Trauma Jaringan Lunak/ Tissue Injury

SOFT TISSUE WOUNDS ASSOCIATED WITH DENTOALVEOLAR TRAUMA ARE ALWAYS TREATED AFTER MANAGEMENT OF THE HARD TISSUE INJURY.

• Evaluasi Anatomis N. Facialis

  

  

• Klasifikasi (Anatomical)

  • Closed wound

    • CONTUSIONS

      • Definisi

        • aka bruise/memar
        • Memar (kontusi) biasanya diakibatkan oleh benturan dengan benda tumpul dan tidak disertai robekan pada kulit atau mukosa tetapi biasanya menyebabkan perdarahan subkutan atau submukosa pada jaringan.

      • Etiologi

        • are caused by blunt trauma that causes edema and hematoma formation in the subcutaneous tissues.
        • The associated soft tissue swelling and ecchymosis can be extensive.
        • Memar juga dapat disebabkan oleh efek gangguan patah (fraktur) tulang pada cedera maksilofasial. Oleh karena itu, memar dapat mengindikasikan fraktur tulang yang mendasarinya

      • Tx

        Observation, but may need to evaluate large haematoma

      

    • Haematoma

      • Definisi

        Haematoma is defned as a collection of blood outside of a blood vessel.

      • Etiologi

        The most common cause of haematoma is injury or trauma to blood vessels.

  • Open wound

    • ABRASIONS

      • Definisi

        An abrasion is a wound caused by friction between an object and the surface of the soft tissue. This wound is usually superficial and occasionally involves deeper tissue

        • Shear forces that remove a superficial layer of skin

      • Tx

        • Gently cleaned with mild soap solution and irrigated with normal saline
        • Reepithelialization without significant scarring is complete in 7 to 10 days

      

    • LACERATIONS

      • Definition

        It is a tear in the epithelial and subepithelial tissues. It is the most common type of soft tissue injury and often caused by a sharp object such as knife

      • Etiology

        • are caused by sharp injuries to the soft tissue

      • CF

        • Lacerations can have sharp, contused, ragged, or stellate margins.
        • The depth of penetration should be carefully explored in the acute

      • Tx

        • Debridement,
        • irrigation with normal saline and layered closure

      

    • Avulsion

    • Puncture wound

    • Amputation

    • Gunshot wound

    • Crush injury

  

• Vulnus/ Luka

  • VULNUS SCISSUM : LUKA SAYATAN.
  • VULNUS LACERATUM : LUKA COMPANG-CAMPING.
  • VULNUS PUNCTUM : LUKA TUSUKAN.
  • VULNUS MOSSUM : LUKA GIGITAN.
  • VULNUS VENOTUM : LUKA GIGITAN BERACUN.
  • VULNUS SCLOPETORUM : LUKA BALISTIK (LUKA AKIBAT PELURU).
  • VULNUS PERFORATUM : LUKA TEMBUS.
  • VULNUS EXCOREATUM : LUKA GORESAN ATAU LECET.

• CLASSIFICATION ANDREASEN (1981)

  Injuries to gingiva or oral mucosa

  • Abrasion of gingiva or oral mucosa

    A superficial wound produced by rubbing or scrapping of the mucosa leaving a raw bleeding surface.

  • Contusion of gingiva or oral mucosa

    N 902.00: A bruise usually produced by an impact from a blunt object and not accompanied by a break of the continuity in the mucosa, causing submucosal hemorrhage.

  • Laceration of gingiva or oral mucosa

    A shallow or deep wound in the mucosa resulting from a tear and usually produced by a sharp object.

• SOFT TISSUES INJURES MANAGEMENT

  • Desinfection injures area
  • adequate anesthesia is provided,
  • the surgical management of lacerations involves four major steps

• Management

  • CLEANSING OF WOUND

    • Mechanical cleansing of the wound is necessary to prevent debris from remaining.
    • Cleansing can be performed with surgical soap and may necessitate the use of a brush.
    • An anesthetic is usually necessary.
    • Copious saline irrigation is then used to remove all water-soluble material and to flush out particulate matter.
    • Pulsed irrigation has been shown to be more effective in removing debris than is a constant flow of irrigation.

  • DEBRIDEMENT OF WOUND

    • Debridement refers to the removal of contused and devitalized tissue from a wound and the removal of jagged pieces of surface tissue to enable linear closure.
    • In the maxillofacial region, which enjoys a rich blood supply, the amount of debridement should be kept to a minimum.
    • Only tissue that is obviously not vital is excised.
    • Additional Treatment
      • DRESSING : sofratulle/ antibiotik ointment with dry gauze dressing
      • PREVENTION OF INFECTION : antibiotic, prophylaxis againt tetanus
      • PAIN CONTROL
      • FOLLOW UP

  • HEMOSTASIS IN WOUND

    • Before closure, hemostasis must be achieved.
    • Continued bleeding might the repair by creating a hematoma within the tissues that can break the tissues open once they are sutured closed.
    • If any bleeding vessels are identified, they should be clamped and tied with ligatures or cauterized with an electro coagulation unit
    • Once the wound has been cleansed, debrided, and hemostasis achieved, the laceration is ready to be closed with sutures.
    • However, not every laceration in the oral cavity must be closed with sutures.
    • Ex. : a small laceration on the inner aspect of the lip or tongue caused by entrapment between the teeth during a fall usually does not require closure.
    • If closure of a laceration is deemed appropriate, the goal during closure is proper positioning of all tissue layers.
    • When lacerations of the gingiva and alveolar mucosa (or floor of mouth) are noted, they are simply closed in one layer. ( how about 2 or 3 layer? )
    • If a patient has a laceration of the tongue or lip that involves muscle, resorbable sutures should be placed to close the muscle layer or layers, after which the mucosa is sutured

  • CLOSURE OF LIP LACERATION

    

• Factors Modifying Wound Healing Or Leading Towards Failure

  • Too tight suturing without adequate drainage, may lead toward wound breakdown
  • Inadequate pressure dressing—collection of haematoma.
  • Oral contamination of the wound, with inadequate closure on the oral mucosa side.
  • Secondary haemorrhage.
  • Inadequate antibiotic therapy .
  • Improper asepsis.
  • Secondary rough handling of the wound.
  • General factors like old age, anaemia, lack of vitamin C, systemic diseases like diabetes, hepatitis, steroid therapy may delay healing.