Debridemen Luka

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Debridemen Luka
Debridemen adalah operasi yang bertujuan untuk membersihkan luka dari bahan
asing dan jaringan mati serta memberikan persediaan darah yang baik di seluruh bagian
itu. Debridemen luka merupakan suatu prosedur sistematis pertama mulai dari lapisan
superfisial kemudian ke lapisan lebih dalam. Penanganan jaringan pada luka haruslah
dengan cara halus untuk mencegah perdarahan. Bila terjadi perdarahan bisa dilakukan
kompresi lokal atau dengan meligasi pembuluh darah.
Tahapan-tahapan debridemen:
1. Harus dilakukan anestesi lokal pada luka dan bila perlu bisa dilakukan
pencukuran rambut sekitar luka debridemen.
2. Cuci luka dengan sabun (saflon) dan air kemudian irigasi dengan cairan NaCl 0,9
% sehingga tidak ada sabun yang tersisa pada luka.
3. Buang semua benda asing yang ditemukan pada luka seperti tanah, rumput, kayu,
kaca atau serpihan pakaian dan kemudian berikan antiseptik.
4. Terkadang diperlukan juga untuk memperluas luka secara longitudinal untuk
melihat semua kerusakan yang terjadi pada jaringan.
5. Lakukan eksisi tipis pada tepi luka.
6. Nilai semua jaringan avital dengan menilai warna yang lebih gelap pada jaringan
normal, konsistensi yang lebih rapuh dan mudah terlepas, kontraktilitas, dan
terakhir dengan menilai kemampuan perdarahan dari jaringan tersebut.
7. Buang semua jaringan avital tersebut dari luka. Bila pada luka tersebut ada
pecahan fraktur tulang maka jangan dibuang terlalu banyak. Pastikan tidak
mengganggu stabilitas pada fraktur.
Pembuluh darah, saraf, dan tendon yang intak tetap dibiarkan setelah luka
dibersihkan. Ligasi apabila terjadi perdarahan. Bila terjadi cedera pada pembuluh darah
besar bisa dilakukan ligasi namun jangan lupa untuk menilai denyut nadi dan sirkulasi
pada daerah distal. Pisahkan saraf dengan menginsersikan benang silk halus 1 atau 2
jahitan yang pada selubung saraf. Umumnya setelah debridemen dilakukan perawatan
luka terbuka.
Tipe-tipe debridemen:
1. Autolytik Debridement
Merupakan debridemen yang
melembabkan untuk mempac

menggunakan enzim dari tubuh dan

2. Enzymatic Debridement
3. Mechanical Debridement
4. Surgical Debridement
Description:
Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally
liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic
tissue is liquefied. It is also virtually painless for the patient. Autolytic
debridement can be achieved with the use of occlusive or semi-occlusive
dressings which maintain wound fluid in contact with the necrotic tissue.

Autolytic debridement can be achieved with hydrocolloids, hydrogels and
transparent films.
Best Uses:
In stage III or IV wounds with light to moderate exudate
Advantages:
Very selective, with no damage to surrounding skin.
The process is safe, using the body's own defense mechanisms to clean the wound of
necrotic debris.
Effective, versatile and easy to perform
Little to no pain for the patient
Disadvantages:
Not as rapid as surgical debridement
Wound must be monitored closely for signs of infection
May promote anaerobic growth if an occlusive hydrocolloid is used

Enzymatic Debridement:
Description:
Chemical enzymes are fast acting products that produce slough of necrotic tissue.
Some enzymatic debriders are selective, while some are not.
Best Uses:
On any wound with a large amount of necrotic debris.
Eschar formation
Advantages:
Fast acting
Minimal or no damage to healthy tissue with proper application.
Disadvantages:
Expensive
Requires a prescription
Application must be performed carefully only to the necrotic tissue.
May require a specific secondary dressing
Inflammation or discomfort may occur

Mechanical Debridement:
Description:

This technique has been used for decades in wound care. Allowing a dressing to
proceed from moist to wet, then manually removing the dressing causes a form of
non-selective debridement.
Hydrotherapy is also a type of mechanical debridement. It's benefits vs. risks are of
issue.
Best Uses:
Wounds with moderate amounts of necrotic debris
Advantages:
Cost of the actual material (ie. gauze) is low
Disadvantages:
Non-selective and may traumatize healthy or healing tissue
Time consuming
Can be painful to patient
Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause
contamination or infection. Disinfecting additives may be cytotoxic.

Surgical Debridement:
Description:
Sharp surgical debridement and laser debridement under anesthesia are the fastest
methods of debridement.
They are very selective, meaning that the person performing the debridement has
complete control over which tissue is removed and which is left behind
Surgical debridement can be performed in the operating room or at bedside,
depending on the extent of the necrotic material.
Best Uses:
Wounds with a large amount of necrotic tissue.
In conjunction with infected tissue.
Advantages:
Fast and Selective
Can be extremely effective
Disadvantages:
Painful to patient
Costly, especially if an operating room is required
Requires transport of patient if operating room is required.

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