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"Kenyamanan merupakan salah satu aspek penting dalam perawatan luka diabetes mellitus (DM). Penelitian ini bertujuan menganalisis ekspresi transforming growth factor beta 1 (TGF â1) dan kadar kortisol pada perawatan luka teknik modern dan konvensional pada luka DM dikaitkan dengan aspek kenyamanan. Penelitian menggunakan true experimental design dengan metode pengumpulan sampel secara stratified random sampling. Pengukuran ekspresi TGF â1 dan kadar kortisol dilakukan pada hari ke 0 (pretest) dan 4 (posttest). Sampel yang diambil berasal dari pasien luka kaki DM di Rumah Sakit Saiful Anwar Malang. Ekspresi TGF â1 diukur dengan metode imunohistokimia, sedangkan pengukuran kadar kortisol dilakukan dengan metode ELISA di laboratorium Fisiologi dan Histologi FK Universitas Brawijaya Malang. Hasil penelitian menunjukkan bahwa pada kelompok modern terjadi peningkatan ekspresi TGF â1, sedangkan pada kelompok konvensional terjadi penurunan ekspresi TGF â1. Kadar kortisol pada kelompok modern menunjukkan penurunan lebih besar dibandingkan kelompok konvensional. Hasil uji t menunjukkan ada perbedaan yang signifikan antara perawatan luka teknik modern dan konvensional terhadap ekspresi TGF â1 dan kadar kortisol pada luka DM (p value < 0,05). Hasil uji korelasi Pearson menunjukkan hubungan yang signifikan antara perubahan ekspresi TGF â 1 dengan perubahan kadar kortisol (p = 0,028). Dapat disimpulkan bahwa teknik perawatan luka secara modern mampu meningkatkan ekspresi TGF â1 dan menurunkan kadar kortisol dibandingkan teknik konvensional.

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Comfort is one among several aspects that should be considered in the treatment of diabetic wounds. This study aimed to analyze the expression of TGF β1 and the level of cortisol in modern and conventional wound care techniques of diabetic wounds. TGF β1 expression and cortisol levels were measured on day 0 (pretest) and 4 (posttest). Samples were taken from patients with diabetic ulcer in the Saiful Anwar District Hospital at Malang. The expression of TGF β1 was measured by immunohistochemical methods in the Department of Physiology, Brawijaya University Faculty of Medicine. Cortisol level was measured with ELISA method. The results obtained from the modern group were increased TGF β1 expression and decreased cortisol level. The conventional group yielded decreased TGF β1 expression and decreased cortisol level. The cortisol level decrease was greater in the modern group. T test results showed no significant differences of modern wound care techniques and conventional on the expression of TGF β1 and cortisol levels in diabetic wounds (p value < 0,05). Pearson correlation test results showed a significant relationship between changes in cortisol levels with changes in expression of TGF β1 (p = 0,028). It can be concluded that the techniques of modern wound care is more able to increase the expression of TGF β1 and to decrease the cortisol levels compared with conventional techniques."

"Latar Belakang: Surgical Site Infection (SSI) adalah infeksi sekitar luka operasi dalam kurun waktu 30 hari pascabedah. SSI merupakan 23,6% dari total infeksi nosokomial pascabedah abdomen di RSCM tahun 2009 – 2011. Tingginya angka morbiditas dan mortalitas dikarenakan SSI menyebabkan biaya penangganan SSI, sehingga pencegahan SSI akan mengurangi biaya pengobatan. Aquadest diketahui cairan yang efektif untuk irigasi luka, mudah didapatkan, murah dan aman untuk irigasi luka.Tujuan: Mengetahui pencucian luka dengan aquadest dibanding perawatan luka Standar.Metode: Penelitian ini merupakan penelitian eksperimental terandomisasi tersamar tunggal, yang dilakukan di departemen bedah, Fakultas kedokteran Universitas Indonesia, Rumah Sakit Cipto Mangunkusumo Mei – Juni 2018. Subyek berjumlah 80 orang setelah laparatomi mediana, dibagi menjadi grup kontrol (n=40) yang menerima perawatan standar dengan tulle setiap 2 hari dan grup eksperimental (n=40) yang menerima pencucian luka dengan aquadest setiap hari, dimulai hari kedua pascabedah. Pada hari ketujuh, dilakukan kultur mikrobiologi yang diambil dari benang jahitan. Parameter yang dievaluasi adalah pertumbuhan kuman, tanda infeksi, dan biaya per subyek antara 2 grup untuk mengetahui efisiensi dan efektivitas keduanya.Hasil: Positif kultur mikrobiologi 57,5% (n=23) pada grup kontrol dan 55% (n=22) pada grup eksperimental. Tidak ada perbedaan bermakna antara kolonisasi kuman di grup kontrol dan grup eksperimental (p=0,820) maupun insiden SSI (p=1,00). Selisih biaya Rp 27.500,00 (Rp 19.400,00 – Rp 40.990,00) lebih rendah pada grup eksperimental (Rp 385.500,00 (Rp 379.500,00 – Rp 385.960,00)) dibanding grup kontrol (Rp 413.000,00 (Rp 398.900,00–Rp 426.950,00))Kesimpulan: Pencucian luka dengan aquadest lebih efisien dibandingkan perawatan luka dengan teknik standar.

