Presentan

Fathichah Hafsyah A
Januar Az Zahrani
Cahya Dinata
Rilo Herlambang

Preseptor
dr. Catur S Damarianto, Sp. B., FinaCS

PROGRAM PENDIDIKAN PROFESI DOKTER

SMF Ilmu Bedah
Fakultas Kedokteran Universitas Islam Bandung
RS Al-Islam Bandung
2018
Critical Wound Healing Period
Tissue

Skin 5-7 days

Mucosa 5-7 days

Subcutaneous 7-14 days

Peritoneum 7-14 days

Fascia 14-28 days

0 5 7 14 21 28
Tissue Healing Time/Days
Surgical Wound Classification
 Clean: (1-5% risk of
infection)  Operative
incisional

 Clean-contaminated:
(3-11% risk)  operative
wounds  in which
the respiratory,
alimentary, genital, or
urinary tract
Surgical Wound Classification
 Contaminated: (10-17%
risk) open, fresh,
accidental wounds,
operations  GIT ,
nonpurulent

 Dirty or infected: (>27%

risk) old traumatic
wounds , necrotic tissue,
perforated viscera  SSI
WOUND TOILET
Preparation
 Informed consent  jenis luka, rencana tindakan,
pasien/keluarga setuju atau tidak (format)
 Septik aseptik sekitar luka
 Lokal anastesi sekitar luka  pastikan sudah ter
anastesi dengan baik
 Posisi  kenyamanan pasien, drainase
WOUND TOILET
Debridement
 “dillution is the best solution”
 NaCl  1 – 2 ltr
 Saflon  2x dianggap sudah steril
 Betadine iritatif
 H2O2  7” bilas NaCl
WOUND TOILET
Nekrotomi
 Eksisi jaringan mati, pus, pasir, tanah dsb
 Sampai jaringan segar  berdarah

Open wound
Drainase pus, oksigenasi

Closed wound
 kosmetik, anaerob, drain
Types of Sutures
 Absorbable or non-absorbable (natural or
synthetic)
 Monofilament or multifilament (braided)
 Sizes 3 to 12-0
Non-absorbable Absorbable
 Not biodegradable  Degraded via
and permanent inflammatory response
 Nylon  Vicryl
 Prolene  Monocryl
 Stainless steel  PDS
 Silk (natural, can  Chromic
break down over  Cat gut (natural)
years)
Natural Suture Synthetic
 Biological  Synthetic polymers
 Cause inflammatory  Do not cause
reaction inflammatory response
 Catgut (connective  Nylon
from cow or sheep)  Vicryl
 Silk (from silkworm  Monocryl
fibers)  PDS
 Chromic catgut  Prolene
Monofilament Multifilament (braided)
 Single strand of suture
material
 Minimal tissue trauma
 Smooth tying but more knots
needed
 Harder to handle due to
memory
 Examples: nylon, monocryl,
prolene, PDS
 Fibers are braided or twisted
together
 More tissue resistance
 Easier to handle
 Fewer knots needed
 Examples: vicryl, silk,
chromic
Suture Selection
 Tiga hal yang menentukan pemilihan jenis benang
jahit, yaitu:
- Jenis bahannya
- Kemampuan tubuh untuk menyerapnya
- Susunan filamentnya
• Benang yang dapat diserap menimbulkan reaksi
jaringan setempat yang dapat menyebabkan fistel
benang atau infiltrate jaringan yang mungkin ditandai
adanya indurasi.
 Non-absorbable cause less scarring but must be
removed
 Absorbable for GI, urinary or biliary
 Non-absorbable for skin, tendons, fascia
 Cosmetics = monofilament or subcuticular
Suture Sizes
 Lokasi penjahitan Jenis benang Ukuran

Fasia Semua 2,0-1

Otot Semua 3,0-0

Kulit Tak diserap 2,0-6,0

Lemak Terserap 2,0-3,0

Hepar Kromik catgut 2,0-0

Ginjal Semua catgut 4,0

Pancreas Sutera atau kapas 3,0

Usus halus Catgut, sutera, kapas 2,0-3,0

Usus besar Kromik catgut 4,0-0

Tendon Tak terserap 5,0-3,0

Kapsul sendi Tak terserap 3,0-2,0

Peritoneum Kromik catgut 3,0-2,0

Surgical Needles
 2 basic configurations for curved needles
 Cutting: cutting edge can cut through tough tissue, such
as skin
 Tapered: no cutting edge. For softer tissue inside the
body
TIPE UJUNG JARUM BEDAH
 Taper. batang bulat atau empat persegi cocok
digunakan untuk menjahit daerah aponeurosis, otot,
saraf, peritoneum, pembuluh darah, katup.
 Blunt. blunt point dan batang gepeng cocok
digunakan untuk menjahit daerah usus besar, ginjal,
limpa, hati
 Triangular. Ujung segitiga dengan batang gepeng atau
empat persegi. Bisa dipakai untuk menjahit daerah
kulit, fascia, ligament, dan tendon.
 Tapercut. Ujung jarum berbentuk segitiga yang lebih
kecil dengan batang gepeng, bisa digunakan untuk
menjahit fascia, ligaments, uterus, rongga mulut, dan
sebagainya.
Surgical Needles
JARUM BEDAH
 Pemilihan jarum bedah : berperan aktif dalam
penyembuhan luka dan tidak merubah atau merusak
jaringan tubuh.
 Bentuk, ukuran, dan rancangan jarum dipilih yang
sesuai dengan prosedur operasi.
Contraindications to Suturing
 Redness
 Edema of the wound margins
 Infection
 Fever
 Puncture wounds
 Animal bites
 Tendon, verve, or vessel involvement
 Wound more than 12 hours old (body) and 24 hrs
(face)
Continuous Locking and Nonlocking Sutures
Subcuticular suture
Vertical Mattress

Good for everting wound edges

(neck, forehead creases, concave surfaces)
Suture Removal
 Average time frame is 7 – 10 days
 FACE: 3 – 5 d
 NECK: 5 – 7 d
 SCALP: 7 – 12 days
 UPPER EXTREMITY, TRUNK: 10 – 14 days
 LOWER EXTREMITY: 14 – 28 days
 SOLES, PALMS, BACK OR OVER JOINTS: 10 days

 Any suture with pus or signs of infections should

be removed immediately.