Wound Management

Mohamad Romdhoni

Surgery Department ,Waled General

Hospital
 
 Curriculum Vitae
 Nama : Mohamad Romdhoni.,dr.Sp.B
 Tempat/Tgl Lahir : Cirebon 25,Juni,1984
 Alamat Rumah : Jl. Pangeran Cakra Buana, Perumahan The Gardens A7/9 Kecamatan Talun, Kabupaten :
Cirebon
 No. HP : 082219178082
 Alamat Kantor : Jln.Prabu kiansantang no.4, RSUD Waled Kab.Cirebon
 Pendidikan
S1 : Fakultas Kedokteran Universitas YARSI Jakarta (2002-2009)
Sp.1(PPDS.1) : Ilmu Bedah, Fakultas Kedokteran Universitas Padjadjaran (2013-2018)
 Pekerjaan : Dokter Umum UPT Puskesmas Susukanlebak kab.Cirebon
Dokter Spesialis Bedah, SMF Bedah RSUD Waled Kab.Cirebon
 Organisasi Profesi : Anggota IDI kab.Cirebon
Anggota PABI Jawa Barat Cabang.Cirebon
 Publikasi Imiah :
1. Characteristics of the patients with hemorhoid were treated at Departement OF Surgery DR.HASAN SADIKIN
2. Profile of Abdominal Trauma patient In Digestive Surgery Division of Dr Hasan Sadikin General Hospital JANUARY
1, 2011- DECEMBER 31, 2013
3. The influence of some risk factors to surgical site infection incidence in emergency laparotomy patients in
digestive surgery division of dr hasan sadikin general hospital
4. Inhibition of caffein and decaffeinated coffee extract, compared with vancomycin on the bacteria culture of
MRSA.( publish on indonesian journal of college surgeon )
WOUND

Granulation
Tissue
Normal Healing Milleu

Response to injury in the problem wound

Buck, Donald. W, et al. 2014. Wound Care. Grabb & Smith’s Plastic Surgery 7th Ed
Buck, Donald. W, et al. 2014. Wound Care. Grabb & Smith’s Plastic Surgery 7th Ed
Prinsip Penanganan Luka

Luka Basah Lembab

(moist) Luka Kering

▪ Kasa Absorben
▪ Hydrocolloid
▪ Hydrofiber
▪ Alginate
▪ Transparent Hydrogel
Dressing
▪ Foam

Menyerap Memelihara Memberi

cairan kelembaban kelembaban

Perdanakusumah, David, et al. 2015. Modern Wound Management: Indication & Application:
Pengetahuan Praktis.
Wound Classification
 T
Tissue non
I
viable or Infection or
deficient inflammation
Debridement

Wound Bed Edge- the edges

Preparation undermined and

the epidermis
Moisture
failing to
imbalance
migrate across
the granulation
tissue

E M
TIME. International Wound Journal. December
2012.
(T) Tissue Management
 Debridement
› Mechanical
› Surgical
› Biological
› Enzymatical
› Autolytic

 Cleansing
 Cleansers & Solutions

 Irrigation
 NORMAL SALINE
 WATER
 Povidone Iodine
 H2O2
 Other product
Mechanical

 Gauze
 Time consuming
 Low cost (gauze)
 Can be painful
 Non selective
 Hydrotherapy
 Tissue maceration
 Waterborne pathogen
contamination
Surgical
 Sharp under anesthesia  Painful
 Fastest method  Costly
 Very selective  Transport to OR
 Large amount of necrotic
tissue
Enzymatic
 Expensive
 Chemical enzymes
 Large necrotic, eschar
 Need prescription
 Fast acting  Careful application
 Need secondary dressing
 Inflammation may occur
Biologic
 Maggots  15-30 minutes to apply
 Larva therapy/  Use within 24 hours of arrival
biodebridement/ biosurgery  Non surgeon can use
 Dissolving dead tissue  Low cost
 Kill bacteria
 Speed healing
 BIOLOGICAL DEBRIDEMENT
MAGGOT DEBRIDEMENT THERAPY

10/cm2
16
Autolytic
 Body"s own enzymes  Slowly process
 Liquefy hard eschar and slough  Wound monitored closely
 Selective
 Safe
 Minimal / No pain
 Effective
18
(I) Inflammation & Infection Control
20
 (M) Moisture Balance

