HECTING SUTURING BY I KADEK ARTAWAN TUJUAN PEMBELAJARAN

HECTING (SUTURING) BY I KADEK ARTAWAN

TUJUAN PEMBELAJARAN Mampu Memahami Anatomi fisiologi Kulit Mampu memahami tenatang luka dan jenis luka Mampu Memahami dan mengerti apa itu Hecting Mampu Memahami dan mnegerti alat dan bahan dalam melakkan suturing Mampu mengaplikasikan dalam paraktik mengenai hecting Mampu memahami perawatan luka post suturing

DAFTAR ISI/CONTENT Anatomi & Fisiologi Kulit Luka (Wound) Suturing/ Hecting Alat & Bahan Teknik Suturing Perawatan Luka Akut

ANATOMI & FISIOLOGI KULIT LAPISAN – LAPISAN KULIT v. Lapisan Basale -1 lapis sel koluimnar/kuboid -Proses pembelahan sel Carville, 2008 v Lapisan Corneum ï Epidermis ï Dermis ï Hypodermis/S ubkutis v Lapisan Spinosum -Sel berbentuk polihedral ( multi muka ) -Disebut “prikle cell” -Proses aktif sintersa protein – pembelahan sel -Sel dibentuk untuk mengganti sel diatasnya v v Lapisan Lucidium Granulosum Spinosum Basale §Fungsi pelindung §Epithel skuamosa §P. darah (-) Telapak tangan v Lapisan Corneum dan kaki Bentuk seperti tanduk, Rata / flat, Relatif tebal, terdapat sel mati, Soft keratin (elastis), melindungi sel hidup, Mudah abrasi dan diganti dengan sel baru v Lapisan Lucidium -Rata, Sel mengandung protein = eleidin, -Hanya di telapak tangan dan kaki, Cegah ultraviolet dan sinar matahari v Lapisan Granulosum Tebal 2 -4 sel, Mengandung granul dan keratohyalin, Memicu Carville, 2008 proses keratinisasi ( sel mati)

ANATOMI & FISIOLOGI KULIT LAPISAN – LAPISAN KULIT ï Epidermis ï Dermis ï Hypodermis/S ubkutis Dengan bertambah usia sintesa kolagen berkurang keriput Ø Dermis banyak pembuluh darah, folikel rambut, kelenjar sebasea dan kelenjar keringat Ø Kualitas kulit tergantung banyak Carville, 2008 tidaknya derivat epidermis di dalam dermis Ø v. Terdiri atas jaringan ikat v. Tebal berbeda-beda, paling tebal di telapak kaki ± 3 mm Terdiri dari 2 lapisan q. L. Reitkuler v Lapisan Papilar q. L. Papilar • • • Analogi dengan sub-epitel Jar. Penunjang longgar Terdapat serat kolagen Bentuk seperti jari tangan Terdapat kapiler dan ujung syaraf • Meissner’s • Terdapat pola ornamen pada jempol v Lapisan Retikuler • Bentuk seperti jala • Jaringan penunjang padat • Terdapat serat kolagen • Terdapat pola sulkus = Garis Langer’s • Insisi pada Garis Langer’s

LUKA (WOUND) WHAT IS A WOUND? § An injury to the integument or underlying structures that may or may not result in a loss of skin integrity and Carville, 2008 KIND OF physiological function of WOUND the tissue is impaired

LUKA (WOUND) CLASSIFICATION OF WOUND § ACUTE Accordance with the process of wound healing § CHRONIC Not in accordance with the Carville, 2008 process of wound healing ACU TE CHR ONI C

HECTING / SUTURING What is SUTURING? ? ? Suturing is the joining of tissues with needle and thread, so that the tissues bind together and heal (Edgerton, 1998; Mc. Carthy, 1990). Suturing is the preferred technique for laceration repair (Forsch, 2008). Tujuan Penjahitan Luka : Suatu Cara untuk a. Mencegah terjadinya menyembuhkan luka dengan menutup perdarahan luka melalui jahitan b. Mencegah infeksi silang menggunkan c. Mempercepat proses benang dan needle

HECTING / SUTURING MATERIAL CHARACTERISTICS IDEAL SUTURE OF AN Ideal suture material should: 1. Have good handling characteristics 2. Not induce significant tissue reaction 3. Allow secure knots 4. Have adequate tensile strength 5. Not cut through tissue 6. Be sterile 7. Be non-electrolytic 8. Be non-allergenic 9. Cheap (Edgerton, 1998; Mc. Carthy, 1990) Classification Of Suture Material : Absorbable Natural: Catgut-plain or chromic Synthetic: Polyglactin (vicryl), polyglycolic acid (dexon) Non-absorbable Natural: Silk linen Synthetic: Polyamide (nylon), polyester (dacron), polypropylene (prolene) .

