S/M/40yo

84.66.45
Chief complaint : Lacerated wound on the
Right Upper Face
It has been suferred since 1 day before
admitted to Adam Malik Hospital. Previously
the patient was riding motorcycle then hitted
by another motorcycle from front side.
Mechanism of trauma was unclear. History of
unconsciousness (-), vomiting (-), seizure (-).
Active Bleeding (+), pain (+). History of
immunization was unclear. Patient was
referred from district hospital.
 Primary Survey
• A : Clear
• B : Spontaneous, RR: 22 tpm
• C : Warm acral, HR: 98 bpm, BP:
101/72mmHg, CRT<2”
• D : Alert, GCS 11, pupil isochor
• E : Lacerated wound (R) Upper Face
 AMPLE History
• A : No history of allergy
• M : No history of medication
• P : No history of past illness
• L : 8 hour before accident
• E : In the street
 Secondary Survey
• Head : in localized state
• Neck : no abnormality was found
• Chest : no abnormality was found
• Abdomen : no abnormality was found
• Genitalia : no abnormality was found
• Extremities : no abnormality was found
 Clinical Picture
Localized State :
(R) Eyes : skin avulsion size 5x3x1cm, irregular
edge, muscle based, contamination, active
bleeding (-) deformity (-), swelling (-)
(R) Cheek : lacerated wound size 6x1x0.5cm,
irregular edge, muscle based, contamination (+),
active bleeding (-), deformity (-), swelling (-)
Thorax Xray
Cervical Xray
Schedel Xray
 Laboratorium
Hb/ Ht/L/PLT : 11.3/ 33.4 / 18,960 / 251.000
Na/K/Cl : 137 / 4,7 / 106
Random Blood Glucose : 98
 Working Diagnose
Lacerated wound o/t (R) Periorbita + Skin
Avulsion o/t (R) Palpebra Inferior + (R) Bulbus
Oculi Exposed + HI GCS 11
 Treatment at the ER
• Inj. ATS 3000 IU IM
• Inj. TT 0.5 cc IM
• Antibiotic  Inj. Ceftriaxone 1 gram
• Analgetic  Inj. Ketorolac 30 mg
• Fluid  IVFD Crystalloid 30cc/BW
Plan:
• Debridement + FTSG
At Operation Theater :

• Patient in supine position under GA-ETT

anesthesia
• Aseptic and antiseptic procedure was performed.
• Wound identification o/t face
• (L) Forehead : lacerated wound size 3x1x0.5cm,
irregular edge, muscle based, contamination,
active bleeding (-) deformity (-), swelling (-)
• (L) Cheek : open degloving injury size 8x3x0.5cm,
irregular edge, muscle based, contamination (+),
active bleeding (-), deformity (-), swelling (-)
• The wound was washed with normal saline and
repeatedly until clean
• Non vital tissue and debris
was removed
• Marginal excision was
performed until seen
bleeding spot.
• Subcutis was sutured using
5/0 multifilament
absorbable round bodies
• Cutis was sutured
interruptedly using 6/0
monofilament non-
absorbable cutting bodies
• Wound was dressed with
tulle and sterile gauze
• Operation was done