ULKUS DEKUBITUS

A Presentation by
Indira Suluh Paramita

DEFINISI
Cedera 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),

EPIDEMIOLOGI
In general, approximately 9% of all
hospitalized patients develop pressure sores
The 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 PREDISPOSISI
Itrinsic

American Academy of Family Physicians

PATOFISIOLOGI

PRESSURE
Tekanan 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.

Infeksi
Jumlah bakteri meningkat pada
area yg tertekan

COMPRESSIO
N of soft
tissues

ISCHEMIC

Necrotic and
Ulceration

INFLAMASI
Pada 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

UDEMA
Tekanan meningkat ->
ekstravasasi-> udem

PENANGANAN
When 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 care
Nutrisi
pertahankan albumin diatas 2g/Dl
Asupan protein 1,5 3 g/kg/ hari
Kalori non protein 25-35 cal/kg /hari
Vit A dan C
Zync untuk percepatan epitelialisasi.

 Infeksi
Gunakan antibiotik oral yang sensitif
terhadap gram negati dan positif
serta anti biotik topikal.
Eg ab topikal : silver sulfadiazine,
mafenide acetat, dakin solution.

 Pembebasan tekanan
Dinsdale 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 OPERATIF
Debridement
Ostectomy
Pressure sore closure

PENCEGAHAN
Prevention 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