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Ns. Siti Nurul Aliyah, Skep, WOC(ET)N

Asisten Manajer Medis RS Thursina

CEO Duri Care Center
Pusat Perawatan :
Luka, Stoma, Inkontinensia & Foot Spa
Jl. Hangtuah No 108 A - Duri
FB . Siti Nurul Aliyah email. [email protected] WA. 085265121662
MODERN WOUND DRESSING
TIME MODEL Of Wound Bed Preparation

Prof Vincent
Tissue
Falanga (2003)
Ephitel
Edge Infection/
Advanceme Inflamatory
nt

Moisture
TIME Balance
MANAJEMEN PERAWATAN LUKA ( 3M )
Issues in Wound Care
HOW TO DRESS
Infection Control
Debridement
Exudate Management
Negative Pressure Drainage
Maintaining moist environment
Pain Management
6
Odor Control
SAFETY PRODUCT
WOUND MANAGEMENT PRINCIPLES

Control or eliminate causative factor

Pressure, shear, friction, moisture, circulation impairment
Provide systemic support to reduce existing and
potential co-factors
NUTRITIONAL, FLUID SUPPORT, EDEMA,
CONTROL SYSTEMIC CONDITION
The ideal wound dressing should provide the optimum environment
to meet the treatment objective and protection from further injury
CHARACTERISTIC RATIONALE
Promotes moist wound healing* Dry wound bed inhibits wound healing
Manages excess exudate Prevent maceration and further wound
breakdown
Provides thermal insulation Reducing temperature at wound bed
Impermeable to micro-organisms reduces fibroblast activity
Prevents damage and reduces pain
Causes minimal trauma on removal
Prevent exit and entry of organisms
Cost effective
Makes best use of available resources
Available in hospital and Accessible to all careers
community
JENIS BALUTAN LUKA

BALUTAN BALUTAN
PRIMER SEKUNDER

BALUTA
N LUKA
DRESSING SELECTION
What is the action of this dressing?
When should it be used?
Are there any contra-indications to its use?
Do I know the method of application and removal?
Is a secondary dressing required ?
If yes which dressing is appropriate ?
The application of an inappropriate secondary dressing may
adversely affect the ability of the primary dressing to function
correctly
HISTORY

 Sebelum th 1980 an, kassa masih menjadi

unggulan balutan

 Setelah th 1980, perubahan dramatis dgn

berbagai jenis balutan yg mendukung
MOISTURE
konsep
BALANCE
 Saat ini lebih dari 3500 jenis balutan ada di
dunia
DRESSING / BAHAN BALUTAN
Gauze / kasa
Transparant film
Hidrogels
Hydrokoloid
Calsium alginate
Collagen
Polyurethane foam
Hydrophobic
Silver
Zink cream: Metcovazin
Fixasi
Gauze has been used as a wound dressing for centuries, and continues to be the most readily available
wound dressing in use today. A wide variety of gauze dressings are available, with choices to be made
between sterile and non-sterile types, gauzes with and without an adhesive border, and woven and non-
woven gauze dressings. Woven gauzes are manufactured from cotton yam or threads and woven like fabric.
Non-woven gauzes are usually manufactured from synthetic fibers, which are pressed together to give the
appearance of a woven fabric. Gauze may be used as a primary or secondary wound dressing.

Contoh Kasus Penggunaan Kasa

pada luka tunneling

Setelah penggunaan modern dressing

GAUZE
Impregnated-gauze dressings may be used as a contact layer on granulating wounds. Despite the ongoing popularity of gauzes, these
dressings have a number of significant drawbacks. Woven gauze may traumatize the wound bed on removal, or leave residue in the
wound bed that may result in inflammatory response, or the formation of a granuloma. Finally, as gauze is highly permeable and
relatively non-occlusive, gauze dressings may promote desiccation in wounds with minimal exudate unless used in combination with
another dressing or topical agent.
Description

Alginate dressings are produced from the calcium and sodium salts of alginic acid, a

polymer obtained from seaweed that is composed of mannuronic and guluronic acid

residues. In the presence of exudate the fibres absorb liquid and swell causing the dressing to take on a
gel-like appearance. This overlays the wound and provides a micro-environment that is believed to

facilitate wound healing.

Whilst in theory all calcium alginate products have haemostatic properties, not all companies have

included this in their information. If choosing an alginate for this specific property the clinician should

ensure the dressing has this licensed indication.

