ulkus dekubitus

ULKUS DEKUBITUS

ULKUS DEKUBITUSA Presentation byIndira Suluh ParamitaDefinisiCedera jaringan lunak pada daerah dekat tonjolan tulang akibat tekanan terus menerus.(Grab and Smiths)Nekrosis jaringan lokal yang cenderung terjadi ketika jaringan lunak tertekan diantara tonjolan tulang dengan permukaan eksternal dalam jangka waktu lama. Terjadi gangguan mikrosirkulasi jaringan lokal dan mengakibatkan hipoksia jaringan. National pressure Ulcer Advisory panel (NPUAP),EpidemiologiIn general, approximately 9% of all hospitalized patients develop pressure soresThe occurrence seen in the acute care setting is as high as 11%.Cited in all studies is the association with other medical problems, including cardiovascular disease (41%), acute neurologic disease (27%), and orthopedic injury (15%).Although 70 percent of ulcers occur in persons older than 65 years, younger patients with neurologic impairment or severe illness are also susceptible.95% of pressure ulcers develop on the lower body (about 65% in the pelvic area and 30% in the lower extremities) Faktor PredisposisiAmerican Academy of Family PhysiciansPATOFISIOLOGICOMPRESSION of soft tissuesISCHEMICNecrotic and UlcerationPRESSURETekanan dari luar akan mengganggu perfusi kapiler. Kerusakan akan dimulai dari otot yang membungkus tulang dan terakhir kulit. Oleh karena itu bentuk lukanya menggaung. Kerusakan yang terjadi tergantung dari lokasi, waktu dan intensitas.

InfeksiJumlah bakteri meningkat pada area yg tertekan

UDEMATekanan meningkat -> ekstravasasi-> udemINFLAMASIPada jaringan normal yg terkena terluka akan terjadi vasokonsriksi, koagulasi, keluarnya sel proinflamasi, dan maturasi matrix. Pada luka kronik terjadi gangguan pada proses proses ini disebabkan oleh peningkatan MMP9: TIMP-1

PenangananWhen an ulcer occurs, documentation of each ulcer (i.e., size, location, eschar and granulation tissue, exudate, odor, sinus tracts, undermining, and infection) and appropriate staging (I throughIV) are essential to the wound assessment.Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. Debridement is indicated when necrotic tissue is present. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs.Mechanical, enzymatic, and autolytic debridement methods are nonurgent treatments. Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. Bacterial load can be managed with cleansing. Topical antibiotics should be considered if there is no improvement in healing after 14 days. Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection.

(Am Fam Physician. 2008;78(10):1186-1194, 1195-1196. Copyright 2008 American Academy of Family Physicians.)

Pre-Operative careNutrisipertahankan albumin diatas 2g/DlAsupan protein 1,5 3 g/kg/ hariKalori non protein 25-35 cal/kg /hariVit A dan CZync untuk percepatan epitelialisasi.InfeksiGunakan antibiotik oral yang sensitif terhadap gram negati dan positif serta anti biotik topikal.Eg ab topikal : silver sulfadiazine, mafenide acetat, dakin solution.Pembebasan tekananDinsdale demonstrated the ability to counteract the deleterious effects of pressure by relieving it for only 5 minutes every 2 hours. In addition, various available mattressand wheelchair padding systems have been designed to relieve pressure, including foam, static flotation, alternating air, lowair- loss pads, and air fluidized beds. The purpose of these systems is to distribute the patients weight more evenly to minimize pressure in any one area, although the use of these expensive adjuncts does not rule out the need for diligent surveillance.Tindakan OperatifDebridementOstectomyPressure sore closurePencegahanPrevention includes identifying at-risk persons and implementing specific prevention measures, such as following a patient repositioning schedule;Keeping the head of the bed at the lowest safe elevation to prevent shear;Using pressure-reducing surfaces;Assessing nutrition and providing supplementation, if needed.Terima kasih