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Pembimbing :
dr. Dharma Gita

Oleh :
Fina Agustiani Liaw
• Epidermis • Subcutaneous Tissue
– Thin, avaskular, stratified, outermost layer of – Supports and anchors the Epidermis and
the skin Dermis to the underlying body tissue.
– The process of differentiation or regeneration – Age, heredity, and nutritional intake
of the epidermal layer is stimulated by growth influence the thickness of this layer.
factors. – Consists of connective tissue and adipose
– The primary cells in this layer are tissue.
Keratinocytes and Melanocytes. – The primary functions of this layer are
– The primary functions of this layer are protection, insulation, energy, and body
Protection and Regulation. shape

• Dermis
– Contains blood vessels, nerve fibers,
lymphocytes, sweat and sebaceous
glands, and hair follicles.
– Main proteins present are collagen
and elastin.
– The primary functions of this layer are
strength, nutrition and structural

Newfoundland Labrador. Skin and Wound Care Manual.Labrador Grenfell Health and Western Health.2008

• A wound is sustained when there is disruption

of normal anatomy and integrity of tissue

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
• Acute - are caused by trauma or surgery.
Acute wounds heal in a predictable period of
time and most will go on to heal within 2-8
• Chronic - are defined as wounds, which have
failed to proceed through an orderly and
timely reparative process to produce anatomic
and functional integrity over a period of 3

Wound Care Guidelines. Central West Community Care Access Centre. 2017
Werdin F. Mayer T, Et al. Evidence based management stratergies for treatment of chronic wounds. 2009. Downloaded in
Acute Wound
1. Incision wound (v. scissum)
2. Contusion wound (v. Contusum)
3. Laceration wound (v. lacerum)
4. Puncured wound (v. punctum)
5. Abrasion wound (vulnus abrasum)
6. Bite wound (v. Morsum)
7. Cut wound (v. caesum)
8. Shot wound (v. sclopetarium)

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
Chronic Wound

Diabetic foot ulcer

The pressure ulcer

The venous stasis ulcer

Jorge I. Chronic Wounds. Medscape. 2017

Diabetic Foot Ulcer
• Management :
consult, off-loading,
debridement, wash
and inspect feel daily,
dry carefully,
maintenance of a
moist wound
Jorge I. Chronic Wounds. Medscape. 2017
Newfoundland and Labrador Skin and Wound Care Manual – July 2008. Section 6 - Page 21
The Pressure Ulcer
• Prolonged pressure over a bony prominence.
• Treatment consists of pressure relief,
debridement, and maintenance of a clean,
moist wound environment.

Jorge I. Chronic Wounds. Medscape. 2017

Venous Stasis Ulcer
• Venous stasis ulcer result from hypoxia in
areas of venous congestion in the lower
• Therapy : Compression hose or boots,
debridement, and maintenance of a clean,
moist wound environment

Jorge I. Chronic Wounds. Medscape. 2017

Surgical Wound Classification
Class I

Class II

Class III

Class IV

Slashing surgical site infectons. Downloaded in http://www.cdc.gov/hicpac/SSI/table7-8-9-10-SSI.html

• Cleansing of the wound can be achieved by 3
main methods :
– Compression
– Irrigation
– soaking
• Wound can be closed by;
– Primary closure
– Delayed primary closure
– Through healing by secondary intention
Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
• Dressing
• Systemic antibiotics
• Tetanus prophylaxis

