FISIOLOGI PENYEMBUHAN LUKA

MOIST WOUND HEALING George D Winter (1962): proved that wounds that were kept moist, healed better than those that were exposed to the air. THE FATHER OF MOIST WOUND HEALING Home WORK : Why MOIST ?

Justifikasi Fibrinolisis : fibrin cepat hilang pada suasana lembab oleh netrofil dan sel endotel Angiogenesisi : proses akan lebih terangsang pada suasana lembab Infeksi : lebih rendah dibandingkan suasana kering ( 2.6 % vs 7.1 % ) Percepatan pembentukan sel aktif : invasi netrofi yang diikuti oleh makrophag, monosit dan limfosit ke daerah luka akan berfungsi lebih dini. Pembentukan growth factor : lebih cepat pada suasana lembab * EGF, FGF dan Interleukin1 dikeluarkan oleh makrophag untuk proses angiogenesis dan pembentukan str. Korneum * Platelet-derived Growth Factor (PDGF) dan Transforming Growth Factor-beta (TGF-beta) dibentuk oleh platelet untuk proses proliferasi fibroblast.

Types of Wound Healing Healing by First Intention Healing by Second Intention Healing by Third Intention

Schematic Diagram of the Phases of Wound Healing

Cells of Wound Healing.

Inflammatory Stage Tanda : kemerahan, panas, nyeri dan bengkak Last approximately 4 to 5 days Permulaan terjadinya proses penyembuhan luka : aktifitas platelet untuk STOP perdarahan dan triggers the immune response 24 jam pertama saat terjadi perlukaan, neutrophils, monocytes and macrophages mengontrol pertumbuhan bakteri dan membuang jaringan mati ( mempersiapkan dasar luka ) Characteristic red color and warmth is caused by the capillary blood system increasing circulation & laying foundation for epithelial growth

Proliferation Stage Begins within 24 hours of the initial injury and may continue for up to 21 days It is characterized by three events: Epithelialization Granulation Collagen synthesis Formation of new capillaries that generate and feed new tissue Granulation tissue is the beefy red tissue that bleeds easily

Proliferation : Epitheliazation Formation of an epithelial layer that seals and protects the wound from bacteria and fluid loss It is essential to have a moist environment to foster growth of this layer It is a very fragile layer that can be easily destroyed with aggressive wound irrigation or cleansing of the involved area

Proliferation : Collagen Synthesis Creates a support matrix for the new tissue that provides it with its’ strength Oxygen, iron, vitamin C, zinc, magnesium & protein are vital for collagen synthesis This stage is the actual rebuilding and is influenced by the overall patient condition of the wound bed

Maturation FINAL stage of wound healing Begins around day 21 and may continue for up to 2 years Collagen synthesis continues with eventual closure of the wound and increase in tensile strength Tensile strength reaches only about 80% of pre-injury strength

5 hari pasca perlukaan

Refference Idral Darwis.2008.Perawatan luka diabet.WOCARE publishing. Indonesia Aida S.D. Suriadiredja.2007. History of wound healing and moist wound healing. Indonesian ETNEP paper.(not publication) Carville Kerylin.1998. Wound care manual. Silver chain foundation.Australia Bryant Ruth.2007. Acute and chronic wound. Mosby.USA