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Menjahit Luka
The document discusses skin anatomy, wound types including acute and chronic wounds, and the phases of wound healing. It emphasizes the management of acute wounds through methods like irrigation, debridement, and suturing, as well as the importance of maintaining a moist environment for better healing. Additionally, it outlines commonly used suture materials and their properties, alongside common mistakes to avoid in wound management.
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Menjahit Luka
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- 6. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Luka Akut vs Kronis • Luka: terputusnya kontinuitas kulit. • Penyembuhan luka: respon organisme secara global terhadap adanya perlukaan. • Luka akut: terjadi dalam 3-4 minggu. • Luka kronis: terjadi lebih dari 4-6 minggu, tidak sembuh, terlambat sembuh… • Luka akut bisa menjadi kronis, dan penyembuhan luka kronis dapat melalui fase “akut” 6
- 7. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Asesmen Luka Akut • Ukuran, bentuk, lokasi • Waktu terjadi luka (onset) • Laserasi, avulsi, atau kronis • Debris, perdarahan, eksudat, pus, bau • Exposed: tendon, vaskuler, saraf, otot, sendi, tulang • Benda asing: perlu X-ray? 7
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- 10. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Fase Penyembuhan Luka • Fase Inflamasi • Fase Proliferasi – Fibrolasi – Granulasi – Kontraksi – Epitelisasi • Fase Remodelling 10
- 11. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Fase Inflamasi 11 • Koagulasi • Vasodilatasi • Migrasi PMN dan makrofag • Peran growth factor, sitokin, dan kemokin.
- 12. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Fase Proliferasi 12 • Keratinosit dan fibroblas • Migrasi sel • Proliferasi • Pembentukan kapiler • Sintesis ECM • Epitel membentuk epidermis
- 13. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Fase Remodelling 13 Parut / scar Keseimbangan antara sintesis ECM dan degradasi oleh protease.
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- 16. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Manajemen Luka Akut (1) • Irigasi & debridement: menyingkirkan jaringan nekrosis dan koloni bakteri • Jaringan nekrotik: menjadi fokus infeksi, memperpanjang fase inflamasi, obstruksi mekanis kontraksi, dan mengganggu reepitelisasi • Autolitik: elastase, kolagenase, myeloperoksidase, hidrolase asam, lisosom • Tindakan debridement: mempercepat penyembuhan • Ragu: tunggu demarkasi 16
- 17. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Manajemen Luka Akut (2) • Bila kering: – Timbul krusta keras – Desikasi pada matriks kolagen – Keratinosit di bawah krusta? • Kondisi “moist” / lembab: – Mendorong migrasi keratinosit dan pembentukan matriks – Mendorong autolitik – Mengurangi nyeri dan bengkak – Mengurangi risiko infeksi dan fibrosis – Secara kosmetik lebih baik. 17
- 18. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Manajemen Luka Akut (3) • Debridement dan Irigasi jaringan non vital • Bilas luka dan singkirkan tato traumatik • Singkirkan semua benda asing • Menjahit luka: – Freshening tepi luka – Hindari dead space, jahit lapis demi lapis – Teknik atraumatik, perlakukan jaringan dengan lembut – Hindari tension dalam penutupan luka – Gunakan jahitan dalam dengan bijaksana • Tunda penutupan luka dengan kontaminasi berat 18
- 19. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Anestesi Lokal dan Blok • Potensi, onset, durasi • Penambahan adrenalin (epinefrin) • Blok: – Wrist, brachial, infraorbita, submental, supraorbita • Infiltrasi: – Intradermal, subkutan, campuran • Dosis maksimal: – Lidokain 5 mg/kgBB – Lidokain + epinefrin 7 mg/kgBB 19
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- 23. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 23 reversecutting; ins needles as convent cutting needles a rule. For example, a semicircular P-2 needle may be used or narrow closures, such as those sometimes encountered on the nose, TABLE3-1 COMPAR USEDREVERSECUTT ETHICON ANDCOVID Ethicon P-1 P-3 PS-1 PS-2 CP-2 FS-1 FS-2 P-2 Comparisondoes not imply nishqualitywithinandbe 3/8circle indiameterexce Point Body Swage Grasp here with needle driver when suturing in tight spaces or through dense tissue. Grasp here with needle driver for most applications. Figure 3-1. The suture needle.
- 24. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 24 TABLE3-3FREQUENTL YUSEDSUTUREMATERIALS IN SKIN ANDSOFTTISSUERECONSTRUCTION Suture Material Name Conf guration Handling Tissue Reactivity Loss o 50% Strength Time to Complete Absorption ABSORBABLESUTURES Vicryl (polyglactin 910) Braided, coated V ery good Moderate 21 days 75 days Polysorb (glycolide/ lactide polymer) Braided, coated V ery good Moderate 21 days 75 days Monocryl (poliglecaprone) Monof lament V ery good Moderate 7 days 60 days Maxon (polyglyconate) Monof lament V ery good Moderate 21 days 6 months PDS I/II (polydioxanone) Monof lament Good Moderate 30 days 6 months Biosyn (glycomer 631) Monof lament V ery good Moderate 21 days 60 days Caprosyn (polyglytone 6211) Monof lament V ery good Moderate 7 days 60 days Catgut Braided V ery good High Plain: 7 days Chromic: 10 days Fast Absorbing: 5 days Plain: 70 days Chromic: 84 days Fast Absorbing: 35 days VicrylRapide Braided, coated V ery good Moderate 5 days 42 days V elosorb Fast Braided V ery good Moderate 5 days 42 days NONABSORBABLESUTURES
- 25. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic 25 CommonlyUsed Nonabsorbable Suture Materials Nylon memory, and there ore ma more challenging to w or nylon. Extra throws are o t during knot tying as well, Caprosyn (polyglytone 6211) Monof lament V ery good Moderate 7 days 6 Catgut Braided V ery good High Plain: 7 days Chromic: 10 days Fast Absorbing: 5 days P C F 3 VicrylRapide Braided, coated V ery good Moderate 5 days 4 V elosorb Fast Braided V ery good Moderate 5 days 4 NONABSORBABLESUTURES Monof lament Nylon Monof lament V ery Good Low Prolene, Surgipro (polypropylene) Monof lament Good Low Novaf l (polybutester) Monof lament V ery good Low Silk Braided Excellent Moderate
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- 30. #bedahplastikntt @robertusarian arian9677@gmail.com @eanplastic Kesalahan Umum • Tidak menyingkirkan debris, tidak freshening tepi luka • Bekas jahitan besar dan mengganggu • Gagal menjahit sesuai posisi anatomis sebelum luka • Dead space • Jahitan diambil tidak tepat waktu 30
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