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FISIOLOGI PENYEMBUHAN LUKA
woc ec l i n i c
a Professional Nurse Lead Service for People with Stomas, Wounds or IncontinenceI j in No. 1196/ 503/ Dinkes/ BAK/ XI I / 2007
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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 ?
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JUSTIFIKASI
1. Fibrinolisis : fibrin cepat hilang pada suasana lembab oleh netrofil dan sel endotel
2. Angiogenesisi : proses akan lebih terangsang pada suasana lembab
3. Infeksi : lebih rendah dibandingkan suasana kering ( 2.6 % vs 7.1 % )
4. Percepatan pembentukan sel aktif : invasi netrofi yang diikuti oleh
makrophag, monosit dan limfosit ke daerah luka akan berfungsi
lebih dini.
5. 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.
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TYPES OF WOUND HEALING
1. Healing by First Intention
2. Healing by Second Intention
3. Healing by Third Intention
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Schematic Diagram of the Phases of Wound Healing
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CELLS OF WOUND HEALING.
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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
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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
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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
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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
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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
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5 HARI PASCA PERLUKAAN
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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