CHRONIC WOUND

MANAGEMENT
Apa yang bisa dikerjakan di FKTP?

17 Oktober 2021 I 09.00 WIB - Selesai I LiveAt Zoom

IDI Cabang Lamongan x RSNU Babat
 BACKGROUND
• Chronic lower extremity ulcers become a major Loss of FUNCTION &
challenge to healthcare systems worldwide. decreased QUALITY OF
• United States: estimated 2.4–4.5 million people, last LIFE
on average 12 to 13 months, recur in up to 60-70% of
px.
• Indonesia: diabetic foot ulcer prevalence 15%,
amputation rate 30%, mortality 1 year after amputation
Significant cause
14,8%, prevalence increased per year 11% (Riskesdas MORBIDITY
2018).
• ETIOLOGY: chronic venous insufficiency, arterial
disease, prolonged pressure, or neuropathy.

Robert G. Frykberg and Jaminelli Banks (2015). Challenges in the High treatment
treatment of chronic wounds. Advances in wound care, volume 4, number 9 COSTS
BACKGROUND
 CHRONIC WOUND INTRODUCTION
• ACUTE wound becomes CHRONIC if healing is not achieved after 4 WEEKS of treatment.
• CHRONIC WOUNDS DEFINITION: wound FAILED TO PROCEED through the orderly process
that produces satisfactory ANATOMIC & FUNCTIONAL INTEGRITY.
• Majority not healed in 3 months: DIABETIC FOOT ULCER, CHRONIC VENOUS
INSUFFICIENCY, DECUBITUS ULCER

Schwartz Manual of Surgery 8th ed

 NORMAL WOUND HEALING

Fase penyembuhan luka seluler, biokimia dan mekanik Histologi A. Fase hemostasis/inflamasi. B. Fase inflamasi lanjut.
C. Fase proliferasi (angiogenesis da sintesis kolagen)
 WOUND MECHANICAL STRENGTH
• Fully healed wound: 75% to 80% of a
normal tissue.
• Delayed healing: decreased wound-
breaking strength (nutritional
deficiencies, infections, or severe
trauma).
• Impaired healing: failure to achieve
mechanical strength equivalent to
normally healed wounds (diabetes,
steroid, radiotherapy).
CHRONIC WOUND PROBLEM
 CHRONIC WOUND PROBLEM

Courtesy of Prof. DR. dr. David S. Perdanakusumah, Sp.BP-

RE (K)
 FACTORS AFFECTING WOUND
HEALING
SYSTEMIC LOCAL
• Age • Mechanical injury
• Nutrition • Infection
• Trauma • Edema
• Metabolic diseases • Ischemia/necrotic tissue
• Immunosuppression • Topical agents
• Connective tissue disorders • Ionizing radiation
• Smoking • Low oxygen tension
• Foreign bodies
TRADITIONAL VS MODERN DRESSING

Traditional dressing: pembalut primer atau

sekunder untuk melindungi luka dari
kontaminasi (kain kasa, serat, perban, kassa,
dan plester).

Modern dressing: balutan yang memiliki sifat

moist, antibacterial, absorbtive, available
(hydrocolloid, hydrogel, alginate, antimicrobial
silver, absorbent dressing, foam, transparent
film).
 WOUND BED PREPARATION
TIME PRINCIPLES
• TISSUE: assessment & debridement of nonviable or foreign material
(including host necrotic tissue, adherent dressing material, multiple
organism-related biofilm, or slough, exudate, and debris).
• INFECTION/INFLAMMATION: assessment of the etiology of each
wound, need for topical antiseptic and/or systemic antibiotic use to
control infection, & management of inappropriate inflammation
unrelated to infection.
• MOISTURE IMBALANCE: assessment of the etiology and management
of wound exudate.
• EDGE OF WOUND: assessment of nonadvancing or undermined
wound edges (and state of the surrounding skin)
Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R.Extending the TIME concept: what have we learned in the past 10 years?. Int
Wound J 2012;9 Suppl 2:1–19
WOUND BED PREPARATION
 CASE: MARJOLIN ULCER
(HISTOPATOLOGI SCC)
PROBLEM NECROTIC FLAP
• Tissue: debridement of nonviable or foreign
material. Modalities: scalpel, scissor
• Infection/inflammation: control infection, and
inflammation. Modalities: wound cleansing,
antibiotic
• Moisture imbalance: management of wound
exudate. Modalities: absorbent (foam dressing)
• Edge of wound: undermined wound edges (and
state of the surrounding skin). Modalities:
periwound hydrocolloid dressing
 MODERN DRESSING
FOR CHRONIC WOUND
PROBLEM COLOUR SURFACE

Courtesy of Prof. DR. dr. David S. Perdanakusumah, Sp.BP-RE (K)

 MODERN DRESSING
FOR CHRONIC WOUND

Irigasi luka Antimikrobial

 HYDROCOLLOID
• Wafers, powders or pastes composed of
gelatin, pectin or carboxymethylcellulose.
• Self-adhering & useful on areas that
require contouring.
• Primary dressing for dry to lightly
exuding wounds.
ALGINATE
Alginate dressings (biopolymer) are
highly absorbent (20x) and suitable for
use on exuding wounds, and for the
promotion of autolytic debridement of
debris in very moist wounds.
 FOAM
DRESSING
• Highly absorbent material and are often
made of polyurethane foam.
• Need a cover dressing and tape to
secure it in place, sometime waterproof
with an adhesive border and do not
require a cover dressing.
• Do not stick to wounds or leave a
residue and are sometimes used for
heavily draining wounds.
 HYDROGEL
• Consist of 90% water in a gel base.
• Keeping the wound moist, assists in
protecting your body from wound
infection and promotes efficient
healing.
• Autolytic debridement
HYDROFIBER
• Soft, non-woven pad or
ribbon dressing that contains sodium
carboxymethylcellulose.
• Absorbs a large amount of wound
exudate and transforms into a soft gel,
creating a moist environment.
• Promoting autolytic debridement,
without damaging newly formed tissue.
 VACUM ASSISTED CLOSURE (VAC)
NEGATIVE PRESSURE WOUND THERAPY (NPWT)

• A wound vacuum device removes

the pressure over the area of the
wound.
• Gently pull fluid from the wound over
time, reduce swelling, and may help
clean the wound and remove
bacteria.
• Pull the edges of the wound
together, stimulate the growth of new
tissue that helps the wound close.
MODIFIKASI DI FKTP
PITFALL
PITFALL
PITFALL
PITFALL
PERIWOUND MANAGEMENT
CASE: ULKUS DIABETIK WAGNER III
CASE: ULKUS DIABETIK WAGNER IV
CASE: ABSES + DM TIPE2
CASE: WOUND DEHISCENCE + DM
TIPE2
 KESIMPULAN

• Perawatan luka kronis di FKTP merupakan suatu tantangan

namun sangat mungkin dilakukan

• Pemilihan wound dressing yang tepat dilakukan setelah

dilakukan penilaian problem, warna dan permukaan luka

• Perawatan luka kronis dengan modern dressing yang optimal

dapat mempercepat penyembuhan luka
TETAP WASPADA
PENULARAN COVID-19
Tidak ada satupun RUMAH SAKIT di dunia mampu
mengatasi PANDEMI COVID-19 hanya dengan
menambah kapasitas tempat tidur atau RUANG
ISOLASI.

Mata rantai penularan covid dapat diputus dengan

langkah sederhana, PAKAI MASKERMU!!!

@dionfaisal31