DRY MOIST WET

 WET

LOW MODERATE HIGH HEAVY

(E) Edge Advancement
Reconstruction Stepladder

Free flap / Flap bebas

Surgical Skill Regional flap / Flap Regional

Local Flap / Flap Lokal

Graft / Cangkok Kulit

Direct tissue closure / Jahit

Primer

Heal by secondary
intention / Sembuh Sekunder
 Wound Dressing

Conventional dressing
honey,povidon iodine, Nacl

Modern dressing
Hydrogel, transparent film, impregnated gauze, TGF, Foams

NPWT (Vacuum assisted closure)

 Advanced Wound Dressings
Criteria:
• Moist healing
• Bacterial barrier
• Permeable
• Waterproof
• Insulate
• Manage exudate
• Trauma protection
• Non-adherent
• Safe & easy to use
Modern
P e m b a l u t a b so r b t if
P em b a lu t a b so r b tif

C a lc iu m a lg in a t e
C a lc iu m a lg in a t e

Foam
Foam

 H y d r o fi b r e

40
H y d r o fi b r e

40
Fo a m

 Gel
 Calcium Alginate
 Hydrocolloid
 Silver
 Transparent dressing
 Hydrofiber
 Absorbent dressing
Black Necrotic Create moist
Hydrogel

28
Slough (Yellow Necrotic)

ENZYM

Collagenase (Santyl ®)

Fibrinolysin (Elase®)

Protease (Panafil®)

Papain urea (Accuzyme®)

Enzymatic or Hydro Gel
Trypsin (Granulex®)
Absorbent dressing

29
Infection (Yellow Green)

Mechanical Debridement (Wet to Dry Gauze)

/ Local Antibiotic / Antiseptic (Iodosorb)
/ Absorbent Gauze + Antiseptic (Silver)
Transparant Dressing

P e m b a lu t a b s o r b ti f

C a lc iu m a l g in a t e

Foam
H y d r o fi b r e

40

30 30
 P em b a lu t a b so r b tif

C a lc iu m a lg in a t e

Foam
H y d r o fi b r e

40

P e m b a lu t a b s o r b tif

C a lc i u m a lg in a t e

Fo am
H y d r o fi b r e

40

31
P e m b a l u t a b so r b t if

C a lc iu m a lg in a t e

F o a m
H y d r o fi b r e

40

32
NEGATIVE-PRESSURE WOUND
THERAPY

was developed in the early 1990s

In general indicated for fullthickness wounds such

as stage III and IV pressure ulcers and other deep
wounds that require assistance with contraction
and granulation tissue formation
Mechanism of NPWT
NPWT
Adapted from Agency for Healthcare Research and Quality. “Negative Pressure Wound Therapy
Devices,” Available at: http://www.ahrq.gov/clinic/ta/negpresswtd/npwtd02.htm. Accessed September
Modified VAC
F, 56 yo
Diabetic ulcer, left calf
0508 (D+3)
 (D+6)
(D+13) (D+17)
0505 (0)

(D+17) II (D+5 II)

M, 69 yo
Diabetic, abses at the back
M, 58 yo
Dm, necrotic tissue, right ankle
1006 (D+0) 1010 (D+4)
1014 (D+8) 1024 (D+4 II)
M, 49 yo
Paraplegic, tb vertebrae,
Sacral pressure sore
0306 (D+3)
0303 (D+0)

0309 (D+6)
0330 (D+26)
 Reference
 Grabbs & Smith, Textbook of Plastic Surgery, Elsevier, 7th
edition,2014
 McCarthy, Platic surgery, volume 1, Saunders,1996
 Hilko Weerda, Reconstructive Facial Plastic Surgery,
Thieme,2001
 Lynch JB. Flaps.InBrown DL. Michigan Manual of
PlasticSurgery.Lippincott Williams&Wilkins. Philadeplhia:2004
 Thorne CH.Techniques and Principals in Plastic Surgery. In
AstonSJ, Beasley RW, Thorne CH, editor: Grabb and Smith’s
Plastic Surgery. 6th Edition. Lippincott-Raven. Philadelphia:2007

43
TERIMAKASIH