ALGINATES MANAGE WOUND EKSUDATE AND STOP BLEEDING

Primary dressing for management of heavily exuding wounds,
Warnings
Do not leave on longer than 7 days.
Cavities should be packed loosely - DO NOT pack tightly.
Description
Hydrogels contain insoluble polymers which swell and increase in volume, until
saturated, facilitating epithelialisation by maintaining a moist environment on the
surface of the wound.
Some hydrogel sheets are available which have a fixed structure.
Indications
May be applied to many wound types including dry, sloughy or necrotic
wounds and are particularly useful for cavity wounds. May be used for
infected wounds (except sheets) - systemic antibiotics may be appropriate.

HYDROGEL
Contraindications
Wounds producing excessive amounts of exudate may dilute and remove gel from wound onto secondary
dressing. Sheets have limited fluid handling capacity.
Do not use where anaerobic infection is suspected, may support growth of micro-organisms.
Some gel contains Propylene Glycol – a potential sensitising agent. Discontinue treatment if signs of adverse
reaction develop.
Drescription
Allevyn® foam dressing consists of a layer of hydrophilic polyurethane foam bonded
to a pink semi- permeable polyurethane film. This pink layer should be uppermost with cream layer in
contact with skin. The film is permeable to moisture vapour but provides an effective barrier to water.
It also prevents the passage of micro-organisms through the back of the dressing. The wound contact
surface of the dressing is covered with a perforated film preventing adherence to granulation tissue.
Lyofoam® consists of a soft, hydrophobic, open-cell polyurethane foam sheet approximately 8mm
thick. The dressing contact layer (shiny side) has been heat treated to collapse the foam cells enabling
liquid absorption by capillarity. The dressing is permeable to gases and water vapour but resists the
penetration of aqueous solutions and wound exudate.

POLYURETHANE FOAM DRESSING

Contra-indications
Not indicated for use on dry wounds covered with a scab or necrotic tissue. The necrosis should first be
removed, if clinically indicated, prior to application of foam .
Description
NA ultra® consists of a knitted open structure made from continuous monofilament viscose yarns onto which has been polymerized a silicone coating. The
dressing acts as a low adherence primary wound contact layer that can be easily removed from wound surface without causing pain or trauma. The silicone
coating does not occlude the pores of the fabric but allows free drainage of exudate from the wound, thus preventing tissue maceration.
Indications
NA ultra® is indicated for the management of clean, lightly exuding, superficial wounds ie leg ulcers, pressure ulcers, burns, cuts and abrasions. Prevents
adherence of dressing to wound bed reducing trauma and pain at dressing change. Its non adherent properties reduce the risk of damage to new capillary
loops of granulation tissue.
Contra-indications
Allergy to silicone (use NA dressing® instead).

NON OR LOW ADHERENT DRESSING /SILLICON

Silicone gel sheets are indicated to prevent or improve the appearance of old and new hypertrophic
and keloid scars.
Description
Based on Carboxymethylcellulose and other polysaccharides and proteins, i.e. gel forming
agents with elastomers and adhesives. On contact with wound exudates, the polymers absorb
water and swell. A gel is formed which remains in contact with the wound surface and these
moist conditions promote fibrinolysis, angiogenesis and wound healing without causing
maceration. This has a characteristic odor but is easily washed off with warmed saline.

HYDROCOLLOID
Contraindications

Known sensitivity to the hydrocolloid or its components.

Do not use on clinically infected wounds. Also if the dressing has to be changed more regularly than every 3 days - this is probably not the most suitable dressing.

Warnings

Inappropriate or too frequent dressing changes may result in skin irritation or stripping. Hydrocolloids may not be acceptable to vegans due to constituents.
Collagen dressings are sheets, pads, particle and gels derived from type I bovine, type III porcine or avian sources of
collagen. These dressings encourage the deposition and organization of newly formed collagen fibers and granulation tissue in the wound bed.
Collagen dressings are indicated for use as a primary dressing in the treatment of partial- and full-thickness wounds such as skin grafts,
donor sites, surgical wounds,
tunneling wounds, infected and non-infected wounds and wounds with minimal to heavy exudate (depending on the form of the dressing).
Collagen dressings are generally contraindicated for dry wounds and
third-degree (full-thickness) burns, and in patients with sensitivities to collagen or bovine products.