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Background: Surgical Site Infection (SSI) is infection at or around the incision site within 30 days postoperative. SSI accounts for 23.6% of total nosocomial infections after abdominal surgery in Cipto Mangunkusumo General Hospital during 2009 – 2011. The high morbidity and mortality due to SSI causes high cost burden for SSI management, hence prevention of SSI will reduced the cost of treatment. Aquadest has known as an effective substance for wound irrigation, easy to obtain, low-cost and safe for wound irrigation.

Aim: The study objective was to know the efficiency of aquadest wound irrigation compared to standard wound care.

Methods: This was a single-blinded randomized experimental study, conducted at the Department of Medical Surgery, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo General Hospital during May-June 2018. Subjects were eighty patients after median laparotomy, randomized into control group (n=40) which received standard wound care with tulle every other day and experimental group (n=40) which received aquadest wound irrigation every day, started on the second post operation day. On the seventh day, microbiological culture taken from surgical suture materials. Parameters evaluated were the bacterial growth, signs of infection and cost per subject between two groups to know the efficiency and efficacy of both treatment.

Result: The positive microbiological culture were 57,5% (n=23) in control group and 55% (n=22) in experimental group. There was no significant difference of bacterial colonization in the control and experimental group (p = 0,820) neither in SSI incidence (p = 1,00). The cost difference was Rp 27.500,00 (Rp 19.400,00 – Rp 40.990,00) lower for subject in experimental group (Rp 385.500,00 (Rp 379.500,00 – Rp 385.960,00)) compared with control group (Rp 413.000,00 (Rp 398.900,00–Rp 426.950,00)).

Conclusion: Surgical wound irrigation with aquadest was more efficient compared with standar surgical wound care."

"Feracrylum merupakan obat topikal yang mengandung garam besi poliakrilat 0.05 sampai 0.5%. Obat ini terbukti memiliki efek antibakteri dan efektif untuk mengobati luka bakar. Suatu uji klinik tentang efektivitas dan keamanan dari feracrylum dibandingkan dengan silver sulfadiazin (SSD) telah dilakukan pada penderita luka bakar, dengan metode studi terbuka, acak, berpembanding. Feracrylum dan SSD dioleskan tiap hari pada masing-masing satu sisi badan dan hasilnya diobservasi selama 11 hari. Tujuh dari 8 pasien dapat menyelesaikan studi ini. Pada hari 7 dan 11 reepitelisasi meningkat pada sisi tubuh yang mendapat feracrylum yang terlihat dengan berkurangnya luas lesi. Persentase epitelisasi pada kelompok feracrylum adalah 70.53±24.298 dan 81.71±28.922 % pada hari ke-7 dan 11. Angka ini lebih tinggi dibandingkan dengan kelompok SSD (66.15±25.080 dan 64.64±74.684%). Secara statistik tidak didapatkan perbedaan yang bermakna. Feracrylum terbukti aman dan dapat ditoleransi dengan baik.

