JENIS-JENIS LUKA dan

PENATALAKSANAANNYA

Pembimbing :
dr. Dharma Gita

Oleh :
Fina Agustiani Liaw
 Anatomy
• Epidermis
– Thin, avaskular, stratified, outermost layer of
the skin
– The process of differentiation or regeneration
of the epidermal layer is stimulated by growth
factors.
– The primary cells in this layer are
Keratinocytes and Melanocytes.
– The primary functions of this layer are
Protection and Regulation.
• Subcutaneous Tissue
– Supports and anchors the Epidermis and
Dermis to the underlying body tissue.
– Age, heredity, and nutritional intake
influence the thickness of this layer.
– Consists of connective tissue and adipose
tissue.
– The primary functions of this layer are
protection, insulation, energy, and body
shape

• Dermis
– Contains blood vessels, nerve fibers,
lymphocytes, sweat and sebaceous
glands, and hair follicles.
– Main proteins present are collagen
and elastin.
– The primary functions of this layer are
strength, nutrition and structural
support.

Newfoundland Labrador. Skin and Wound Care Manual.Labrador Grenfell Health and Western Health.2008
 Wound

• A wound is sustained when there is disruption

of normal anatomy and integrity of tissue
function.

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
 • Acute - are caused by trauma or surgery.
Acute wounds heal in a predictable period of
time and most will go on to heal within 2-8
weeks.
• Chronic - are defined as wounds, which have
failed to proceed through an orderly and
timely reparative process to produce anatomic
and functional integrity over a period of 3
months

Wound Care Guidelines. Central West Community Care Access Centre. 2017
Werdin F. Mayer T, Et al. Evidence based management stratergies for treatment of chronic wounds. 2009. Downloaded in
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691645/
 Acute Wound
1. Incision wound (v. scissum)
2. Contusion wound (v. Contusum)
3. Laceration wound (v. lacerum)
4. Puncured wound (v. punctum)
5. Abrasion wound (vulnus abrasum)
6. Bite wound (v. Morsum)
7. Cut wound (v. caesum)
8. Shot wound (v. sclopetarium)

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
 Chronic Wound

Diabetic foot ulcer

The pressure ulcer

The venous stasis ulcer

Jorge I. Chronic Wounds. Medscape. 2017

 Diabetic Foot Ulcer
• Management :
consult, off-loading,
attentive
debridement, wash
and inspect feel daily,
dry carefully,
maintenance of a
moist wound
environment.
Jorge I. Chronic Wounds. Medscape. 2017
Newfoundland and Labrador Skin and Wound Care Manual – July 2008. Section 6 - Page 21
 The Pressure Ulcer
• Prolonged pressure over a bony prominence.
• Treatment consists of pressure relief,
debridement, and maintenance of a clean,
moist wound environment.

Jorge I. Chronic Wounds. Medscape. 2017

 Venous Stasis Ulcer
• Venous stasis ulcer result from hypoxia in
areas of venous congestion in the lower
extremity.
• Therapy : Compression hose or boots,
debridement, and maintenance of a clean,
moist wound environment

Jorge I. Chronic Wounds. Medscape. 2017

 Surgical Wound Classification
Class I
Clean

Class II
Clean-contaminated

Class III
Contaminated

Class IV
Dirty-infected

Slashing surgical site infectons. Downloaded in http://www.cdc.gov/hicpac/SSI/table7-8-9-10-SSI.html

 Management
• Cleansing of the wound can be achieved by 3
main methods :
– Compression
– Irrigation
– soaking
• Wound can be closed by;
– Primary closure
– Delayed primary closure
– Through healing by secondary intention
Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
 • Dressing
• Systemic antibiotics
• Tetanus prophylaxis

