2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^
TRANSCRIPT
![Page 1: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/1.jpg)
![Page 2: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/2.jpg)
ADVANCED WOUND CARE:An experience in diabetic foot ulcer
PSMIK, Fakultas Kedokteran UNHASEditor in Chief Jurnal Luka Indonesia
Griya Afiat Makassar, Wound Care and Home Care
Saldy Yusuf.,PhD.,ETN
Kongres Nasional PERS, Novotel Hotel, Palembang 25-27 Juli 2017
![Page 3: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/3.jpg)
Topics
1. Current status DFU in Indonesia2. Risk Assessment3. Wound care of DFU4. Case series.
2
![Page 4: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/4.jpg)
PREVALENSI DIABETES MELLITUS
1. Waspadji S, Ranakusuma A, Suyono S, Supartondo S, Sukaton U. Diabetes Mellitus in an Urban Population in Jakarta, Indonesia. Tohoku J exp Med. 1983;141:219-228.2. Mihardja L, Delima, Siswoyo H, Ghani L, Soegondo S. Prevalence and determinants of diabetes mellitus and impaired glucose tolerance in Indonesia (a part of basic health
research/Riskesdas). Acta Med Indones. 2009;41(4):169-74.3. Shaw, J.E., Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14.4. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract.
2014;103(2):137-149.5. Pramono, L. a, Setiati, S., Soewondo, P., Subekti, I., Adisasmita, A., Kodim, N., & Sutrisna, B. (2010). Prevalence and predictors of undiagnosed diabetes mellitus in Indonesia. Acta
Medica Indonesiana, 42, 216–223. 3
1.63%
5.7% 6%7.00%
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
PREVALENCE DM IN INDONESIA1,3,4
19831 20072 20303
ta
12 Juta
0
2
4
6
8
10
7 Ju
12
14
2010 2030
Populasi DM di Indonesia2013 2035
Country Millions Country Millions
China 98.4 China 142.7
India 65.1 India 109.0
USA 24.4 USA 29.7
Brazil 11.9 Brazil 19.2
Russian 10.9 Mexico 15.7
Mexico 8.7 Indonesia 14.1Indonesia 8.5 Egypt 13.1
Germany 7.6 Pakistan 12.8
Egypt 7.5 Turkey 11.8
Japan 7.2 Russian 11.1
Prevalensi DM yang tidak terdiagnosa cukup tinggi sebesar 4.1 %
![Page 5: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/5.jpg)
Prevalence Acute and Chronic Wound
85.1
0
14.8
0
34.6
19.2
38.4
7.6
Sembuh Rujuk Drop out Meninggal
Summary Outcome in Wound Care Setting2013
Luka Akut Luka Kronis
26
1512
118 8
7
3 3 31 1 1
Prevalensi Acute and Chronic Wound in Home Care Setting
Saldy Yusuf., Sukmawati.,Mayumi Okuwa.,Junko Sugama. Development Enterostomal Therapy Nurse Outpatient Wound Clinic In Indonesia: A Retrospective Descriptive Study. 2013. Wound Research and Practice. 21(1):41-47
DFUs is major wound problems in clinical setting in Indonesia High number of Drop Out Patients
![Page 6: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/6.jpg)
Prevalence DFUs in Indonesia• Prevalence of risks (neuropathy and angiopathy) in Hospital
Setting 55.4% (95% CI: 53.7-57.0%)(Yusuf et al., 2015).
• Prevalence of DFUs:– Hospital 12% (95% CI: 10.3-13.6%)
(Yusuf et al., 2015).
– Home care 26%(Yusuf et al., 2013).
• One year observation; healing (64.7%), recurrence (17.6%),dead (11.8%), unheal (5.9%)
(Baharia et al., 2014)
1. Yusuf, S., Okuwa, M., Irwan, M., Rassa, S., Laitung, B., Thalib, A., … Sugama, J. (2015). Prevalence and risk factor diabetic foot ulcers: A cross sectional study among DM type 2 in eastern Indonesia. OWM Journal.
