HECTING (SUTURING) BY I KADEK ARTAWAN

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

Anatomi & Fisiologi Kulit Daftar Isi/Content Anatomi & Fisiologi Kulit Alat & Bahan Luka (Wound) Teknik Suturing Hecting Suturing/ Perawatan Luka Akut

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

ANATOMI & FISIOLOGI KULIT LAPISAN – LAPISAN KULIT Terdiri atas jaringan ikat Tebal berbeda-beda, paling tebal di telapak kaki ± 3 mm Epidermis Dermis Hypodermis /Subkutis Terdiri dari 2 lapisan L. Reitkuler L. Papilar Lapisan 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 Lapisan Retikuler Bentuk seperti jala Jaringan penunjang padat Terdapat pola sulkus = Garis Langer’s Insisi pada Garis Langer’s berpengaruh pada penyembuhan Dengan bertambah usia sintesa kolagen berkurang keriput Dermis banyak pembuluh darah, folikel rambut, kelenjar sebasea dan kelenjar keringat Kualitas kulit tergantung banyak tidaknya derivat epidermis di dalam dermis Carville, 2008

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 physiological function of the tissue is impaired KIND OF WOUND Carville, 2008

CLASSIFICATION OF WOUND ACUTE LUKA (WOUND) CLASSIFICATION OF WOUND ACUTE ACUTE Accordance with the process of wound healing CHRONIC Not in accordance with the process of wound healing CHRONIC Carville, 2008

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

SUTURING MATERIAL HECTING / SUTURING Ideal suture material should: CHARACTERISTICS OF AN IDEAL SUTURE 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 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) (Edgerton,1998; McCarthy, 1990).

HECTING / SUTURING (Edgerton,1998; McCarthy, 1990).

HECTING / SUTURING Ethicon, 2005

HECTING / SUTURING (Edgerton,1998; McCarthy, 1990).

HECTING / SUTURING Ethicon, 2005

Suture Needle / Jarum HECTING / SUTURING 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

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

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

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 INFLAMMATION PROLIFERATIVE From 0-3 days Haemostasis & formation scab. PMN protect against invasion of pathogens. Macrophages digest debris & dead bacteria PROLIFERATIVE From 2-24 days Macrophages continue clean debris and stimulate fibroblasts to produce collagen Angiogenesis , wound contraction & re-epithelialisation occurs. Penyembuhan Luka MATURATION Prinsip Penyembuhan “MOIST” lembab. From 24 days – 1 year Remodelling of the wound. Replacement tissue has a more organised structure (Carville, 2005)

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

Langkah – Langkah Perawatan Luka 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

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

KESIMPULAN

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

TERIMA KASIH