COLLAGEN DRESSING
The following general warnings apply to collagen-based dressings. Always refer to manufacturer information for Warnings
and Precautions for a specific product.
Require a secondary dressing.Not recommended for necrotic wounds.May require rehydration on removal.
ZINC CREAM
Topical zinc is widely used in wound treatment although the beneficial effect of zinc has only been documented in zinc-
deficient patients who were given zinc orally. The main purpose of this study was to investigate the effect of topically
applied zinc on leg ulcer healing and examine its effect on some mechanisms in wound healing using standardized animal
models. Additionally, absorption of zinc into wounds and intact skin treated topically with zinc was studied. topical zinc
may stimulate leg ulcer healing by enhancing re-epithelialization, decreasing inflammation and bacterial growth. When zinc
is applied on wounds it not only corrects a local zinc deficit but also acts pharmacologically.
DUA MINGGU YANG BERHARGA
1. MEMBAIK, masih disertai tanda dan gejala infeksi

2. MEMBAIK, tanda dan gejala infeksi berhenti

3. TIDAK MEMBAIK,
STOP penggunaan, evaluasi untuk penggunaan silver dressing lainnya
dengan atau tanpa AB sistemik

SILVER DRESSING

Description
Silver containing products are impregnated with silver metallic ions. When these products are placed on a wound the silver is
activated and becomes antimicrobial. It originally came in the form of silver sulphadiazine cream but is now available in the form of
impregnated dressings. It may act in one of two ways over a period of time:
deliver ionic silver to the wound, targeting bacteria
absorb infected matter and expose it to ionic silver within the dressing
These dressings can be placed directly onto the wound bed. Frequency of dressing change varies between products. Pure elemental
silver is inactive but silver ions are highly reactive. Silver is continuously available when the dressing is in place. This provides an
antimicrobial barrier, protecting the wound.
Description. Iodoflex® consists of individual applications of a cadexomer iodine
paste consisting of a macrogol ointment base incorporating sterile, yellow-brown
microspheres or beads 0.1–0.3 mm in diameter. The beads, which are formed from
a three-dimensional network of cadexomer - a chemically modified starch, contain
elemental iodine within their structure. The paste is presented between two layers
of gauze fabric which act as carriers and facilitate application. In the presence of
aqueous solutions or wound fluid, the beads in the paste take up liquid and swell,
slowly releasing the iodine, which imparts antibacterial properties to the dressing.

Warnings
Iodine is absorbed systemically especially when applied to
large wounds and therefore Iodoflex® should be used with
care on patients who have a history of thyroid disorders.
There is a potential interaction of iodine with lithium and
therefore co-administration is not recommended. Iodoflex®
should not be used on dry wounds. CADEXOMER IODINE
DescriptionSterile larvae for wound management come from the greenbottle Lucilla Sericata. In optimum conditions they produce
powerful proteolytic enzymes breaking down necrotic, sloughy tissue. The larvae subsequently ingest this degraded, liquefied tissue
as a source of nutrient. When initially applied to the wound the larvae are just 2-3mm in length. On removal from a necrotic wound
their size may be increased to 8-10mm in length.
IndicationsSterile larvae are suitable for use on a variety of sloughy necrotic wounds that require debridment. Infected, malodorous
wounds are also indicated as larvae combat odour while ingesting and killing bacteria present in the wound.
ContraindicationsLarvae should not be applied to wounds close to large blood vessels, bleeding wounds or wounds that
communicate with a body cavity or internal organ.
Warnings If the larvae cause bleeding in the wound the treatment should be removed and the wound reassessed. Pain associated with
the larvae should result in treatment being discontinued.

LARVAE THERAPY / MAGGOTS

Storage
Larvae should be used within 12 hours of receipt. If the time delay between receipt and use is longer the
larvae should be stored in a cool, dark place at a temperature of 8-10 degrees. Sterile saline should be added
to the bag containing the larvae vial for storage to prevent the larvae drying out.
Vacuum assisted closure (also called vacuum therapy, vacuum sealing or topical negative pressure therapy) is a sophisticated development of a standard surgical procedure, the use

of vacuum assisted drainage to remove blood or serous fluid from a wound or operation site.

A piece of foam with an open-cell structure is introduced into the wound and a wound drain with lateral perforations is laid on top of it. The entire area is then covered with a

transparent adhesive membrane, which is firmly secured to the healthy skin around the wound margin. When the exposed end of the drain tube is connected to a vacuum source,

fluid is drawn from the wound through the foam into a reservoir for subsequent disposal.

The plastic membrane prevents the ingress of air and allows a partial vacuum to form within the wound, reducing the volume of the foam and facilitating the removal of fluid. The

foam ensures that the entire surface area of the wound is uniformly exposed to this negative pressure effect, prevents occlusion of the perforations in the drain by contact with the

base or edges of the wound, and eliminates the theoretical possibility of localised areas of high pressure and resultant tissue necrosis.

VAC OR NPWT
Contraindications
Fistulas to organs or body cavities Necrotic tissue in eschar Osteomyelitis (untreated) Malignancy in the wound
In addition, and for obvious reasons, special precautions should be observed when using the technique where haemostasis is difficult, in the presence of
active bleeding or in the treatment of patients receiving anticoagulant therapy.
Honey is naturally antimicrobial and a preferred treatment application
because it does not possess the same toxicity as ionic silver. Additionally,
MEDIHONEY® has been used successfully along with other advanced wound care modalities,
including being used before, during, and after negative pressure applications, as well as being
used as cover dressings for skin grafts and skin substitutes.

