Upload
ecthelon
View
233
Download
0
Embed Size (px)
Citation preview
8/3/2019 Teori Dari Wound
1/25
8/3/2019 Teori Dari Wound
2/25
Wound
8/3/2019 Teori Dari Wound
3/25
A wound is an area ofthe body
whose normal integrity has
been compromised.
8/3/2019 Teori Dari Wound
4/25
PunctureBruiseContusion (from blunt trauma)Abrasion
Incision (inflicted by a sharp object likescalpel)
Laceration (inflicted by a less sharp objectlike broken glass)
Ulcer (a break in epithelial continuity)Avulsion (partial or complete)Degloving (openor closed)Amputation (total, or near total)
8/3/2019 Teori Dari Wound
5/25
Open
Sharp : vulnus scissum, puncture wound Dull : vulnus laceratum, openfracture,
excoriation
Close
1.Vulnus contussum
2.Bullae
3.Hematome
4.Sprain
5.Dislocation
6.Close fracture
7.Vulnus traumaticum
8/3/2019 Teori Dari Wound
6/25
8/3/2019 Teori Dari Wound
7/25
Penetrating
Non-penetrating
8/3/2019 Teori Dari Wound
8/25
Acute : normally proceed through an orderly
and timely reparative process sustained
restoration of anatomic and functional
integrity
Chronic : wounds that failed proceed like
acute wound, or repair without establishingan anatomic and functional result
8/3/2019 Teori Dari Wound
9/25
Coagulation
Damage vessel&lymphatics hemorrhage vasoconstriction diapedesis fibrin mesh +
cytokine stop bleeding Inflammation
Migrationofleukocytes PMN + Macrophages
Fibroplasia Synthesis protein collagen 10hr after wound,
peak at 5-7 days, reduced gradually
8/3/2019 Teori Dari Wound
10/25
Remodeling
Inflammation stop inflammatory cells
diminished
equilibrium ofcollagen synthesisanddegraded
8/3/2019 Teori Dari Wound
11/25
72hr 2-4days 21days
8/3/2019 Teori Dari Wound
12/25
8/3/2019 Teori Dari Wound
13/25
Skin
Mucosa
Bone
Brain
8/3/2019 Teori Dari Wound
14/25
Sterile wound
Contaminative wound
Infection wound
8/3/2019 Teori Dari Wound
15/25
Antitetanus
Antibiotics ifnecessary
Immobilisation
Analgesics
8/3/2019 Teori Dari Wound
16/25
Clean
Debride
Irrigate
Excise
8/3/2019 Teori Dari Wound
17/25
Management of
sterile wound
Stop the bleeding
Close one by
one
8/3/2019 Teori Dari Wound
18/25
Wash the area surrounding ofthe wound
Dodesinfection surrounding the wound
Close the wound
Local anestesia
Wash the wound with H2O2/ dilutedPovidon
Do the evaluation
Wound toilet anddebridement
Prevention to tetanus etc.
8/3/2019 Teori Dari Wound
19/25
Disinfection surrounding the wound
Dont do infiltratifanestesia, do with blockanestesia or general anestesia
Washing byH2O2/ diluted povidone
Debridement
Dont do primary closure
Sistemic antibiotic
Prevention tetanus etc.
8/3/2019 Teori Dari Wound
20/25
Primary Closure
Surgical wound
DelayedPrimary Closure
Delayedfor several days to prevent infection inwounds (foreign bodies, contamination)
Spontaneous Closure or Secondary Wound
Closure Wounds margin move together by biologic
process ofcontraction
8/3/2019 Teori Dari Wound
21/25
8/3/2019 Teori Dari Wound
22/25
Mechanical (or local)
General
8/3/2019 Teori Dari Wound
23/25
Controllable by the surgeon:
avoidance ofuse ofstrong chemicals in skin
preparation avoidance ofinadvertent crushing oftissue
achieving adequate haemostasis
avoidance ofspillage ofinfective materials
8/3/2019 Teori Dari Wound
24/25
Nutrition
Oxygen
Oxygen radicals
Drugs
Smoking
Age
Temperature
Diabetes mellitus
8/3/2019 Teori Dari Wound
25/25
Wound infection Systemic infections
Chronic wounds andulcers Scars and contractures Keloids Lymphoedema
Bone complications: osteitis, osteomyelitis Tetanus Pressure ulcers