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Closed degloving

Kelompok jaga 17 juni 2013

Definisi
Degloving
• Avulsi kulit dari otot dan tulang di bawahnya
(MacCollum DW. Wringer arm. NEJM 1938)

• Cedera degloving terdiri dari lepasnya kulit
dan jaringan sub kutis dari fascia dan otot di
bawahnya dan ruptur dari vasa perforator
(Wojcicki P, Wojtkiewicz, Drozdowski P. Severe lower extremities degloving
injuries-medical problems and treatment results.Polski Przeglad
Chirurgiczny 2011;83(5):276-82)

Knottenbelt J. Closed degloving injuries: Results following conservative surgery. Plast Reconstru Surg 1992. Fractures of the acetabulum 2nd ed Berlin. • Letournel E.Closed internal degloving injury • Cedera soft tissue dimana jar.subcutan terobek dari fascia di bawahnya menyebabkan adanya ruang potensial yg bisa terisi cairan serous. hematom & liquefied fat • Hudson DA. 1993:87) . Germany: Springer. Krige J. Judet R.Verlag. 89: 853.

Penyebab KLL (45 %) Mesin pabrik / pertanian (31 %) Pejalan kaki vs motor (24 %) .

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• 1 papilla dermis punya satu arteri asenden dan satu cabang vena. antara dermis dan jaringan subkutis.VASKULARISASI KULIT • Sistem pendarahan pada kulit: – Sistem perforator / plexus – Sistem direct cutaneous • Arteri  pleksus antara lapisan papiler dan retikuler dermis. .

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Mekanisme Compressive. transferred to High energy soft tissue Torsion. injury Tangential forces & bones .

Avulsi kulit & jar subcutan k/ shearing force sepanjang fascia Ruptur vasa perforata Vascularisasi kulit  Underlying fascia (-)  (+) : Plexus dermal + subcutan .

Clin Plast Surg 1986. Lower extremity avulsion injuries.Klasifikasi • Hidalgo (3) : – Typical. open degloving injuries – Atypical (closed) degloving injuries = Morell- Lavallee injury – Skin avulsion in particular areas (scalp & soles) Cedera bisa di sekeliling bagian atau bagian ttt tubuh (Hidalgo DA.13(4):701-10) .

Closed degloving injury = 1.Open degloving injury Morell-Lavallee . 2.

3. Skin avulsion in soles .

Reconstructive & Aestethic Surgery 2010. Non circumferential degloving 3. Multi plane non circumferential degloving (Arnez ZM.Khan U. (4)  ekstensi mekanisme cedera 1. …klasifikasi • Arnez et al. Tyler MPH.63:1865-69) . Classification of soft-tissue degloving in limb trauma. Single plane non circumferential degloving 4. Journal of Plastic. Limited degloving with abrasion / avulsion 2.

Jika selubung jaringan lunak degloved  penilaian menjadi tidak jelas Keputusan : excisi / conserve  sulit .

kulit intak o Palpasi  fluktuasi o Pemeriksaan : tes flouroscein. test shaves • Penunjang : akumulasi cairan o USG o CT . swelling .Diagnosis • Anamnesa : Riwayat & mekanisme cedera • PF o Inspeksi  benjolan. thrombosed sub cutaneus veins.

Mntkn vaskularisasi avulsion bed : garis demarkasi ant kulit viabel & non viabel .Iv flouroscein .kompleks. kdg over estimate Thrombosed sub cutaneus vein Menandai zona demarkasi Test Shave Demarkasi : bintik perdarahan dari jar viabel .

CT Scan (subcutaneus fluid collection) .

21(10). Sheldon GF.Kudsk KA. . The Journal of Trauma 1981. Walton RL. Degloving Injuries of the Extremities and Torso.

. Closed degloving injuries: Results following conservative surgery. Plast Reconstru Surg 1992.Penatalaksanaan closed degloving • MacCollum. 89: 853. Krige J. Knottenbelt J. Hudson  conservative management o hematom sub cutan & jaringan lemak yg mati dibuang o Diikuti drainase & balut tekan (pressure dressing) Hudson DA.

…penatalaksanaan closed degloving • Kebanyakan peneliti menyarankan opening the fluid collections dan drainase • Beberapa melaporkan keberhasilan penanganan secara tertutup dikombinasi dengan terapi dekompresif dan decompression puncture .

…penatalaksanaan closed degloving • Variasi metode / teknik kombinasi tx : o Kompresi o Aspirasi cairan o Liposuction o Injeksi scleroting agent o Open surgical debridement .

Wojtkiewicz.Wojcicki P.83(5):276-82 . Severe lower extremities degloving injuries- medical problems and treatment results 2011. Drozdowski P.

Severe lower extremities degloving injuries-medical problems and treatment results 2011.Germany: Springer. Wringer arm. Judet R.83(5):276-82 • Hudson DA.Knottenbelt J. Clin Plast Surg 1986.13(4):701-10 . • Letournel E.Verlag. 89: 853. Daftar Pustaka • MacCollum DW. Closed degloving injuries: Results following conservative surgery. 1993:87) • Hidalgo DA. Drozdowski P. Krige J. Lower extremity avulsion injuries. Fractures of the acetabulum 2nd ed Berlin. Plast Reconstru Surg 1992. NEJM 1938 • Wojcicki P. Wojtkiewicz.

Classification of soft-tissue degloving in limb trauma. Tyler MPH.63:1865-69 • Kudsk KA. Reconstructive & Aestethic Surgery 2010. Walton RL.Khan U. Sheldon GF.• Arnez ZM.21(10). Journal of Plastic. The Journal of Trauma 1981. Degloving Injuries of the Extremities and Torso. .