HECTING / SUTURING (Edgerton, 1998; Mc. Carthy, 1990) .

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING (Edgerton, 1998; Mc. Carthy, 1990) .

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING Suture Needle / Jarum ada dua jenis: A straight needle can be used without instruments. A curved needle must be handled with forceps and a needle holder. Although hand sewing with a straight needle does not require forceps, the technique is cumbersome and entails a much higher risk of accidentally sticking yourself. Hence, suturing with a straight needle is Uncommon and not recommended if curved needles are available. There are two types of curved needles. Cutting Needle. Digunakan untuk penjahitan kulit. Jarum Cutting memiliki ujung tajam dan keras. Tapered Needle. Tapered needles, or round-bodied needles, have a sharp tip with smooth edges and are less traumatic to the surrounding tissues. They are used primarily on the deeper, subcutaneous tissues, blood vessels, and intestinal anastomoses. Atapered needle is notgood for simple skin suturing because it is difficult to pass the tapered needle through the skin.

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING TEKNIK SUTURING Single inturruptered suture Running “baseball” closure Subcuticular running closure Forsch, 2008

HECTING / SUTURING TEKNIK SUTURING Vertical mattress suture Horizontal mattress suture Forsch, 2008 Half- buried mattress suture Proper technique of single interrupted

HECTING / SUTURING TEKNIK SUTURING Hair opposition suture technique Proper technique for aplication Tissue Adhesive Skin Stapler Forsch, 2008

HECTING / SUTURING TEKNIK SIMPUL Suquere Knot: simpul yang paling mudah dan bisa dugunkan hampir jenis benang pembedahan. Cut gut, monocryl, vicryl dll Surgeon/Friction Knot I direkomendasikan pada benang seperti vicryl (coated vicryl), etilon (nilon), Polyester, polypropyline Surgeon/Friction Knot II Deep Tie : dugunakan pada baigian tubuh yang dalam dan susah Instrument Tie: digunkan jika ujung – ujung benang pendek

HECTING / SUTURING TEKNIK SIMPUL

ALAT DAN BAHAN LAIN

MANAGEMEN LUKA THE PROCESS OF WOUND HEALING INFLAMM § From 0 -3 days ATION § Haemostasis & formation scab. PMN protect against invasion of pathogens. Macrophages digest debris & dead bacteria PROLIFE § From 2 -24 days RATIVE Penyembuhan Luka Prinsip Penyembuhan “MOIST” lembab. (Carville, 2005) § Macrophages continue clean debris and stimulate fibroblasts to produce collagen § Angiogenesis , wound contraction & re-epithelialisation MATURAT occurs. § From ION 24 days – 1 year § Remodelling of the wound. Replacement tissue has a more organised structure

MANAGEMEN LUKA TIME Managemen LUKA Tindakan/cara merawat luka dengan efektif sehingga mencapi tingkat kesembuhan yang optimal dan §Tissue Management efesien §Inflamation/Infection Control §Moist Balance §Edge of Wound Advancement (Schultz et al, 2003; Falanga, 2004; Moffat, 2004)

MANAGEMEN LUKA Langkah – Langkah Perawatan Luka Membuka Balutan Luka yang lama Melakukan Pencucian Luka (wound cleansing) Pengakjian Luka (ukuran luka, tipe eksudat, dasar luka, foto luka Pemilihan balutan luka (TIME) Dokumentasi Carville, 2008

MANAGEMEN LUKA Jenis Balutan Kasa Transparan Film Kalsium Alginat Hidrokoloid Salep : Metcovazin

KESIMPULAN

REFRENSI v Carville, K. (2008). Wound Care: manual 5 th ed. Osborne Park. Silver chain Foundation. v Edgerton M. (1998). The Art of Surgical Technique. Baltimore, Williams & Wilkins. v Ethicon, INC. (2005). Wound closure manual. Tradmark. Jhoson-Jhonson Company v Forsch, Randall T. (2008). Essential of skin laceration repair. American Familly Physician. 78 (8) v Kuder, Mohan H. , Pai, Sathish B. , Prabhu, samitha. (2009). Suture and suturing technique in skin closure. Indian J Dermatol Leprol. 75 (4): 425 -434 v Edgerton M. (1998). The Art of Surgical Technique. Baltimore, Williams & Wilkins. v Mc. Carthy JG (1990) Introduction to plastic surgery. In Mc. Carthy JG (ed): Plastic Surgery. Philadelphia, W. B. Saunders. 48 -54. v

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