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
Antibiotik
Cefadroxil
Dewasa : Oral 1-2g/hari diberikan 2x dalam sehari
Anak : Oral >6 tahun <40 kg 30-50 mg/kgBB sehari, diberikan 2x sehari. Maksimal 100 mg/kgBB dalam sehari.
Ibu hamil : kategori B
Levofloksasin
Dewasa : Oral 500 mg/hari, diberikan 1x dalam sehari selama 7-14 hari.
Anak : 16-20 mg/kg/hari PO diberikan 2 kali
dosis maksimum : 750 mg/hari
Ibu hamil : kategori B
Klindamisin
Dewasa : Oral 150-300 mg per kali. Diberikan 3x sehari.
Anak : 1 bulan - 18 tahun, PO: 6mg/kg/kali diberikan 4 kali sehari (berat badan <10kg, dosis minimum 37.5mg 3 kali
sehari)
IV: 6–10mg/kg/kali diberikan setiap 6 jam
dosis maksimum : 1.8 g/day
Ibu hamil : kategori B
Amoxicillin
Dewasa : Oral 500 mg/kali. Diberikan 2x sehari.
Anak : 1 bulan - 18 tahun, PO: 15–30mg/kg/kali diberikan 3 kali sehari (maksimum 500mg/kali)
IV: 30–60mg/kg/kali diberikan setiap 8 jam
dosis maksimum : 4 g/hari
Ibu hamil : kategori B
Penicilin
Dewasa : Oral 125 – 312 mg 4x sehari
Parenteral : Dewasa 0,6 – 3,6 g sehari diberikan 4-6x sehari secara IM atau IV lambat < 300 mg/menit
Anak : bayi baru lahir 50 mg/kgBB sehari diberikan 2x sehari. 1-4 minggu 75 mg/kgBB sehari diberikan 3x sehari.
1 bulan – 12 tahun 100 mg/kgBB sehari diberikan 3x sehari. Tidak melebihi 4 g/hari.
Ibu hamil : kategori B
Analgesik
Na Diklofenac : Dewasa Oral 75-150mg/hari, diberikan 2-3x sehari.
Anak : oral/rektal >6 bulan : 300 mikrogram - 1mg/kg/kali, 3 kali
sehari ( dosis maksimum 150mg/hari).
IM/IV >6 bulan : 300 mikrogram - 1mg/kg/kali, 1-2 kali sehari (
dosis maksimum 150 mg/kg/hari)
Ibu hamil : kategori C
Asam Mefenamat (NSAID) : Dewasa Oral 500 mg/kali. Diberikan 3x sehari.
Anak : 10-25 mg/kg/hari ( dibagi setiap 6 jam)
Ibu hamil : kategori C
Ibuprofen (NSAID) : Dewasa Oral 200-400mg/kali. Diberikan 3-4x sehari.
Anak Oral 4-10 mg/kgBB/hari. Diberikan 3-4x sehari.
Ibu hamil : kategori C

Acetaminophen (Analgesic Non-Opioid) :

Dewasa Oral 0.5-1 g/kali. Diberikan maksimal 4x sehari.
Anak Oral, <60 kg 10-15 mg/kali. Diberikan maksimal 4x sehari.
Ibu hamil : kategori A

Petidine (Opioid) : Dewasa Oral 50-150 mg setiap 4 jam jika dibutuhkan

Anak, Oral 2 bulan – 12 tahun 0.5-2mg/kgBB diulang setiap 4-6
jam jika dibutuhkan. 12-18 tahun 50-100 mg diulang setiap 4-6 jam
jika dibutuhkan.
Tetanus
Surgical Sutures
• Absorbable
Natural :
– Plain cat gut : Made from submucosa of healthy sheep and serosa of healthy cattle. It contains collagen
. digests it in about 5-6 days.
– Chromic cat gut : Used in subcorticular closure, for viscera and small vessels ligation to arrest
hemorrhage and for inner layer of bowel.
Synthetic :
– Vicryl suture : The benefits include good handling, decreased inflammation. It is absorbed by hydrolysis.
Vicryl suture is commonly used in ligation of vessels, skin closure, subcutaneous closure. It is absorbed
in 3 months.
– Monocryl : absorbed faster than vicryl and handling is not as good as vicryl. Its memory is intermediate,
inflammation is decreased more than vicryl and is absorbed by hydrolysis.

• Non- absorbable
– Natural : silk suture made from the raw silk from the cocoon of the silk worm. Character includes good
handling.
– Synthetic :
• prolene suture :Characters include intermediate handling , does not cause inflammation, and anti-
thrombogenic (does not form thrombus). Used mainly for vascular anastomosis, other uses
include subcutaneous closure, closure of fascia.
• Nylon : Characters include poor handling, does not cause inflammation. Used in skin closure,
fascia, tendon, hernioplasty and subcutaneous skin closure
 Needle Types

Torre J. Sutures in Surgery. Medscape. 2017

THANK YOU