Penatalaksanaan vulnus degloving
-
Upload
saifuddin-suhri -
Category
Health & Medicine
-
view
216 -
download
17
Transcript of Penatalaksanaan vulnus degloving
![Page 1: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/1.jpg)
DEGLOVIN
G INJURY
1
Oleh : Antonius Nirmala
![Page 2: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/2.jpg)
2
2
![Page 3: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/3.jpg)
ETIOLOGI Cedera degloving trauma yang
hebatEktremitas inferior yang tersering!!
Penyebab : >> kecelakaan lalu lintas (69%) terlindas!!!
Permasalahan :- Perawatan & penutupan defek- penutupan luka
3
![Page 4: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/4.jpg)
DEFINISI
SKIN ELEVATION + SHEARING FORCE
4
![Page 5: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/5.jpg)
DEFINISI
5
![Page 6: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/6.jpg)
Wringer InjuriesPneumatic tyre torsion avulsion injuries (Prendiville, 1950)
Friction Injuries (Slack, 1952)Shear Force atau Delamination (Mc. Grouther DA&Sully, 1980)
6
ISTILAH LAIN DEGLOVING ..
![Page 7: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/7.jpg)
TIPE DEGLOVING
Degloving tertutup Degloving terbuka
PERMUKAAN KULIT MASIH INTAK
Mobilitas kulit dan fluktuasi di subkutis
Jejas ban kendaraan atau luka bakar akibat gesekan
Paling sering pada tungkai bawah (60%)
DISERTAI DENGAN TERPUTUSNYA KONTINUITAS PERMUKAAN KULIT
Mudah diidentifikasi
Kerusakan jaringan bervariasi
7
![Page 8: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/8.jpg)
8
KLASIFIKASI LAIN DARI DEGLOVING
Type I : Common AvulsionDisekeliling luka terdapat undermined tissue
Type II : Atypical AvulsionTerdapat luka luar yang kecil disertai robekan luas dari jaringan lunak dalam
Type III : Specific Area AvulsionContoh : scalp, telinga, plantar pedis
![Page 9: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/9.jpg)
PATOFISIOLOGI (MEKANISME DEGLOVING)
Gesekan roda dengan jalan↓
Gaya puntir dari kulit di sekitar poros tengah
tungkai↓
Kontinuitas kulit terputus↓
Pembuluh darah perforator terputus
↓Vitalitas jaringan terganggu Mc Gregor IA. Fundamental Techniques of Plastic Surgery and Their
Surgical Application, Edinburgh London and New York, 1980;55;194-5
![Page 10: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/10.jpg)
![Page 11: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/11.jpg)
PATOFISIOLOGI NEKROSIS KULIT
Kerusakan vaskuler
Avulsi
Kerusakan endotel
Thrombosis arteri & vena
Penurunan suplai darah & kongesti vena
NEKR OSIS
D e v a sk u la r is a s i lem ak
P e le p a s a n m e ta b o li t to ks ik& ra d ik a l b e b a s
![Page 12: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/12.jpg)
DIAGNOSIS
12
Anamnesa
PemeriksaanFisik
Pemeriksaan
Penunjang
![Page 13: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/13.jpg)
DIAGNOSIS mekanisme trauma gejala-gejala yang
mengarahkan kecurigaan pada degloving
13
Anamnesa
![Page 14: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/14.jpg)
DIAGNOSIS Kulit dan jaringan lunak
dibawahnya terlepas dari dasarnya (fascia)
Disertai atau tidak disertai terputusnya kontinuitas permukaan kulit
Fluktuasi di subkutis Jejas ban kendaraan atau
luka bakar akibat gesekan
14
PemeriksaanFisik
![Page 15: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/15.jpg)
DIAGNOSIS Tes tekan
(bila ditekan pucat dan kembali dalam 4 detik)
Tes fluorescen (dimasukkan cairan fluorescen intravenous dengan dosis 15 mg/kg dalam 200 ml NaCl 0,9% selama 10 menit, dilihat dibawah lampu ultraviolet dalam ruang gelap).
