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Chronic Wound Management 2020
Chronic Wound Management 2020
TOPIKAL THERAPY
WOUND BED PREPARATION
JARINGAN MANAGEMENT AUTOLISIS
NEKROSIS SAFE SUPPORT
INFEKSI DEBRIDMENT PENYEMBUHAN
WOUND BED PREPARATION
Tissue management
Hilangkan jaringan mati & benda asing
SAFE Debridemang:
Surgical
Objectives of debridement
Promote and develop healthy wound bed that supports tissue regeneration
Riduce bioburden of wound; prevent and control infection in deteriorating
wounds
Remove necrotic, devitalized tissue without causing harm to surrounding tissue
or the host organization:
Selective
Zero to minimal Blood loss
Cost and time efficient
Tecnical ease and availability
Autolytic Debridement
SAFE
Debridemang
Advantages and Disadvantages of Debridement Methods
Chemical Debridement Bectericidal and bactereositic agents Chemical agents may be cytotoxic to healthy cells in
wounds
Some agents can be inactivated in the presence of
blood or pus
Biological or Parasitic Usually fast and efficient Sterile larvae may be difficult to obtain
Debridement Effective againts a wide range of bacteria May be socially unacceptable
including Clostrydyum welchii, MRSA and A slight pyrexia may occuras a result of lysis of
Pseudomonas aureginosa bacteria by larvae
Irritation may occur if larvae come in contact with
surrounding skin.
Inflammation & Infection control
Cairan pencuci
Dressing yg tepat (topikal antimicrobial &
antiseptik)
Sistemik therapy (jika perlu)
Inflammation & Infection control
Critically colonised wounds can present with
alterations in tissue characteristics and these include:
Static healing
Increased exudate
Pale grey or deep red coloured granulation tissue
Frible granulation that bleeds on contact
Hipergranulation
Rolled wound edge
MASERASI
Cairan pencuci luka
Efektif cara mencuci
Swab
Tekanan
Irigasi
Pilih cairan yang tepat
Iodine / chlorhexidine / asam asetat 10 % / herbal dg astrigen / Alkohol /
Hypochlorite
Air & sabun/normal salin
Antibacterials Plant resin packs
Aromatic wood burning
Frankincense
Cadaxomer iodine
Povidone iodine impregnated tulle gras
Chlorehexidine impragneted tulle gras
Wound honey
Silver impregnated dressings
Moisture Balance
Manajemen:
Pencucian adekuat
Penipisan tepi luka
Moisture balance dressing
Epithelial edge advancement
Hypergranulation can be controlled by:
Topical antimicrobials to correct bacterial imbalance
Hypertonic impregnated to control oedema and
bacterial balance
Local pressure application using a foam dressing and
either compression bandage of fixation tape
CSWD
Chemical debridement with caustic agents such as
silver nitrate and copper sulphate
Topical corticosteroids
INFEKSI
BIOBURDEN
Adanya kuman diluka
meningkatkan beban
(burden) dari lukanya
sehingga menghambat
penyembuhan luka
Klasifikasi:
Kontaminasi
Kolonisasi
Kritikal kolonisasi
Infeksi
Luka dg Kontaminasi
Luka yang memiliki
organisme tapi belum
bereplikasi dan tidak
terlihat
Biasanya dari flora
normal, lingkungan,
sekitar luka
(periwound)
Manajemen:
Pencucian adekuat
Luka dg Kolonisasi
Mikroorganisme sudah
bereplikasi
Tidak ada tanda
infeksi
Manajemen:
Adequate Cleansing
SAFE DEBRIDMENT
Luka dengan Kritikal Kolonisasi
• Mikroorganisme sudah
bereplikasi
• Warna dasar merah
pucat
• Ada tanda infeksi
• Manajemen:
– Adequate Cleansing
– Mechanical Debridement
(KP)
– Topical ANTIMICROBIAL
Luka dengan Infeksi
Mikroorganisme sudah
bereplikasi > 105 per gram
jaringan (kultur lab)
Leukositosis
Sangat Exudatif
Ada tanda infeksi
Manajemen:
Adequate Cleansing
Mechanical Debridement
Dengan topical Anti Microbial
dan
Systemic AB
THANK YOU