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AbstractInstead of haemostatic effect, feracrylum provides antibacterial activity; wound improvement has been clinically proven. Feracrylum is a water soluble mixture of incomplete ferrous salt of polyacrylic acid containing 0.05 to 0.5% of iron in physiologic solution (0.85% solution of sodium chloride). A clinical study on safety and efficacy of feracrylum compared to silver sulfadiazine (SSD) was conducted in burn management, since with the widely use of SSD, the sulfadiazine?s disadvantages lead to wound healing impairment. In this open, randomized, controlled study, feracrylum and SSD were topically applied, each on different side of the burnt areas in parts of body for a treatment period of eleven days. Of eight enrolled patients, seven patients completed the study; one patient withdrew due to acute burn complication. On day 7th and 11th, the re-epithelialization in group receiving feracrylum increased as the raw surface area reduced. Mean percentages of epithelialization on both evaluation days in Feracrylum group were 70.53±24.298 and 81.71±28.922, respectively, which were higher than SSD group (66.15±25.080 and 64.64±74.684 respectively). Feracrylum was found to be safe and well tolerated. This study showed a clinical difference although it was not significant statistically. "

"Latar Belakang: Penyembuh luka yang dikenal luas oleh masyarakat modern saat ini adalah povidone iodine 10%, sedangkan masyarakat tradisional lebih memilih bubuk kopi. Penelitian ini dilaksanakan dengan tujuan untuk membuktikan bahwa bubuk kopi lebih efektif dalam menyembuhkan luka dibandingkan dengan povidone iodine 10%. Metode: Enam ekor tikus putih Rattus norvegicus betina dengan usia 10-12 minggu dibuatkan 3 luka sebesar 0.5x1 cm yang dijadikan kelompok kontrol, povidone iodine 10%, dan bubuk kopi. Tiga tikus pertama dikorbankan dihari ketiga dan sisanya dihari ketujuh. Bekas luka dipotong dan dibuat sediaan histopatologi dengan pewarnaan Hematoxylin dan eosin untuk fibroblas dan Van Gieson untuk serat kolagen. Hasil: Terdapat proses inhibisi penyembuhan luka oleh povidone iodine 10% dan bubuk kopi pada hari ke-1 sampai 3, tetapi terdapat stimulasi fibroblas dan serat kolagen setelah hari ketiga. Pada hari ketiga, kelompok kontrol memiliki tingkat fibroblast dan serabut kolagen paling tinggi, sedangkan pada kelompok povidone iodine 10% dan bubuk kopi relatif sama dengan di tingkat yang rendah. Pada hari ketujuh, semua kelompok memiliki tingkat fibroblas dan serabut kolagen yang hampir sama. Walaupun begitu, perbedaan ini tidak bermakna (p=0.427 untuk fibroblast, dan p=0.300 untuk serat kolagen). Kesimpulan: tidak terdapat perbedaan bermakna dari povidone iodine 10% dan bubuk kopi terhadap tingkat fibroblas dan kolagen.

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Background: Common wound healing treatment used by modern society is povidone iodine 10%, but traditional society prefer to choose coffee powder. This research is done to prove the effectiveness of coffee powder as wound healing treatment in compared to povidone iodine 10%.

Methods: 3 wounds with each 0.5x1 cm are made in female Rattus norvegicus white rats with age around 10-12 weeks and divided into control, povidone iodine 10% and coffee powder group. The first three rats were sacrificed on the third day and the rest on the seventh day. Histopathological specimens were made from the cutting wounds and stained using Hematoxylin-eosin for fibroblas dan Van Gieson for collagen fibers analysis.

Result: There is an inhibition processed by povidone iodine 10 and coffee powder in the 1st until 3rd day, but there is a stimulation of fibroblast and collagen fibers after day 3. On the 3rd day, control group has the highest level of fibroblast and collagen fibers, but on the 7th day, all groups have approximately the same level of fibroblast and collagen. However, this differences is not significant (p=0.427 for fibroblast, and p=0.300 for collagen fibers).

Conclusion: there is no significant difference between povidone iodine 10% and coffee powder towards the level of fibroblast and collagen."

"Surgery needs skill. Skill needs knowledge. Knowledge of tricks, moves, and tools. This book is about such knowledge. Expert authors have contributed technical pearls, gained by years of experience. The short “how-I-do-it” chapters offer the reader a quick and effective guide that will be invaluable when addressing any penetrating injury. The book is not intended to serve as a comprehensive volume of pathophysiology and management in trauma; rather the goal is to provide practical solutions on how to treat injuries surgically. It describes the steps that you must take when, in the middle of the night, confronted with devastating bleeding, you will have only one chance to save a life."