2. Yusuf, S., Kasim, S., Okuwa, M., & Sugama, J. (2013). Development of an enterostomal therapy nurse outpatient wound clinic in Indonesia : a retrospective descriptive study. Wound Practice and Research, 21(1), 41–47.
3. Baharia Laitung, Muhammad Irwan, Saiful Rassa, Sukmawati, Saldy Yusuf. One year recurrence incidence and risk factors of diabetic footulcer in Makassar, eastern Indonesia (pre eliminary study). 1st WOC Scientific Meeting, Yogyakarta 2014. 5
![Page 7: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/7.jpg)
DFU status on 1st admission
INFECTIONS ODOUR
CALLUSMASERASIEDEMA
UNDERMININGNECROTIC
POST AMPUTASI
Saldy Yusuf (2013) Current Status of Diabetic Foot Ulcers in Makasar, Indonesia. Baruga AP. Pettarani, 9Desember 2013
![Page 8: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/8.jpg)
7
DFU presence in one way
11. WGDF, “Pathophysiology of foot ulceration Pathophysiology of foot ulceration,” 2012.
DIABETES MELLITUS
Neuropathy Angiopathy
PRE ULCER
DIABETIC FOOT ULCER
AMPUTATION
Dry Skin Corn Callus Tinea Pedis
PRE ULCERS: SKIN PROBLEMS
Onychocriptosis Onychodistrofi Onychogriposis Onychomycosis
PRE ULCERS: NAIL PROBLEMSPRE ULCERS: DEFORMITY PROBLEMSHallux VagusBunionHammer Toe
PRESENCE DIABETIC FOOT ULCER
Amputation
![Page 9: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/9.jpg)
Golden Assessment
ABI dan TBIMONOFILAMENT TEST
ANGIOPATHYNEUROPATHY
8
Its not widely available in health care facilities
Alternative?
![Page 10: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/10.jpg)
Foot palpatianIpswich Test
ANGIOPATHYNEUROPATHY
Diabetic Foot Check Up
How about its validity and reliabity?
Alternative Assessment
![Page 11: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/11.jpg)
10
Palpasi Nadi Dorsalis Pedisdan Posterior Tibialis
Ipswich Test
• Sensitivity (66.7-100%)• Spesifisity (80.0-94.6%)
(Sulasti, Yusuf, Jafar, & Syam, 2017)
• Reliability between nurses (Cohen's Kappa = 0.724-0.909)
(Sulasti, Yusuf, Jafar, & Syam, 2017)
• Sensitivity (25-100%)• Spesificity (97.5-100%)
(Desri, Yusuf, Jafar, & Syam, 2017).
Validity and Reliability
Considerable to be valid and reliable as alternative assessment
![Page 12: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/12.jpg)
Risk Category for DFUs
RESIKO 0
RESIKO 1 RESIKO 2A RESIKO 2B RESIKO 3BRESIKO 3A
No Neuropathy No Deformity No IschemicNo History of UlcerNo History of amputation
Neuropathy + Deformitas + PAOD + History of + History of ulcers amputation
Avery, D. A. C. L., Lavery, L. A., Peters, E. J. G., Williams, J. R., Murdoch, D. P., Hudson, A., & LAvery, D. C. (2008). Reevaluating the Way We Classify the International Working Group on the Diabetic Foot. Diabetes care, 31, 154–156. doi:10.2337/dc07-1302.Abbreviations
![Page 13: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/13.jpg)
Eligible: 259
Analysis:249 (inpatient 14)
Drop Out: 10
Group 0:90 (36.1%)
12
Our findings
Group 1:14(5.6%)
Group 2A: 64 (25.7%)
Group 2B: 34 (13.7%)
Group 3A: 14 (5.6 %)
Group 3B: 3 (1.2%)
No DFU: 219 DFU:30
Yusuf, S., Okuwa, M., Irwan, M., et al (2016). Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital , Eastern Indonesia. Open Journal of Nursing, 6, 1–10.
