FISIOLOGI PENYEMBUHAN LUKA

FISIOLOGI PENYEMBUHAN LUKAOleh :SITI HUZAIMATUL HIMMAH, SST, M.MKesMOIST WOUND HEALINGGeorge 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 HEALINGHome WORK : Why MOIST ?JustifikasiFibrinolisis : fibrin cepat hilang pada suasana lembab oleh netrofil dan sel endotel

Angiogenesisi : proses akan lebih terangsang pada suasana lembab

Infeksi : lebih rendah dibandingkan suasana kering ( 2.6 % vs 7.1 % )

Percepatan pembentukan sel aktif : invasi netrofi yang diikuti olehmakrophag, monosit dan limfosit ke daerah luka akan berfungsilebih dini.

Pembentukan growth factor : lebih cepat pada suasana lembab* EGF, FGF dan Interleukin1 dikeluarkan oleh makrophaguntuk proses angiogenesis dan pembentukan str. Korneum* Platelet-derived Growth Factor (PDGF) dan TransformingGrowth Factor-beta (TGF-beta) dibentuk oleh platelet untukproses proliferasi fibroblast.Types of Wound HealingHealing by First Intention

Healing by Second Intention

Healing by Third Intention

Schematic Diagram of the Phases of Wound Healing

Fisiologi Penyembuhan LukaFase Penyembuhan Luka

Fisiologi Penyembuhan Luka (cont)Proses Penyembuhan Luka

Fisiologi Penyembuhan Luka (cont)Faktor-faktor yang Mempengaruhi Proses Penyembuhan LukaFaktor LokalFaktor SistemikUsia Hormonal Stress Nutrisi Obesitas Diabetes Obat-obatan Alkohol Merokok

Oksigenasi InfeksiCells of Wound Healing.

Inflammatory StageTanda : 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 response24 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

Proliferation StageBegins within 24 hours of the initial injury and may continue for up to 21 days

It is characterized by three events:EpithelializationGranulationCollagen synthesisFormation of new capillaries that generate and feed new tissue

Granulation tissue is the beefy red tissue that bleeds easily

Proliferation : EpitheliazationFormation of an epithelial layer that seals and protects the wound from bacteria and fluid lossIt is essential to have a moist environment to foster growth of this layerIt is a very fragile layer that can be easily destroyed with aggressive wound irrigation or cleansing of the involved area

Proliferation : Collagen SynthesisCreates 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

MaturationFINAL stage of wound healingBegins around day 21 and may continue for up to 2 yearsCollagen synthesis continues with eventual closure of the wound and increase in tensile strengthTensile strength reaches only about 80% of pre-injury strength