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7/24/2019 Acute Hand Injury
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PENANGANAN CEDERAPENANGANAN CEDERA
TANGAN AKUTTANGAN AKUT
DAVID S PERDANAKUSUMADAVID S PERDANAKUSUMA
BAGIAN/SMF BEDAH PLASTIKBAGIAN/SMF BEDAH PLASTIK
FK.UNAIR - RSU DR. SOETOMOFK.UNAIR - RSU DR. SOETOMO
SURABAYASURABAYA
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6 Jaringan6 Jaringan
1.1. KulitKulit
2.2. Tula!Tula!
".". S#$iS#$i%.%. P#&'ulu( Da)a(P#&'ulu( Da)a(
*.*. T#$+T#$+
,.,. Sa)aSa)a
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"
Konsep RekonstruksiKonsep Rekonstruksi
1.1. E0i0i a)i!a )u0a $a t#)+ta&ia0iE0i0i a)i!a )u0a $a t#)+ta&ia0i
2.2. P#)'aia 0#!#)a i&$iat#3 0#lu)u(P#)'aia 0#!#)a i&$iat#3 0#lu)u(a)i!a a! 4#$#)aa)i!a a! 4#$#)a
".". S#4#5ata !!ati a)i!a a!S#4#5ata !!ati a)i!a a!(ila!(ila!
%.%. R#4aaa 5#!!atia uit u!0i+alR#4aaa 5#!!atia uit u!0i+al
*.*. R#(a'ilita0i ati $iiR#(a'ilita0i ati $ii
,.,. M#&5#)i)aa u4ti+al +ut4+M#&5#)i)aa u4ti+al +ut4+
6.6. K#&'ali $a5at '##)aK#&'ali $a5at '##)a
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ANATOMIANATOMI
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*
Anatomi fungsional TanganAnatomi fungsional Tangan
27 tulang27 tulang
! persen"ian! persen"ian
# otot $ %& intrinsik' %& ekstrinsik (# otot $ %& intrinsik' %& ekstrinsik ( s)araf utama s)araf utama
*istim pem+ulu, "ara, )g sangat +aik*istim pem+ulu, "ara, )g sangat +aik
*truktur penun-ang )g sangat kompleks*truktur penun-ang )g sangat kompleks
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,
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7/24/2019 Acute Hand Injury
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)a$ial 'u)0a)a$ial 'u)0a
'#)(u'u!a'#)(u'u!a
$#!a ula) 'u)0a$#!a ula) 'u)0a0#ita) *9-79:0#ita) *9-79:
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12
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1"
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1%
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1*
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1,
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;#$#)a ta!a u&u&a $ala& '#tu
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Pemeriksaan fisik .e"era tanganPemeriksaan fisik .e"era tangan
1.1. Statu0 >a0ula)i0a0i 'a!ia $i0tal $a)i t#&5atStatu0 >a0ula)i0a0i 'a!ia $i0tal $a)i t#&5at4#$#)a4#$#)a
2.2. K+$i0i ulit $i 0#ita) luaK+$i0i ulit $i 0#ita) lua".". Fu!0i t#$+ 'a!ia $i0tal $a)i luaFu!0i t#$+ 'a!ia $i0tal $a)i lua
%.%. Fu!0i 0a)a 'a!ia $i0tal $a)i luaFu!0i 0a)a 'a!ia $i0tal $a)i lua
*.*. ;#$#)a tula!;#$#)a tula!
,.,. D#)aat +ta&ia0i atau #&u!ia i#0iD#)aat +ta&ia0i atau #&u!ia i#0i$a)i lua.$a)i lua.
6.6. Statu0 tal $a #&+0i $a)i 5a0i#.Statu0 tal $a #&+0i $a)i 5a0i#.
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Diagnosis Luka
Preparasi luka
Pengelolaan jaringan non vitalKontrol bakteri
DebridementAntibiotik
GraftSekunderPrimer Flap
Luka telah terpreparasi
Luka sembuh
Penutupan luka
PenilaianPasien
Tes Vitalitas aringan
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Pengelolaan A/alPengelolaan A/al
P#4u4ia luaP#4u4ia lua
D#')i$#t < t#0 >italita0 a)i!a $aD#')i$#t < t#0 >italita0 a)i!a $a
#0i0i a)i!a + >ital.#0i0i a)i!a + >ital.
P#utu5a lua < 5)i)? 5#)0#u$a&?P#utu5a lua < 5)i)? 5#)0#u$a&?
0i !)at $a la5.0i !)at $a la5.
A#0t#0i < 'l+4? iilt)ati? it)a>#+u0A#0t#0i < 'l+4? iilt)ati? it)a>#+u0)#!i+al? 'iu0 u&u&)#!i+al? 'iu0 u&u&
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'l+4 Iilt)a0i $+)0al
#li)u
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2323
0nsisi Kulit0nsisi Kulit
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2%
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2*
Primary Closure
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2,
Skin Graft
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Conservative Treatment
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Replantation
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"2
B#$a( Mi)+>a0ul#) $ilaua utuB#$a( Mi)+>a0ul#) $ilaua utu
5#&'ulu( $a)a( $iat#) @ 2?* &&5#&'ulu( $a)a( $iat#) @ 2?* &&
P#&ili(a '#a! 19-9 &++ila l+P#&ili(a '#a! 19-9 &++ila l+
utu 5#&'ulu( $a)a( 9?7 1?* &&utu 5#&'ulu( $a)a( 9?7 1?* &&
8-9 utu $iat#) 1?, 2?* &&8-9 utu $iat#) 1?, 2?* &&
11-9 utu $iat#) @ 9?6 &&11-9 utu $iat#) @ 9?6 &&
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""
1olar 13 a"4an.ement flap $Ataso)(
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"%
5ateral 13 a"4an.ement flap $Kutler(
omo"igital *tep5a""era"4an.ement
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"*
g p neuro4as.ular flap
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",
Side finger flap
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"6
Pal&a) la5
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"7
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"8
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%9
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%1
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%2
Intrinsic plushand
Lumbricalposition
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P)i0i5 5#a!aaP)i0i5 5#a!aa
Riaat 5a0i#Riaat 5a0i#
P#)i0aa i0iP#)i0aa i0i
E05l+)a0i 5#&'#$a(aE05l+)a0i 5#&'#$a(aP)i0i5 +5#)a0i a0ula)i0a0i ! a$#uatM#!#&'alia >a0ula)i0a0i ! a$#uat
2.2. P#utu5 a)i!a lua a! 'aiP#utu5 a)i!a lua a! 'ai
".". Sta'li0a0i $a ali!t tula!Sta'li0a0i $a ali!t tula!%.%. M#!#&'alia u!0i 0a)aM#!#&'alia u!0i 0a)a
*.*. M+'ili0a0i 5#)0#$iaM+'ili0a0i 5#)0#$ia
,.,. M#!#&'alia u!0i t#$+M#!#&'alia u!0i t#$+
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