![Page 14: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/14.jpg)
Advanced Assessment:Mobile Infra Red Thermography
![Page 15: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/15.jpg)
Identification neuropathy
2008(Bharara,
Viswanathan, & Cobb, 2008a and
2008b)
2009(Nishide et al., 2009)
(Roback, Johansson, & Starkhammar, 2009)
Identification Inflammation & sign
for foot diseaseDiagnosis
neuropathy
2012(Balbinot, Canani,
Robinson, Achaval, & Zaro, 2012)
IdentificationPlantar pattern
2011(Nagase et al., 2011)
2014(Yavuz et al., 2014)
Evaluation peakshear stress
HistoryMilestone application infra red thermography in diabetic foot
Saldy Yusuf: Identification Clinical Features Diabetic Foot Ulcers Using Non-Contact Thermography Based On Mobile Phone: A Case Series. WCET 2016 Conference, Cape Town, South Africa; 03/2016
![Page 16: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/16.jpg)
Mobile Thermography as advanced assessment
Courtesy: Griya Afiat Makassar
![Page 17: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/17.jpg)
Our FindingsThermography Features Clinical Features
Dorsal
Plantar
Clinical features showed necrotic area along side dorsal forefoot to medial, However thermography findings identified “cold pattern” at all fingers and forefoot area.
Yusuf, S., Sukmawati, K., & Laitung, B. (2016). Identification Clinical Features Diabetic Foot Ulcers Using Non Contact Thermography Based on Mobile Phone: A Case Series. In WCET 21st Biennial Congress.
![Page 18: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/18.jpg)
Sandi, Selina, et al (2017)
Screening for risk
17
Our study will investigate infra red thermography based iPhone as early screening tool in community setting
Butterly Pattern Asymmetrically Pattern
![Page 19: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/19.jpg)
Thermography: Pressure Ulcer
Thermography dapat digunakan untuk memprediksi terbentuknya “undermining” pada luka decubitus (Yusuf, S., et al 2016)
![Page 20: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/20.jpg)
We noted some advantages:• Less expensive amazon(US $217.99).• Real time support time serial observation.• Non contact no contamination.• 2 Dimension imaging advanced analysis.• Pocket size Useful in various setting.• Attach to smartphone easy to capture,
saving, sending, uploading and printing.
Advantages
![Page 21: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/21.jpg)
Wound Care:Wound Bed Preparation and TIME
20
![Page 22: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/22.jpg)
TIME CONCEPT
European Wound Management Association (EWMA). Position Document: Wound Bed Preparation in Practice. London: MEP Ltd, 2004
EWMA merekomendasikan:1. Debridement secara berkala dan radikal.2. Inspeksi dan kontrol bakteri.3. Moisture balance untuk mencegah maserasi.
![Page 23: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/23.jpg)
Moura, L. I. F., Dias, A. M. a, Carvalho, E., & de Sousa, H. C. (2013). Recent advances on thedevelopment of wound dressings for diabetic foot ulcer treatment--a review. ActaBiomaterialia, 9(7), 7093–114. doi:10.1016/j.actbio.2013.03.033
MOISTURE BALANCEPemilihan Balutan yang Tepat
![Page 24: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/24.jpg)
Proses Perawatan
European Wound Management Association (EWMA). Position Document: Wound Bed Preparation in Practice. London: MEP Ltd, 2004
Cleaning Debridement Dressing
![Page 25: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/25.jpg)
24
METODE DESKRIPSI KEUNTUNGAN KERUGIANMechanical Menggunakan kasa basah-
kering atau irigasi cairanmembersihkan bantalan luka dari kontaminasi bakteri.
Non selektif, sehingga jaringan sehat juga dapat terganggu, dapat menimbulkan nyeri..
Sharp-sequential bedside
Menggunakan scalpel atau gunting jaringan
Metode debridement yang paling cepat.
Perdarahan merupakan efek merugikan.
Biosurgeri Menggunakan belatung
kurang lebih 5-8/cm2
Belatung mensekresikan enzim yang merangsang granulasi.
Belatung steril tidak tersedia di semua unit pelayanan kesehatan.
Autolitycmenciptakan lingkungan lembab.
