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Workshop Manajemen Ulcus Diabetic Dan Ulcus Diabeticus PDF
Workshop Manajemen Ulcus Diabetic Dan Ulcus Diabeticus PDF
Workshop Manajemen Ulcus Diabetic Dan Ulcus Diabeticus PDF
Junaidy Heriyanto
Wounds (vulnus) are a bodily injury caused by
physical means, with disruption of the normal
continuity of structures.
ACUTE: Heals in approximately 2
weeks to 6 months
9
Stage 1.
Skin intact, persistent skin erythema.
Stage 2.
Skin breakdown & ulceration of subcutaneous
fat.
Stage 3.
Sores have ulceration to the level of muscle.
Stage 4.
Involvement of bone or join
Removal debris
Control of infection
Clearance of inflammation
Angiogenesis
Contraction
Maturation
No foreign
bodies
Free from
Tissue is excessive
viable bact.
infection
Normal
healing
process
• For example: venous
Therapy of underlying disease
insufficiency, DM
Elimination of extrinsic
factors that trigger injury
• For example: Nutrition, pressure
Create physiological
wound healing conditions
• For example: moist wound healing
Parts involved:
skin, fascia, muscles, or other tissues
1.Surgical/sharp
2.Mechanical
3.Autolytic
4.Enzymatic
5.Biological
1. Use a scalpel, scissors, forceps, or curette
2. Very selective and fast
3. Only allowed by experienced doctors (skill
and knowledge)
4. Bedside can be done
5. Sometimes it requires an operating room
and GA for further procedures
6. It is recommended to control severe
infections
Contraindications:
Injury to malignancy
Patients with bleeding disorders
Ischemic tissue
Unstable
Underneath there is a dialysis fistula,
protesis, or arterial bypass graft
Attention to hand and face area wounds
Attention to immunocompromised patients
1. Wet-to-dry: moist dressing is placed on the
wound let it dry released
› Big wound
› Nonselective
› Very painful
› Change dressings often
› Maseration and Bleeding
› Fiber dressing puncture the wound reaction
› Spread of bacteria when opened
Contraindications:
Clean wounds
Using hydrocolloids and hydrogels
Rehydration of necrotic cells and remove
damaged tissue using body enzymes (present
in infected wounds).
Consideration:
Long time
For small to moderate debridement
Patients have a minimal risk of infection
Can be done anywhere
Can be combined with other methods
Selective
Safe, easy to use
No pain when dressing
Slow
Risk of maceration
Removal of dressings is often painful
Smells
Some require secondary dressing in addition
to primary dressings
Absorptive dressings cause dehydration of
the wound
Contraindications:
Some dressings cannot be used for infection
wounds
The tendons and bones are exposed
Friable skin
Deep wounds
Severe neutropenia
Immunocompromised patients
Use streptokinase or streptodornase or bacterial-
derived collagenases.
Streptokinase and streptodornase break down
and rehidrate necrotic tissue
Consideration:
Patient with anticoagulant therapy
Can be used for infection wounds
Cost effective
Use bedside
Can be selective
Inflammation around the wound in several enzymes
Contraindications:
Clean wounds
Allergy components of the enzyme
= maggot therapy
Larva Lucilia sericata (greenbottle fly) eat
necrotic tissue and pathogens.
This technique is fast and selective
Consideration:
Psychological stress
Allergic reactions
Time consuming
Selective and less painful
Expensive
Decreased number of bacteria
Bedside use
Can be used for various types of wounds, including
infection wounds
Contraindications:
Allergy to adhesives, fly larvae, eggs, and
soybeans
Bleeding disorders
Deep and tunneled wounds
Adequate humidity level
Normal temperature
PH
ulcers and open sores media for bacterial
growth
necrotic tissue:
Excessive inflammatory response wound
contractions are disturbed Inhibiting wound
closurea
21 oC
tissue temperature at open wound
25-27 oC
tissue temperature when covered with
gauze
33-35 oC
tissue temperature when covered with
foam
Winter GD, Scales JT. Effect of airdrying and dressings on the surface of a wound. Nature 1963; 197:91.
Ovington, LG. Hanging wet-to-dry dressing out to dry. Advances in Skin and Wound Care 2002; 15(2): 79-84
local vasoconstriction
impaired leucocyte mobility
increased oxygen-Hb affinity
increased susceptibility to infection
Prevent and overcome infections
Clean the wound
Lift dead tissue
Maintain moisture
Eliminates dead spacce
Control odor
Eliminate / minimize pain
Protecting the skin around the wound
Polyurethane
Absorben dressing
Moderate-heavy
exudate
karboksimetilselulose
Adhesif, elastomer,
gelling agent, oklusif
Primer/skunder
dressing
Reddish wounds/
exudative are minimal
Absorben
Moderate-heavy
exudate
Retaining fluid inside
Requires secondary
dressing
Made from glycerin /
water
Provide moisture
Requires secondary
dressing
For dry / necrotic
wounds (autolysis)
Polyurethane film
Semi-occlusive,
adhesive, non
absorbent
Superficial wound, non
exudative
Infection wound
Silver
Cadexomer iodine
Non woven
Net
Acute wound
Short term
contain vaselin and
antibiotic/antiseptic
Absorbent dressing
Stick to wound surface
Trauma during
removal
Non-selective
Osmotic effect
Easily becomes dry
Local tissue cooling
Wet absorb
Dry moist
Hollow/dead space filled in
Dirt clean
Multidisciplinary approach for wound
treatment, will give benefit for our patient
Multidisciplinary approach for wound
treatment,need a strategic planning
Multidisciplinary approach for wound
treatment,must have a good coordination
Always tie pain medication to function!
Safety first!
Yogyakarta, 15 Desember 2018