Teng MC. Acute wound and management. The Singapore family physician Vol 4. 2015
Dewasa : Oral 1-2g/hari diberikan 2x dalam sehari
Anak : Oral >6 tahun <40 kg 30-50 mg/kgBB sehari, diberikan 2x sehari. Maksimal 100 mg/kgBB dalam sehari.
Ibu hamil : kategori B
Dewasa : Oral 500 mg/hari, diberikan 1x dalam sehari selama 7-14 hari.
Anak : 16-20 mg/kg/hari PO diberikan 2 kali
dosis maksimum : 750 mg/hari
Ibu hamil : kategori B
Dewasa : Oral 150-300 mg per kali. Diberikan 3x sehari.
Anak : 1 bulan - 18 tahun, PO: 6mg/kg/kali diberikan 4 kali sehari (berat badan <10kg, dosis minimum 37.5mg 3 kali
IV: 6–10mg/kg/kali diberikan setiap 6 jam
dosis maksimum : 1.8 g/day
Ibu hamil : kategori B
Dewasa : Oral 500 mg/kali. Diberikan 2x sehari.
Anak : 1 bulan - 18 tahun, PO: 15–30mg/kg/kali diberikan 3 kali sehari (maksimum 500mg/kali)
IV: 30–60mg/kg/kali diberikan setiap 8 jam
dosis maksimum : 4 g/hari
Ibu hamil : kategori B
Dewasa : Oral 125 – 312 mg 4x sehari
Parenteral : Dewasa 0,6 – 3,6 g sehari diberikan 4-6x sehari secara IM atau IV lambat < 300 mg/menit
Anak : bayi baru lahir 50 mg/kgBB sehari diberikan 2x sehari. 1-4 minggu 75 mg/kgBB sehari diberikan 3x sehari.
1 bulan – 12 tahun 100 mg/kgBB sehari diberikan 3x sehari. Tidak melebihi 4 g/hari.
Ibu hamil : kategori B
Na Diklofenac : Dewasa Oral 75-150mg/hari, diberikan 2-3x sehari.
Anak : oral/rektal >6 bulan : 300 mikrogram - 1mg/kg/kali, 3 kali
sehari ( dosis maksimum 150mg/hari).
IM/IV >6 bulan : 300 mikrogram - 1mg/kg/kali, 1-2 kali sehari (
dosis maksimum 150 mg/kg/hari)
Ibu hamil : kategori C
Asam Mefenamat (NSAID) : Dewasa Oral 500 mg/kali. Diberikan 3x sehari.
Anak : 10-25 mg/kg/hari ( dibagi setiap 6 jam)
Ibu hamil : kategori C
Ibuprofen (NSAID) : Dewasa Oral 200-400mg/kali. Diberikan 3-4x sehari.
Anak Oral 4-10 mg/kgBB/hari. Diberikan 3-4x sehari.
Ibu hamil : kategori C

Acetaminophen (Analgesic Non-Opioid) :

Dewasa Oral 0.5-1 g/kali. Diberikan maksimal 4x sehari.
Anak Oral, <60 kg 10-15 mg/kali. Diberikan maksimal 4x sehari.
Ibu hamil : kategori A

Petidine (Opioid) : Dewasa Oral 50-150 mg setiap 4 jam jika dibutuhkan

Anak, Oral 2 bulan – 12 tahun 0.5-2mg/kgBB diulang setiap 4-6
jam jika dibutuhkan. 12-18 tahun 50-100 mg diulang setiap 4-6 jam
jika dibutuhkan.
Surgical Sutures
• Absorbable
Natural :
– Plain cat gut : Made from submucosa of healthy sheep and serosa of healthy cattle. It contains collagen
. digests it in about 5-6 days.
– Chromic cat gut : Used in subcorticular closure, for viscera and small vessels ligation to arrest
hemorrhage and for inner layer of bowel.
Synthetic :
– Vicryl suture : The benefits include good handling, decreased inflammation. It is absorbed by hydrolysis.
Vicryl suture is commonly used in ligation of vessels, skin closure, subcutaneous closure. It is absorbed
in 3 months.
– Monocryl : absorbed faster than vicryl and handling is not as good as vicryl. Its memory is intermediate,
inflammation is decreased more than vicryl and is absorbed by hydrolysis.

• Non- absorbable
– Natural : silk suture made from the raw silk from the cocoon of the silk worm. Character includes good
– Synthetic :
• prolene suture :Characters include intermediate handling , does not cause inflammation, and anti-
thrombogenic (does not form thrombus). Used mainly for vascular anastomosis, other uses
include subcutaneous closure, closure of fascia.
• Nylon : Characters include poor handling, does not cause inflammation. Used in skin closure,
fascia, tendon, hernioplasty and subcutaneous skin closure
Needle Types

Torre J. Sutures in Surgery. Medscape. 2017