Contoh: Hydrogel
Menggunakan balutan yang Selektif sehingga tidakmengganggu jaringan yang sehat.
Sifatnya kerjanya lambat, kurang tepat untuk nekrotik yang luas dan melekat kuat.
Enzymatic Menggunakan preparat
enzim
Bersifat selektif, karena hanya bekerja pada jaringan nekrotik
Sifatnya yang lambat dibanding terapi conservative,.
Bates-Jensen, Barbara.M., MacLean, Catherine.H. (2007)
Metode Debridement
![Page 26: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/26.jpg)
Pencucian LukaAda beberapa tekhnik pencucian luka:1. Menggosok (Swabbing),2. Mengguyur (Showering), Dan3. Merendam (Bathing)
namun tidak ada perbedaan yang signifikan diantara tekhniktersebut (Moore & Cowman, 2005).
![Page 27: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/27.jpg)
Manfaat pencucian luka
26Makoto Oe, et al 2014., unpublished data
Patient ID 1 2 3 4 5
Wound location Sole (Right)5th toe(Left)
2nd Toe-dorsum (Right)
2nd Toe-sole
(Right)
Dorsum(Left)
Age (yrs.) 49 49 60 60 56
Gender Male
Duration of DM(yrs.) 14 14 6 6 13
Neuropathy NeuropathyABI 1.18 1.18 0.85 0.85 0.65Bacteria count (bedfore cleansing) 6.33x106 9.78x105 3.47x106 6.68x106 6.74x107
Bacteria count (aftercleansing)
1.34x106 3.38x105 1.89x107 1.23x107 1.56x106
![Page 28: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/28.jpg)
0 day 5 day 7 day 11 day 14 day
5 day 14 day0 day 2 day
2 day HoneyIndonesiangroup
Control group7 day 11 day
0 day 2 day 5 day 7 day 11 day 14 dayManuka Honey group
Madu sebagai alternatif
Haryanto, Urai, T., Mukai, K., Suriadi, Sugama, J., & Nakatani, T. (2012). effectiveness of Indoensian Honey on the Aceleration of Cutaneous WOund Healing: An Experimental Study in Mice. WOUNDS, 24(4), 110–119.
![Page 29: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/29.jpg)
2
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
00 1 2 3 4 5 9 10 11 12 13 14
Control
Indo
Manuka
Rat
ioof
area
sto
orig
inal
area
s
per group .Ratio of the wound area. Value was expressed Mean±SD. n = 6 ANOVA; Tukey-Kramer (** p < 0.01)
6 7 8
Days after wounding
** ** ****
NS
Madu sebagai alternatif
Haryanto, Urai, T., Mukai, K., Suriadi, Sugama, J., & Nakatani, T. (2012). effectiveness of Indoensian Honey on the Aceleration of Cutaneous WOund Healing: An Experimental Study in Mice. WOUNDS, 24(4), 110–119.
![Page 30: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/30.jpg)
Case Series
29
![Page 31: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/31.jpg)
5 Okt 20132 Okt 201327 Sept 2013
23 Sept 201320 Sept 2013
Kanan (Ada/absent)
Monofilament Absent
Pin Prick Absent
Palpasi
Dorsalis Pedis Absent
Posterior Tibialis Absent
ABPI
Dorsalis Pedis 1.1
Posterior Tibialis 0.6
Case 1: Callus
![Page 32: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/32.jpg)
Case 1: DFU Wagner IV
![Page 33: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/33.jpg)
Case 2: Abscess
6 Sept 201526 Agustus 201523Agustus 2015
13 Oktober 201521 September 201516 September 2015
![Page 34: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/34.jpg)
LAPORAN KASUSLuka Kaki Diabetic Wagner IIIdi Klinik Griya Afiat Makassar
Saldy Yusuf, PhD.,ETN1,2.,Baharia Laitung, S.Kep1., Sukmawati, S.Kep1.
1Griya Afiat Makassar, Wound Care and Home Care Clinic, Makassar, Indonesia.2Chroni Wound Department, Kanazawa University Japan.
