WOUND CARE AND

MANAGEMENT
3 bln yang lalu, operasi ganglion di
lengan di antebrachii dextra distal,
lateral, dikerjakan dikamar bedah,
narkosa umum, ODS

Selama 3 bulan luka tidak

sembuh2 dengan berbagai cara
pengobatan

Pseudomonas (+), kolonisasi atau

infeksi?

OS sangat depresi, tidak mau

pulang ke Brunei, keluarga
terpisah

Telah dibicarakan di komite medik

 Mahasiswa ITB, asal
Siborong borong SUMUT
2 tahun yang lalu
appendectomy, tp luka tidak
sembuh2
Pernah eksplorasi dgn
anestesi lokal dan
perawatan klinik
Terakhir kurang lebih
sebulan yl eksplorasi
narkosa umum, ODS,
benda2 asing berupa
benang tak diserap diambil
, debridement sampai
subfacia
Fistulografi tidak ada
hubungan dengan usus
FOUR PHASES OF WOUND HEALING

1. Hemostasis
2. Inflammation
3. Repair
4. Remodelling
SQUENCE OF MOLECULAR
AND CELLULAR EVENTS IN
SKIN WOUND HEALING
 PATIENTS PERCEPTION
NORMAL WOUND HEALING
Inflammatory phase
Induration
Heat
Discomfort
Redness
Swelling
Are part of normal wound healing processes not
likely to be due to wound infection!
The first 3 weeks after surgery, the patient is at
high risk for wound dehiscence and evisceration
 CLASSIFICATION OF EXUDATE

I . TYPE = Colour and consistency

Serious or clear fluid
Sanguineous for blood
Purulent PUS
II. AMOUNT : When the dressing is removed
None
Small-Less than 33% of dressing surface
Moderate less than 67%
Large covering more than 67%
 THE MNEMONIC:
WOUND PICTURE

Wound or ulcer? Pain?

Odor? Induration
Ulcer category? Color
Necrotic tissue? Tunneling?
Dimension? Undermining?
Redness?
Edge of Skin?
 WOUND INFECTION
CLINICAL SIGNS AND SYMPTOMPS
Superficial wound infection (NERDS)
Non healing wound
Exudate wound
Red and bleeding wound surface granulation
tissue
Debris on the wound surface
Smell on unpleasant odor
 WOUND INFECTION
CLINICAL SIGNS AND SYMPTOMS

Deep Infection (STONES)

Size bigger
Temperature increase
Os = prone to or exposed bone
New on satellite areas of breakdown
Exudate, evythemia, edema
Smell
 MANAGING WOUND BIOBURDEN

Wound cleaning
Cleaning agents?
Skin cleaners ? no!
Antiseptic ? no!
Cleaning devices?
Wound irrigation?
Optimum pressure for wound cleaning? (5-15 psi)
 MANAGING WOUND BIOBURDEN

Antimicrobial therapy
After removal of necrotic tissue
Topical elemental antimicrobial therapy with
silver based creams be limited to 2 weeks
The effectiveness of systemic antibiotics is
dependent on an adequate blood supply to the
wound
 WOUND TREATMENT OPTIONS

Moist wound therapy

Dressings based on assessment of wound
characteristics
Indications for use of dressings by categories
The advantages and disadvantages for each dressing
category
The principles of care in dressing selection
Use of advanced therapies
 THE CASE AGAINST GAUZE DRESSINGS

A gauze dressing can impair wound healing because it lowers

the wound temperature and impedes fluid evaporation
Wet-to-dry gauze dressings are non-selective mechanical
debridement method removal of healthy tissue causes
injury to the wound and pain
Higher infection rates than transparent films or
hydrocolloids
Bacteria are released into the air when gauze dressings are
removed
Semi occlusive dressings are more financially feasible form a
total cost perspective

Ovington LG: Advanced in Skin & Wound Care 15 (2), 79-84,2002

 WHY ARE GAUZE DRESSINGS STILL USED ?

