Department of Otorhinolaryngology Head and Neck Surgery
Faculty of Medicine - Andalas University
Dr. M. Djamil Hospital, Padang 2019
Wound Healing
Lorensia Fitra Dwita
Facial Plastic and Reconstructive Surgery SubDivision
Pendahuluan
Scar
Hipertrofi
scar /
keloid
Wound
Healing
• Kerusakan
jaringan
• Inflamasi
Facial Plastic & Reconstruction Surgery SubDivision
Pendahuluan
Wound Healing (The Edwin Smith Papyrus)
1600SM
suatu sistem terkoordinasi yang melibatkan
respon bioseluler waktu cedera jaringan 
pelepasan sitokin dan growth factor, aktivasi sel
dan regenerasi jaringan
Facial Plastic & Reconstruction Surgery SubDivision
Pendahuluan
Facial Plastic & Reconstruction Surgery SubDivision
(Papel, ID et al dalam Facial Plastic and Reconstructive Surgery, 4th edition, 2016)
Wound Healing
(Maria Z et al, Plastic and Reconstructive Surgery, 2010)
Fase wound healing
Hemostasis
and
Inflammation
Kemotaksis
dan Aktivasi
Epitelisasi,
angiogenesis
0 – 4 s/d 6 hari
Neutrofil, monosit,
sitokin-sitokin dan
mediator inflamasi
Hari 4 – 14
Aktivasi endotelium
dan platelet 
aktivasi koagulasi
cascade
Infiltrasi neutrofil 2428 jam after injury
Kolagen, IL, TNF 
stimulate fibroblast 
granulasi,tissue
formation
Fibrin clot
Inisiasi transisi ke
fase proliferatif
FGF  angiogenesis,
TGF  epitelialisasi
Maturasi dan
Remodelling
Hari 7 – bulan hingga
1 tahun
Scar  lebih kuat,
mengecil dan
warnanya mulai
menyerupai warna
kulit normal
(Papel, ID et al dalam Facial Plastic and Reconstructive Surgery, 4th edition, 2016)
Wound Healing
Local factor
Systemic factor
• Iskemik
• Infeksi
• Medikasi
• Penyakit herediter
• Penyakit Vaskular
• Metabolik, imunologi
defisiensi
Wound
Healing
Facial Plastic & Reconstruction Surgery SubDivision
Facial Plastic & Reconstruction Surgery SubDivision
Wound Healing
Normal
scar
Abnormal
scar
Facial Plastic & Reconstruction Surgery SubDivision
Abnormal wound healing
Hipertrofi scar
• “overhealing” states
• Excessive production + deposition collagen and
glycoprotein
• Menebal namun tidak melebihi di atas batas luka
• Regress with time
• Terapi  Injeksi steroid intralesi
Facial Plastic & Reconstruction Surgery SubDivision
Abnormal wound healing
Keloid
• Tumbuh menebal dan melebihi batas luka, meluas ke
jaringan normal sekitar
• Rekuren (8%)
• Injeksi kortikosteroid intralesi  mengurangi
produksi fibroblast dan protein matriks extraseluler
• Kombinasi terapi tekanan local, interferon, bedah
Facial Plastic & Reconstruction Surgery SubDivision
Bone Healing
Facial Plastic & Reconstruction Surgery SubDivision
Bone Healing
Fase inflamasi  0-5 hari after injury  fibroblast ke
matrik tulang, kartilago dan fibrin tulang 
menguatkan pertumbuhan tulang (hingga minggu 2-3)
 Kalus  deposit osteoid  kalsifikasi  tulang
immatur
Facial Plastic & Reconstruction Surgery SubDivision
Bone Healing
Normal
union
Abnormal
union
Facial Plastic & Reconstruction Surgery SubDivision
Abnormal bone healing
Mal- Nonunion union
Facial Plastic & Reconstruction Surgery SubDivision
TERIMA KASIH
Facial Plastic & Reconstruction Surgery SubDivision
Facial Plastic & Reconstruction Surgery SubDivision
Facial Plastic & Reconstruction Surgery SubDivision