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The Concept of
Wound Management
BASIC in ADVANCE WOUND CARE PROGRAM (BAWCP)
Luka sembuh
Pengertian :
Terciptanya kontinuitas lapisan
kulit serta adanya kekuatan jar.
parut yang mampu melakukan
fungsi / aktifitas yang normal

Outcome tergantung :
kondisi biologik
lokasi luka
luas luka
KONSEP LAMA (TRADISIONAL)

Luka kering
Perawatan luka
terbuka
Perawatan luka kering
/ basar
Berdarah berarti
bagus lukanya
KONSEP BARU
(EVIDENCE BASED PRACTICE / EBP)

Dimulai tahun 1962 :

oleh Dr. George D. Winter

Konsep dasar :

perawatan berbasis suasana lembab

sembuh 2x lebih cepat dibandingkan luka
kering
EBP: http://en.wikipedia.org/wiki/George_D._Winter

In 1962, while working at the Department of

Biomechanics and Surgical Materials at the
University of London, Winter published his
landmark Nature paper Formation of the scab
and the rate of epithelisation of superficial
wounds in the skin of the young domestic pig
(Nature 193:293 1962) where he demonstrated
that, contrary to the conventional wisdom that
wounds should be allowed to dry out and form
scabs to promote healing, wounds instead
healed faster if kept moist.
EBP:
http://www.thehealthline.ca/healthlibrary_docs/H.1.IntroMoistWoundHeali
ng.pdf
Since Dr. George Winter (1962)
(i) demonstrated faster epithelialization in a small sample of experimental porcine wou
nds covered with an occlusive dressing, the principles of moist wound healing have evo
lved into a science.
Sophisticated dressingsii (Thomas 1997) (ii)
provide moist, isotonic, interactive and nontoxic environments for healing, but only fu
nction optimally when they match the characteristics of the wound (iii)
Marks et al.
(iv) (1987) described the ideal characteristics of a wound dressing, including: Imperme
ability to water and bacteria, Freedom from particulate matter, Thermal insulation, Ab
sorption and retention of exudate, Prevention of trauma on removal, Removal of toxic
substances, Prevention of dehydration, Allow for gaseous exchange.
Sharp et al. (v) (2001 ) added pain relief and comfort. (vi)

i Winter, G.D. 1962. Formation of the scab and rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 193, 29329
ii Thomas, S. 1997. A structured approach to the selection of dressings. World Wide Wounds [Online] Available at: http://www.worldwidewounds.com [A
ccessed: Jan 1, 2008].
iii Schultz, G.S., Sibbald,.RG., Falanga, V., Ayello, E., Dowsett, C., Harding, K., Romanelli, M., Stacey, M.C., Teot, L., VanScheidt, W. 2003. Wound bed prepa
ration: a systematic approach to wound management. Wound Repair and Regeneration 11(2), pp. 128.
iv Marks, J., Harding, K.G. & Hughes, L.E. 1987. Staphylococcal infections of open granulating wounds. British Journal of Surgery 74, pp. 9597.
v Sharp, C.A. and McLaws, M. (2001) Wound dressings for surgical sites. (Protocol) Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD00309
1. DOI: 10.1002/14651858.CD003091. Chichester, UK: John Wiley & Sons, Ltd., pp. 15.
Fisiologi tanpa penyulit : Debris (pembersihan) pada luka (A) selama proses
inflamasi. Pembentukan SCAB/KEROPENG (B) ketika luka dibiarkan terbuka
(kering)
Fisiologi tanpa penyulit: Scab: melindungi suasana lembab dibawahnya
hingga terbentuk kulit yang baru. Setelah epitelisasi (luka menutup) scab
menjadi scar
 SUASANA LEMBAB: MINIMAL KOMPLIKASI
KONSEP LEMBAB DAN OCCLUSIVE /
KONSEP KERING DAN TERBUKA
TERTUTUP
Akibat dari faktor penyulit yang
tidak diatasi:
Luka fisiologis menjadi patologis
Luka akut menjadi luka kronis
Luka steril menjadi luka terkontaminasi
Luka primer menjadi tersier (delayed primary)

PENTING mengatasi faktor penyulit dari proses penyembuhan luka

FAKTOR YANG
MENGHAMBAT/PENYULIT
SISTEMIK FAKTOR
UMUM
USIA

PENYAKIT PENYERTA

PENURUNAN VASKULARISASI

HILANG SENSASI DAN GANGGUAN GERAK

NUTRISI YANG BURUK

OBESITAS

PENGOBATAN
LOKAL
WOUND MANAGEMENT PRACTICE

HIDRASI

TEMPERATURE

PRESURE, FRICTION, SHEAR FAKTOR

LOKAL
ADA BENDA ASING

INFEKSI
LUKA DENGAN PENYULIT
TERIMAKASIH