINCIPLES OF
WOUND CARE
Local Bioburden Management / Infection
Control
Wound Debridement
Surgical / sharp debridement
Mechanical Debridement
Chemical or Enzymatic Debridement
Autolytic Debridement
Concept of Wound Bed
Preparation
Debridement of nonviable tissue and
denatured extracellular matrix (ECM),
Types of debridement :
Surgical / sharp debridement
Mechanical Debridement
Chemical or Enzymatic Debridement
Autolytic Debridement
Surgical Debridement
Sharp debridement uses a scalpel, scissor or
other instrument to cut devitalized tissue
Scab
Exudate Epidermis
Dry dead skin
Dermis
Fat
Traditional Collagenase :
- Bromelain : nanas
- Papain : papaya
- Maggots
Maggots Therapy
Autolytic Debridement
Autolytic debridement takes advantage of the
body's own ability to dissolve dead tissue.
The key to the technique is keeping the
wound moist,
which can be accomplished with a variety of
dressings. These dressings help to trap wound
fluid that contains growth factors, enzymes, and
immune cells that promote wound healing.
Autolytic debridement is more selective than
any other debridement method, takes the
longest time to work.
Inappropriate for wounds that have become
infected.
2. Bacterial Load
Management
Antibiotic ?
Antiseptic ?
Bacterial burden in the wound bed (Melhuish 1994)
Systemic
antibiotics and
local antimicrobial
No antimicrobial treatment - Local
treatment
standard MWH antimicrobial
treatment
Bacterial count
Critically colonised
Contaminated Colonised Infected
Moist
Moist
Environment
Environment
WOUND HEALING’S
CONCEPT
TYPES OF WOUNDS &
COLOUR’S SYMBOLS
Necrotic tissue
Black
Slough
Yellow
Infection
Green
Granulation
Red
Epithelialization
Pink
INDICATIONS OF MODERN
DRESSINGS
Kinds & Properties of Wound Dressing
e Choice of Wound Dressings
Scab Necrosis Granulation Epithelialization
Formation
Red → Black Yellow Red Pink
Degree I
Degree II
Degree III
Degree IV
(N=Normal)
Tipis,
Semi permeable
polyurethane film
Mencegah kontaminasi
bakteri
Menjaga kelembaban luka
Protective Layer
Absorptive Layer
Polyurethane foam
Daya Absorbsi tinggi
Mampu menampung eksudat secara
optimal
Product Information
Indikasi
Untuk penyembuhan luka basah/ normal (luka
gores, luka trauma, luka bernanah akut &kronik,
luka borok, leg ulcer, luka diabetes, luka bedah,
luka bakar tingkat I & II, luka ganas )
Penggunaan
1x pakai, dapat di potong sesuai ukuran luka
Product Information
(B=Based)
Absorptive Layer
Polyurethane foam
Daya Absorbsi tinggi
Mampu menampung eksudat
secara optimal
Product Information
Indikasi
Untuk penyembuhan luka sangat basah/ parah (luka bernanah kronis &
akut, luka borok, leg ulcer, luka diabetes, luka ganas, luka bakar
tingkat III)
Penggunaan
1x pakai, dapat di potong sesuai ukuran
Product Information
(F=Film)
Low allergetic
Waterproof
Mudah digunakan
Adhesive Film
Layer
Protective Film
Absorptive Layer
Tipis, Layer
Semi permeable polyurethane film Polyurethane foam
Mencegah kontaminasi bakteri Daya Absorbsi tinggi
Menjaga kelembaban luka Mampu menampung eksudat secara
optimal
Product Information
Indikasi
Untuk penyembuhan luka dengan luas luka kecil & ringan
Penggunaan
1x pakai , langsung ditempel pada luka.
TERIMA KASIH
56