HONEY
MEDIHONEY® dressings, a unique line of dressings by Derma Sciences containing active Manuka
(Leptospermum scoparium) Honey from New Zealand, possess unique qualities that make them ideal for the
management of chronic and acute wounds and burns. A strong and growing evidence base – including several
large scale randomized controlled studies – have shown that MEDIHONEY® dressings are effective on hard-to-
heal wounds and burns, in addition to helping to debride wounds and keeping wound beds clean of necrotic tissue.
when microorganisms come into close contact with DACC, they become
irreversibly bound to the dressing as a result of hydrophobic interaction. Once
bound
to the dressing these microorganisms are rendered inert and prevented from reproducing or
releasing harmful toxins3. The hydrophobic microorganisms are then removed with each dressing
change, helping to reduce the bacterial load in the wound bed and leaving the non-hydrophobic
microorganisms to stimulate healing3-7.

DACC (Dialcylcarbamoxyl chloride)

In-vitro testing and studies using a simulated moist wound environment have shown that the use of a hydrophobic dressing
(Cutimed® Sorbact®) can reduce microbial load in
a wound3. The DACC-coated dressing demonstrated a binding action to common wound pathogens, including Staphylococcus
aureus, Pseudomonas aeruginosa and Candida albicans and was found to be most effective in wounds with moderate to high levels
of exudate3. In addition, Cooper and Jenkins20 have demonstrated a potential role for DACC in the management of
biofilms and multi-resistant organisms.
Transparent filmdressings
are thin, flexible sheets of clear polyurethane incorporating an adhesive coating o
n one side to allow adherence to the skin. The adhesive reacts with wound fluid to
prevent adhesion to the wound bed, while allowing the dressing to stick to the dry,
periwound skin. Film dressings are highly elastic and conformable to body contou
rs, and are suitable for use either as a primary or secondary dressing. The transpare
nt quality of film dressings allows useful visualization of the wound bed.

TRANSPARANT FILM DRESSING

They are permeable to water vapor, oxygen, and carbon dioxide, but impermeable to bacteria and water. This means that oxygen is
allowed into the wound to promote healing, while the water vapor and carbon dioxide produced are allowed to escape. The dressing
also acts as an effective barrier to water and bacteria. It is this semi-permeable nature of transparent film dressings that helps them
achieve lower overall infection rates than traditional gauze dressings.
ISLAND DRESSING

Gauze dressings continue to be the most readily available wound dressings in use today. Gauze is highly permeable and relatively
non-occlusive. Therefore, gauze dressings may promote desiccation in wounds with minimal exudate unless used in combination
with another dressing or topical agent. Gauze may be used as a primary or secondary wound dressing. Gauze dressings are
inexpensive for one-time or short-term use. Gauze dressings come in many forms: squares, sheets, rolls, and packing strips.
HIGHLY ABSORBENT DRESSING

GOLD DUST
 Gold Dust™ hydrophilic polymer wound filler is an
PREMIUM PRODUCT exceptionally high absorber. Recommended only for
highly exudating wounds. Tends to inhibit bacterial
proliferation.

 When managing moderate to low exudating wounds,

one must pre-moisten the Gold Dust™ granules to
form a gel to avoid over-drying the tissue. Because of
the high absorption capacity of the product, even the
Gold Dust™ as a pre-moistened gel can cause a
painful burning or stinging sensation for the patient.
Often the pain will go away after 10 to 30 minutes.
However, in some cases additional measures must be
used to prevent or reduce this burning from occurring.
TAPE - FIKSASI
GENTLE ANTISEPTIC

The antiseptic agent polyhexamethylene biguanide (also known as polihexanide or PHMB) has been used for over 60
years in a wide range of applications from swimming pool sanitisers to preservatives in cosmetics and contact lens
solutions. In Europe, it has been available as a wound irrigation fluid for some time. PHMB is a fast-acting biguanide
compound composed of a synthetic mixture of polymers.The compound is structurally similar to the antimicrobial
peptides (AMPs) produced by many cells within the wound, such as keratinocytes and inflammatory neutrophils, where
they are thought to help protect against infection (Sorensen et al, 2003; Ousey and McIntosh, 2009). AMPs have a broad
spectrum of activity against bacteria, viruses and fungi, inducing cell death by disrupting cell membrane integrity (Ikeda
et al, 1983; Ikeda et al, 1984; Moore and Gray, 2007;).
TERIMAKASIH