ACUTE WOUND

Shakiena M. F. Adenan
DEFINITION OF SKIN WOUND

 Wound: Any violation of live tissue integrity

 Skin as a primary line of defense against external threats  maintenance of
integrity of the skin is a key prerequisite for healthy survival.
 Healthy skin  can regenerate and repair itself under most common conditions.
CLASSIFICATION OF SKIN WOUND

Acute
Wound
Wound
Chronic
Wound
ACUTE WOUND

 Bersih
 Kontaminasi
 Kotor
 Infeksi
ACUTE WOUND

 Daerah luka akut yang yang berisiko terhadap fungsi jika mengenai:
 Pembuluh darah besar
 Saraf penting: contoh N VII, plexus brachialis
 Tendon
 Organ: mata, jantung, hati
 Duktus/ saluran kelenjar
LUKA AKUT BERISIKO INFEKSI

 Luka lebih dari 6 jam

 Luka kontaminasi/ kotor
 Terjadi di tempat kotor
 Luka dalam dan benda kontaminan/ kotor (paku/besi/bambu)
LUKA AKUTYANG BERISIKO KELOID/
HYPERTROPHIC SCAR
 Luka laserasi dalam
 Luka laserasi kotor
 Luka compang-camping
 Luka tegang
 Luka akut jadi kronis
ACUTE WOUND

 Abrasion wound (Vulnus Excoriatum)

 Puncured Wound (V. Punctum)
 Incised Wound (V. Scissum)
 Cut Wound (V. Caesum)
 Crush Wound (V. Contusum)
 Torn wound (V. Laceratum)
 Bite Wound (V. Morsum)
 Shot Wound (V. Sclopetarium)
 Skin Avulsion
 Amputation
ABRASIONS

 The superficial layer of the skin is

removed;
 Blunt trauma
 Mild
 Good wound healing
 LACERATIONS
 ragged tears and cuts;
 masses of torn tissue underneath;
 caused by dull knife, bomb fragments and machinery
and may include crushing of tissues;
 frequently contaminated
 PUNCTURE
 sharp penetrations caused by nails,needles, wire, or
bullets
 These are of great concern in patients with diabetes,
as many of these patients have polyneuropathy and
have insensate feet, leading to occult injury.
 Many times these patients will step on thumb tacks,
safety pins, or other sharp household objects and
not even know it: this, coupled with compromised
vascular status, leads to chronic wound infection
AVULSIONS

 sections of skin torn off either in part (attached to body) or totally (detached from
body);
 heavy bleeding is common
AMPUTATIONS

 traumatic amputation results in nonsurgical removal of limb from the body and
accompanies heavy bleeding.
MANAGEMENT

Primary Survey
• Life-threatening

Secondary Survey
• Manajemen luka
TUJUAN MANAJEMEN LUKA AKUT

 Membuat luka menjadi bersih

 Mengurangi/mencegah risiko infeksi
 Mencegah menjadi luka kronis
 Mecegah parut buruk (keloid/ hypertrophic scar)
 Good wound
management

Simple
Laceration
Good
Debridement
& wound
healing
toilet
esthetic &
Complex Wound functional

Good surgery
technique
WOUND EVALUATION
& CARE
IRRIGATION & DEBRIDEMENT

 Debridement – excision of all devitalized, contaminated & Foreign bodies

 If possible, Vital sturctures including nerves, blood vessels, tendons and bones
shouldn’t be debribed.
 Irrigation with NaCL
 Mechanical debridement (sharp& blunt)
 Gauze debridement
 Chemical debridement
DEFECT CLOSURE

 Need meticulous surgical technique

 Good approximation  SOLVE the puzzle
 Suture material
 Tissue handling
 Intradermal suture
 Cutaneus suture  eversion
 Suture removal within 5 - 7 days
 Dressing
GENERAL TECHNIQUE OF WOUND
TREATMENT
 Primary Intention : all tissues, including the skin, are closed with suture material
after completion of the operation
 Secondary Intention : the wound is left open and closes naturally
 Tertiary Intention : the wound is left open for a number of days and then closed if
it is found to be clean.
THANK YOU