![Page 35: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/35.jpg)
21 Januari 201420 Januari 2014 25 Januari 2014
29 Januari 2014 31 Januari 2014 7 February 2014
19 February 2014 23 February 201413 February 2014
PROSES PERAWATAN
![Page 36: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/36.jpg)
26 February 2014 11 Maret 20141 Maret 2014
14 Maret 2014 24 Maret 201419 Maret 2014
28 Maret 2014 10 April 20142 April 2014
PROSES PERAWATAN
![Page 37: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/37.jpg)
LAJU PENYEMBUHAN
20 Januari 2014 19 February 2014 11 Maret 2014 10 April 2014
Skor awal BBJ 48 , Skor akhir BBJ 13, laju penyembuhan 35/82 hari = 0.42/hari
Baharia., Sukmawati., Saldy Yusuf (2014) Case Report: Honey Impregnated wound dressing in DFU Wagner III. Data on file.
![Page 38: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/38.jpg)
Baharia., Sukmawati., Saldy Yusuf (2014) Case Report: Honey Impregnated wound dressing in DFU Wagner III. Data on file.
Efektifitas waktu:• Lama perawatan : 82 hari.• Frekuensi perawatan : 23 kali.• Rata rata pergantian balutan : 4 hari.• Rata-rata waktu perawatan: 30-60 menit.Efektifitas dressing:• Tidak nyeri.• Bau terkontrol.• Balutan tidak lepas.Efektifitas hasil:• Sembuh tanpa komplikasi.• Sembuh tanpa amputasi (minor atau mayor).
EFEKTIFITAS
![Page 39: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/39.jpg)
LAPORAN KASUSDiabetic Ulcer Non Foot
di Klinik Griya Afiat Makassar
Saldy Yusuf, PhD.,ETN1,2.Baharia Laitung, S.Kep1., Sukmawati, S.Kep1.,
1Griya Afiat Makassar, Wound Care and Home Care Clinic, Makassar, Indonesia.2Chroni Wound Department, Kanazawa University Japan.
![Page 40: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/40.jpg)
Healing Progress
26 JULY 2014 31 JULY 2014 2 AGUSTUS 2014 7 AGUSTUS 2014
11 AGUSTUS 2014 18 AGUSTUS 201423 SEP 2014 28 OKT 2014
![Page 41: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/41.jpg)
Wound phase
Dressing
Primary Secondary Tertiary Periwound Care
Inflamation • Hydro L• Epitel Salf• Metco
• Cutisorb • Hypafix • Metco/Zinc
Exudate • Madu • Foam Cavity
• Cutisorb
• Hypafix • Metco
Granulasi • Madu • AlCutisor b
• Alginate
• Hypafix • Metco
Epitel • Film
Wound care
![Page 42: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/42.jpg)
Graphic 1: Wound Healing Progress
27 2934
39 40 40
30 30 29 2925 24
1815 13
10
5
0
15
20
25
30
35
40
45
1 2 3 4 5 11 12 13 14 156 7 8 9 10
Wound Care Series
Wound Healing Progress (BBJ Score)
Duration of care 95 days, Frequency of wound care 15 times,Baseline BBJ 27, Outcome BBJ 13:Wound Care Interval = 6.3 Days
Wound healing progress= 0.14 BBJ score/days
![Page 43: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/43.jpg)
Kesimpulan• Di Indonesia Prevalensi DFU cukup tinggi.• Ipswich test dan palpasi nadi dorsalis pedis-
posterior pedialis dpt digunakan untuk identifikasi resiko.
• Perawatan DFU berorientasi pada penyebabdan status luks.
• Wound bed preparation dalam manajemen DFU dapat menekan biaya dan mengefektifkan waktu perawatan.
![Page 44: 2. syaldi-27 juli 2017 kongres persi palembang · î ð d dk ^](https://reader035.vdocuments.mx/reader035/viewer/2022062506/5f3c5f21bc63991ac560e398/html5/thumbnails/44.jpg)
Spesialis Perawatan LukaJl. Syekh Yusuf V/3 MakssarHp: 0812 418 418 00
TERIMA KASIH
GRIYA AFIATMAKASSAR