kuliah bedah plastik ii
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Ishandono Dachlan
Sub-Bagian Bedah Plastik, Bagian Bedah
Fakultas Kedokteran, Universitas Gadjah Mada
KULIAH BEDAH PLASTIKKULIAH BEDAH PLASTIK(Bagian II)(Bagian II)
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LUKA BAKAR
Luka Thermal / Combustio / Burn
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TIGA FAKTOR PENTING DALAM LUKA BAKAR
1. ETIOLOGI / PENYEBAB
2. KEDALAMAN LUKA BAKAR
3. LUAS LUKA BAKAR
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ETIOLOGI / PENYEBAB
1. SUHU
PANAS ( API, UAP, AIR )
DINGIN ( FROST BITE )
2. LISTRIK (4). RADIASI
3. KIMIA (5). LASER
ASAM - BASA
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KEDALAMAN LUKA BAKAR
• DERAJAT SATU
Superficial Skin Burn
• DERAJAT DUA
Partial Thickness Skin Burn
• DERAJAT TIGA
Full Thickness Skin Burn
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KEDALAMAN LUKA BAKAR
Superficial Skin Burn
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KEDALAMAN LUKA BAKAR
Luka Bakar Derajat Satu
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KEDALAMAN LUKA BAKARPartial Thickness Skin Burn
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KEDALAMAN LUKA BAKAR
Luka Bakar Derajat Dua
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KEDALAMAN LUKA BAKAR
Full Thickness Skin Burn
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KEDALAMAN LUKA BAKAR
Luka Bakar Derajat Tiga
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LUAS LUKA BAKAR
Rule of Nine’s
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LUAS LUKA BAKAREXTENT OF BURN WOUND
Age (Years)
Area 0-1 1-4 5-9 10-15
Head 19 17 13 10
Neck 2 2 2 2
Anterior trunk 13 13 13 13
Posterior trunk 13 13 13 13
Buttock 5 5 5 5
Genitalia 1 1 1 1
Arm 4 4 4 4
Forearm 3 3 3 3
Hand 2½ 2½ 2½ 2½
Thigh 5½ 6½ 8½ 8½
Leg 5 5 5½ 6
Foot 3½ 3½ 3½ 3½
TABEL LUND & BROWDER
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PENANGANAN
PRE HOSPITAL
• STOP - DROP - ROLL
• Menghilangkan Heat Restore
(Masih Efektif bila < 2 menit)
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PENANGANAN
RESUSITASIA - B - C
A: Curiga Trauma Inhalasi
* Bila kejadian di ruang tertutup
* Bulu hidung terbakar
ET LEBIH BAIK DARIPADA TRACHEOSTOMY
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PENANGANAN
RESUSITASIA - B - C
B: Luka Bakar Pada Dinding Dada
ESCHAROTOMY
C: FORMULA BAXTER
Infus RL: 4 cc x BB (Kg) x LUAS LB (%)
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CONTOH KASUS
PASIEN DENGAN BB 50 Kg LLB 20%
Kebutuhan Cairan : 4 x 50 Kg x 20 %
4000 cc RL
8 Jam pertama 2000 cc 62 tts/mnt
16 Jam berikut 2000 cc 31 tts/mnt
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MONITORING
• Vital Sign
• Urin Output Dewasa 30 ml / Jam
Anak 1-2 ml / Kg / Jam
• Suara Nafas
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INDIKASI RAWAT INAP
• LB Derajat II > 15% Dewasa
> 10% Anak / Geriatri
• LB Derajat III > 10% Dewasa
• Listrik / Kimia
• LB di daerah muka, tangan, genital, perineal
• LB dengan kelainan lain / trauma lain yang berat
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PERAWATAN LUKA
• Derajat Satu
• Derajat Dua Cuci NaCl + Savlon
500 cc 5 cc
Sofratul
Kassa Steril
(Biarkan Satu Minggu)
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PERAWATAN LUKA
Derajat Tiga
Cuci NaCl 500 cc + Savlon 5 cc
Debridement tiap hari
Dermazin® / Burnazin®
(Silver Sulfadiazin) tiap hari
K/P Escharectomy + Skin Graft
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TRAUMA
KRANIO-FASIAL
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Anatomi
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Trauma Kranio Fasial
Deformity
Ocular Disparity
Maloclusion
False Motion
Diagnosis
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Fraktur Mandibula Diagnosis
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Fraktur Mandibula
Lokasi Fraktur
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Fraktur Mandibula
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Fraktur Mandibula
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Fraktur Mandibula
Treatment : IDW -IMW
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IDW - IMW
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Fraktur Mandibula
Post OperasiPre Operasi
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Fraktur MaksilaDiagnosis
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Fraktur Maksila
1. Lefort I
2. Lefort II
3. Lefort III
Klasifikasi
4. Sagital
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Fraktur Maksila
Lefort I
Lefort II
Lefort III
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Fraktur Maksila
Post OperasiPre Operasi
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Fraktur Zigoma
Diagnosis
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Fraktur Zigoma
Diagnosis
Foto Waters
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Fraktur Zigoma
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Fraktur Zygoma
Pre Operasi Post Operasi
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Fraktur Nasal
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Terima Kasih