Teori Dari Wound

8/3/2019 Teori Dari Wound

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Wound


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A wound is an area ofthe body

whose normal integrity has

been compromised.


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PunctureBruiseContusion (from blunt trauma)Abrasion

Incision (inflicted by a sharp object likescalpel)

Laceration (inflicted by a less sharp objectlike broken glass)

Ulcer (a break in epithelial continuity)Avulsion (partial or complete)Degloving (openor closed)Amputation (total, or near total)


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Open

Sharp : vulnus scissum, puncture wound Dull : vulnus laceratum, openfracture,

excoriation

Close

1.Vulnus contussum

2.Bullae

3.Hematome

4.Sprain

5.Dislocation

6.Close fracture

7.Vulnus traumaticum


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Penetrating

Non-penetrating


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Acute : normally proceed through an orderly

and timely reparative process sustained

restoration of anatomic and functional

integrity

Chronic : wounds that failed proceed like

acute wound, or repair without establishingan anatomic and functional result


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Coagulation

Damage vessel&lymphatics hemorrhage vasoconstriction diapedesis fibrin mesh +

cytokine stop bleeding Inflammation

Migrationofleukocytes PMN + Macrophages

Fibroplasia Synthesis protein collagen 10hr after wound,

peak at 5-7 days, reduced gradually


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Remodeling

Inflammation stop inflammatory cells

diminished

equilibrium ofcollagen synthesisanddegraded


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72hr 2-4days 21days


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Skin

Mucosa

Bone

Brain


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Sterile wound

Contaminative wound

Infection wound


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Antitetanus

Antibiotics ifnecessary

Immobilisation

Analgesics


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Clean

Debride

Irrigate

Excise


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Management of

sterile wound

Stop the bleeding

Close one by

one


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Wash the area surrounding ofthe wound

Dodesinfection surrounding the wound

Close the wound

Local anestesia

Wash the wound with H2O2/ dilutedPovidon

Do the evaluation

Wound toilet anddebridement

Prevention to tetanus etc.


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Disinfection surrounding the wound

Dont do infiltratifanestesia, do with blockanestesia or general anestesia

Washing byH2O2/ diluted povidone

Debridement

Dont do primary closure

Sistemic antibiotic

Prevention tetanus etc.


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Primary Closure

Surgical wound

DelayedPrimary Closure

Delayedfor several days to prevent infection inwounds (foreign bodies, contamination)

Spontaneous Closure or Secondary Wound

Closure Wounds margin move together by biologic

process ofcontraction


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Mechanical (or local)

General


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Controllable by the surgeon:

avoidance ofuse ofstrong chemicals in skin

preparation avoidance ofinadvertent crushing oftissue

achieving adequate haemostasis

avoidance ofspillage ofinfective materials


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Nutrition

Oxygen

Oxygen radicals

Drugs

Smoking

Age

Temperature

Diabetes mellitus


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Wound infection Systemic infections

Chronic wounds andulcers Scars and contractures Keloids Lymphoedema

Bone complications: osteitis, osteomyelitis Tetanus Pressure ulcers

Teori Dari Wound

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