Professional Documents
Culture Documents
Oleh :
NUR FITRIAH
FAHMI MAULANA IBRAHIM
FABIOLA CHRISTELLA WULUR
NIRMALA SURYADI
Pembimbing Residen :
Supervisor :
dr. Roichan Firdaus
dr. Michael John, M.Kes.Sp.OT
dr. Indra Marionto R.
.
Sivananthan S, Sherry E. Mercer’s Textbook of Orthopaedics and Trauma. Hodder Arnold Publishers. 2012;1467-70
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ANATOMI
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ANATOMI
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ANATOMI
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ANATOMI
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ANATOMI
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ANATOMI
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ANATOMI
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ETIOLOGI
Neuropati Perifer
Trauma
ETIOLOGI
Aterosklerosis
Faktor yang berkontribusi
Diabetes
• Gibbons GW, Marcaccio EJ, Habershaw GM. Management of diabetic foot. In: Callow AD, Ernst CB, eds. Vascular surgery: theory and practice. Connecticut: Appleton and Lange. 1995:167-179. 9
• Singh N, Amstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. J Am Med Ass. 2005;293:217-28.
• Tellechea A, Leal E, Veves A, Carvalho E. Inflammatory and angiogenic abnormalities in diabetic wound healing: role of neuropeptides and therapeutic perspectives. Open Circulation Vascular J. 2010;3:43-55.
KLASIFIKASI
Core MAD, Ahn J, Lewis RB, Raspovic KM, Lalli TAJ, Wukich DK. The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot
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Infections. American Orthopaedic Foot & Ankle Society. 2018.
TIPE
Neuropatik Neuroiskemik
• Kaki teraba panas, • Kaki teraba dingin,
pulsasi masih teraba pulsasi tidak teraba
• Kulit kering dan terdapat • Risiko tinggi terjadi
fissura infeksi
• Terdapat callus dan • Minimal callus,
biasanya tebal cenderung nekrosis
Botros M, et al. Best Practice Recommendations for The Prevention and Management of Diabetic Foot Ulcers. WoundsCanada. 2019. 11
Rosyid FN. Etiology, Pathophsyiology, Diagnosis, and Management of Diabetic s’ Foot Ulcer. Int J Res Med Sci. 2017.
PATOFISIOLOGI
• Sensasi Protektif
• Proprioseptif
Sensorik
• Tekanan plantar
Neuropati Motorik • Mobilitas sendi terbatas
Gangguan Mikrovaskular
Kelainan
Vaskular
Makrovaskular Gangguan arteri perifer
Solomon, L. Apley’s System of Orthopaedic and Fractures. Hodder Arnold Company. 2010. 258-260 12
Lepantalo M. European Journal of Vascular and Endovascular Surgery : The Official Journal of the eurpoean Society for Vascular Surgery.. 2011;60-74
PATOFISIOLOGI
Gangguan
• Sensasi Protektif Kehilangan sensasi nyeri, arteri perifer
• Proprioseptif suhu, sentuhan, tekanan
• Tekanan plantar
• Mobilitas sendi
terbatas
kalus
• Produksi keringat
• Distribusi darah amputasi
dry skin fissure
Gangguan
Mikrovaskular
Solomon, L. Apley’s System of Orthopaedic and Fractures. Hodder Arnold Company. 2010. 258-260 13
Lepantalo M. European Journal of Vascular and Endovascular Surgery : The Official Journal of the eurpoean Society for Vascular Surgery.. 2011;60-74
TANDA & GEJALA
• Rasa kebas dan kesemutan di kaki
• Sensasi terbakar
• Keluhan membaik bila istirahat
• Nyeri pada kaki dan tungkai yang membatasi mobilitas
• Keluhan membaik bila istirahat
• Riwayat ulkus pada kaki dan tungkai
• Bebngkak pada kaki dan tungkai
IDF Clinical Practice Recommendations on the Diabetic Foot. 2017. A guide for healthcare professionals
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PEMERIKSAAN
RADIOLOGI
Sanverdi SE, Ergen FB, Oznur A. Current Challenges in Imaging of the Diabetic Foot. Coaction. 2012.
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PEMERIKSAAN
RADIOLOGI
• Osteomyelitis of the
navicular bone
• AP view : Ulkus dalam
pada Os naviculare
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Hochman MG, Cheung Y, Brophy DP. Parker JA. Imaging of the Diabetic Foot. Humana Press Inc. 2010.
PEMERIKSAAN
RADIOLOGI
• Lateral view :
subcutaneous air in both
dorsal and plantar soft
tissues surrounding the
metatarsal
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Hochman MG, Cheung Y, Brophy DP. Parker JA. Imaging of the Diabetic Foot. Humana Press Inc. 2010.
PEMERIKSAAN
RADIOLOGI
• Neuroarthropathy
(Charcot’s Foot) :
lateral subluxasi 1-5
tarsometatarsal joints
dengan peningkatan
densitas tulang
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Dhanda S, Quek ST. Imaging in Diabetic Foot. Journal of Arthritis. 2017
PEMERIKSAAN
RADIOLOGI
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Sanverdi SE, Ergen FB, Oznur A. Current Challenges in Imaging of the Diabetic Foot. Coaction. 2012.
DIAGNOSIS
- Anamnesis
- Pemerikasaan fisis
- Pemeriksaan P
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DIAGNOSIS
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TATA LAKSANA
Tatalaksana
Mechanical Pressure Control Non Weight Bearing:
Temporary shoes, Cast, Crutches, Wheelchair
Abscess Incision, Surgery
Wound Control Debridement
Carbonated/ Hydrophilic/ Silver impregnated dressing
Iodine
Hydrocoloid dressing
Vascular Control Berhenti Merokok , Aspirin, Warfarin
Revascularization
Metabolic Control Antihyperglikemia
Microbiological Control Antibiotik 2-6 weeks
First: Broad Spectrum Antibiotic {gram +, gram – (cephalosporin)
and anaerobic (metronidazole)}
Setelah kultur: Antibiotik Spesifik
Analgetik NSAID (Ibuprofen 600mg 4x1)
TCA (Amitriptillin 50-150 mg saat malam)
Setiati S, Sudoyo AW, Alwi I, Simadibrata M, Setiyohadi B, Syam FA. Buku Ajar Ilmu Penyakit Dalam.Edisi 6. Jakarta: Interna, 2014 22
KOMPLIKASI
• Deformitas
• Infeksi
• Ulkus
Frykberg RG, et al. Diabetic Foot Disorders : A Clinical Practice Guideline. The Journal of Foot & Ankle Surgery. 2006 23
EDUKASI
25
Lopez V. Diabetic Ulcers. Cited at April 2019.
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