15
PemeriksaanFisik
![Page 16: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/16.jpg)
DIAGNOSIS Lab Foto polos X-ray (AP dan
Lateral)
16
Pemeriksaan
Penunjang
![Page 17: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/17.jpg)
DIAGRAM PENANGANAN DEGLOVING Degloving
TerbukaTertutup
Tes Vitalitas JaringanTes Vitalitas Jaringan
Non VitalVital Non VitalVital
Jahit Tidak Tegang
STGDefatted
FTG
Eksisi
STG
Kulit
Baik
Kulit
Tidak Baik
Insisi Kecil Eksisi
Irigasi
STG
Balut Tekan
Drain
![Page 18: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/18.jpg)
PENANGANAN DEGLOVING
Terbuka Tertutup
18
![Page 19: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/19.jpg)
Terbuka Survey Primer (ABCDE) Debridemant, irigasi dan pengembalian flap Penilaian vitalitas kulit degloving Eksisi jaringan yang tidak vital Rotasi atau transposisi otot yang viabel untuk
menutup tulang yang ekspose Tutup raw surface dengan STG atau FTG
(penutupan luka tanpa tegangan)
19
PENANGANAN DEGLOVING
![Page 20: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/20.jpg)
![Page 21: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/21.jpg)
Tertutup Survey Primer (ABCDE) Penilaian vitalitas jaringan Eksisi jaringan non-vital Bila jaringan vital:
1. Insisi kecil diatas daerah degloving2. Evakuasi hematom dan jaringan lemak nekrotik3. Irigasi luka4. Pasang Drain5. Balut Tekan
21
PENANGANAN DEGLOVING
![Page 22: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/22.jpg)
Tes Vitalitas Jaringan
22
![Page 23: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/23.jpg)
PENILAIAN VITALITAS KULITTAHAPAN
Methylen blue daerah degloving
Jahit flap yang terelevasi Penilaian perkiraan vaskularisasi degloving
Tes tekan & tes fluoresensiSplit Thickness Skin Excision (STSE) 23
![Page 24: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/24.jpg)
24
1. Flap degloving dikembalikan dan difiksasi pada
bed luka2. Split thickess skin graft sekitar 0,14 inci (lapis
pertama)3. Lapis kedua ditempat yang sama, split thickness
dermis (0,14 inci).4. Lapis ketiga, flap degloving yang tersisa setelah
dilakukan defatted (sebagai biological dressing).
Trilaminar Skin Coverage Technique
![Page 25: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/25.jpg)
OPERASI
Indikasi
• Degloving tertutup dengan jaringan non vital
• Degloving terbuka
25
![Page 26: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/26.jpg)
KOMPLIKASI
Nekrosis flap kulitInfeksiGraft lisis
26
![Page 27: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/27.jpg)
PERHATIAN
(1) Tyre mark pada kulit pasien degloving injury
(2) 1 1/3 missed !!!
(3) “Jangan pernah meletakkan kembali flap yang memiliki panjang yang lebih besar dari pedikelnya”
(4) Kulit baik : Defatted dan diletakkan kembali sebagai FTG
(5) Kulit rusak : STG segera atau ditunda27
![Page 28: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/28.jpg)
28
KESIMPULAN
Penanganan tidak memadai meningkatkan morbiditas
Penilaian vitalitas jaringan menentukan modalitas
Degloving luas teknik Trilaminar Skin Coverage
penanganan yang tepat = morbiditas
![Page 29: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/29.jpg)
29
REFERENSI Degloving Injury, David S. Perdanakusuma,
Prakolega - edisi II / 1996 - 29 Grabb & Smith’s Plastic Surgery, 6th eds, 2007,
Lippincott Williams & Wilkins. Fundamental Techniques of Plastic Surgery, 10th eds,
2000, Churchill Livingstone. Mathes’s Plastic Surgery, 2nd eds, 2005, Saunders /
Elsevier. Schwartz’s Manual of Surgery, 8th eds, 2006, McGraw-
Hill. Primary surgery vol 2 – trauma : wounds: degloving
or avulsion injuries
![Page 30: Penatalaksanaan vulnus degloving](https://reader033.fdocument.pub/reader033/viewer/2022050701/58a301dd1a28abea508b4fd7/html5/thumbnails/30.jpg)