Gauze dressings have a long tradition in wound care- gauze

and saline are familiar and readily available
Gauze is perceived is being inexpensive how about total
cost?
Most advanced dressings are discrete dimensions and cant
always be adjusted for wounds of different sizes
Many practitioners are unaware of the broad array of
alternative dressing may be perceived as more expensive
than gauze

Ovington LG: Advanced in Skin & Wound Care 15 (2), 79-84,2002

 PRACTICE POINTS
Partial thickness wounds in pigs covered with a plastic
material had two times faster epithelialization than identical
wounds left open to air
Nature 193: 293-94.1962
Dressing choice = wound assessment + principles of wound
care
If the wound is dry, add moisture, if the wound has drainage,
absorb it, if the wound has necrotic tissue, debride it
Wound dressings should be changed to meet the
characteristics of the wound bed
 THE IDEAL DRESSING

Maintain a moist environtment

Facilitate autolytic debridement
Be comfortable for the range of use needed
Come in numerous shape and sizes
Be absorbent
Provide thermal insulation
Act as a bacterial barrier
Reduce or eliminate pain at the wound site and not
cause pain on dressing removal

Seaman S, J Am Podiatric med Ass, 92 (1) 24-33, 2002

 HOW TO EVALUATE THE DRESSING

Number of days the dressing can remain in place

Reason for change and removal
Appearance of dressing (soiled or intact)
Ease of dressing application
Ease of dressing removal
Ease of dressing maintenance
Ease of teaching about dressing to caregiver

Seaman S, J Am Podiatric med Ass, 92 (1) 24-33, 2002

MOIST WOUND THERAPY AND DRESSING
OPTIONS

1. Transparant film dressings

2. Hydrocolloid dressings
3. Hydrogel dressings
4. Foam dressings
5. Calcium alginate dressings
6. Hydrofiber dressings
7. Composite dressings
8. Collagen dressings
9. Contac layer dressings
10. Gauze dressings
11. Antimicrobial dressings
 ADVANCED THERAPIES

Tissue engineered skin substitutes

Negative pressure wound therapy (NPWT)
Electrical stimulation
Low-level laser therapy in wound healing
Ultraviolet light
Compression therapy
Growth factors
Hyperbaric oxygen therapy
Ultrasound energy for wound healing
Dallam IE, Barkankas C, Ayello EA et al :
pain Management Wounds, in Wound
Care Essentials 2nd edit, Lippincot,
Williams & Wilkins, 2008
 KONSEP MANAJEMEN LUKA
Dasar - Dasar Perawatan Luka

1. Ekstraksi 2. Irigasi 3. Pengkondisian dengan 4. Penge - 5. Pengangkatan

zat-zat asing bahan dressing spesial luaran jaringan mati

1. Larutan Pember - 1. Jahitan pada

makanan sihan luka

2. Faktor-faktor
2. Staples
pertumbuhan
Stimulasi LUKA Penutupan
3. Kompres 3. Plester peng -
salep ganti jahitan

4. Arus Coverage / 4. Perekat

listrik Perlindungan jaringan

2. Dressing 3. Tubular Dressing 4. Film 5. Special

1. Dressing
siap pakai Dressing Dressing
 KONSEP MANAJEMEN LUKA
II. PERAWATAN LUKA

Pencegahan infeksi dengan

Obat-obat ter - pengangkatan
tentu yang zat-zat asing dan kuman
dapat Pember- Mengurangi
menggantikan celah luka,
sihan
kekurangan sehingga
dari zat-zat memungkinkan
esensial yang Stimulasi LUKA Penutupan kerusakan jari -
dapat menunda ngan diperbaiki
penyembuhan, dengan lebih
dengan demiki Coverage / cepat
-an akan mem -
Perlindungan
bantu proses
penyembuhan
Dressing memelihara luka dari faktor
- faktor yang mengganggu
Characteristics of an ideal wound dressing

Maintains a moist wound environment

Absorbs excess exudate
Eliminates dead space
Does not harm the wound
Provides thermal insulation
Provides a bacterial barrier

(Seaman. S, Dressing selection in chronic wound management, Journal of

the American Podiatric Medical Association, 92[1]:24-33)
TEHNIK JAHITAN LUKA