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Lubis, Andri Maruli Tua
"Saat ini penanganan osteomielitis kronis masih merupakan masalah dalam bidang orthopaedi. Debridemen dan pemberian antibiotika merupakan penatalaksanaan yang dianut. Seringkali antibiotika yang diberikan secara oral maupun parenteral tidak dapat mencapai lokasi infeksi dengan baik. Para ahli mengembangkan pemberian antibiotika lokal dalam bentuk antibiotic beads. Antibiotic beads yang terdapat dipasaran saat ini sangat mahal, sehingga kami mencoba membuat antibiotic beads sendiri dengan menggunakan bahan aktif ceftriakson. Ceftriaxone impregnated beads dibuat dengan mencampur 2 gram bubuk ceftriakson dan 40 gram polimetilmetakrilat secara steril. Ukuran beads 3x5 mm. Digunakan 30 ekor kelinci jantan yang masing-masing dilakukan induksi osteomielitis pada tulang radius kirinya dengan menggunakan kuman Staphylococcus aureus. Pada minggu ke-4 dilakukan pemeriksaan klinis, radiologis, biakan kuman dan histopatologis untuk membuktikan adanya osteomielitis. Selanjutnya dibagi menjadi tiga kelompok dengan jumlah setiap kelompoknya sepuluh kelinci. Kelompok pertama hanya dilakukan debridemen. Kelompok kedua debridemen diikuti pemberian ceftriakson intravena. Kelompok ke-3 debridemen diikuti pemberian ceftriakson intravena dan ceftriaxone impregnated beads. Setelah empat minggu kembali dievaluasi secara klinis, radiologis, biakan kuman dan histopatologis. Pada kelompok pertama, kejadian osteomielitis pada akhir empat minggu terapi adalah 60% (angka keberhasilan 40%). Pada kelompok kedua, angka kejadian osteomielitis setelah pengobatan adalah 20% (angka keberhasilan 80%). Sedangkan kejadian osteomielitis setelah empat minggu pengobatan pada kelompok ketiga adalah 0% (angka keberhasilan 100%). Kesimpulan: kombinasi antibiotik sistemik dengan ceftriaxone impregnated beads lebih efektif dari antibiotik sistemik. (Med J Indones 2005; 14: 157-62).

Up to now, orthopaedic management of chronic osteomyelitis is still problematic. Debridement and antibiotic administration is still a widely practiced management. However, oral or parenteral antibiotics often cannot reach the infection site well. Some experts have developed a system to administer local antibiotic in the form of antibiotic beads. Antibiotic beads on the market are still very expensive. Therefore, we made efforts to make our own antibiotic beads by using Ceftriaxone as the antibiotic. Ceftriaxone impregnated beads were made by mixing 2 grams of Ceftriaxone powder with 40 grams of polymethyl methacrylate (PMMA) bone cement sterilely. The size of the beads was 3 x 5 mm. Thirty male rabbits that were induced to get osteomyelitis by inoculating Staphylococcus aureus to their left radius bones were used. In the fourth week, clinical, radiological, histological examination and bacterial culture were performed to prove the presence of osteomyelitis. Then, the samples were divided into 3 groups of ten. The first group only underwent debridement. The second group underwent debridement followed by intravenous Ceftriaxone administration. The third group underwent debridement followed by intravenous Ceftriaxone and Ceftriaxone-impregnated beads administration. After four weeks, clinical, radiological, histological examination and bacterial culture were repeated. In the first group, the incidence rate of osteomyelitis at the end of the fourth week of therapy was 60% (success rate 40%). In the second group, after four weeks of therapy the incidence rate of osteomyelitis after treatment was 20% (success rate 80%), whereas that of the third group was 0% (success rate 100%). In conclusion, the efficacy of combination of systemic antibiotic therapy and ceftriaxone impregnated beads in the therapy of chronic osteomyelitis is better than systemic antibiotic therapy. (Med J Indones 2005; 14: 157-62)."
Medical Journal of Indonesia, 2005
MJIN-14-3-JulSep2005-157
Artikel Jurnal  Universitas Indonesia Library
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Kana Fajar
"Debridement merupakan salah satu cara perawatan pada luka kronik. Penelitian ini bertujuan untuk mengetahui tentang gambaran tingkat pengetahuan perawat Indonesia tentang metode debridement luka kronik. Desain penelitian ini mengunakan deskriptif analitik dengan pendekatan potongan lintang (cross-sectional) menggunakan sample perawat yang mengikuti pelatihan perawatan luka selama 4 hari denga jumlah sampel sebanyak 110 responden yang dipilih dengan tehnik purposive sampling. Hasil penelitian dianalisis menggunakan analisis unvariat. Ratarata hasil penelitian gambaran tingkat pengetahuan perawat tentang metode debridement pada luka kronik dengan pengetahuan kurang sebanyak 79.1%. Penelitian ini dapat menjadi bahan pengembangan penelitian selanjutnya mengenai metode debridement pada luka kronik dimasa yang akan datang.

The debridement is one of treatment in chronic wounds. This study aims to determine the level of knowledge about the Indonesian nurses in chronic wound debridement methods. This study design using descriptive analytical approach cross section (crosssectional) using a sample of nurses who trained wound care premises for 4 days total sample of 110 respondents were selected by purposive sampling technique. The results of the study were analyzed using univarite analysis. The average level overview of the research about nurse knowledge in chronic wound debridement methods with lack of knowledge are 79.1%. This research can be use as material development for future research in methods of debridement chronic wounds.
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Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2014
S57379
UI - Skripsi Membership  Universitas Indonesia Library
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Dogma Handal
"[ABSTRAK
Pendahuluan: Kaki diabetik (KD) merupakan salah satu komplikasi kronik dari Diabetes Mellitus (DM), karena sering berujung pada kecacatan karena tingginya angka amputasi dan bahkan kematian. WHO merekomendasikan klasifikasi Perfusion, Extent/Size, Depth/Tissue Loss, Infection, Sensation (PEDIS) sebagai sarana penegakkan diagnosis dan membantu menentukan tatalaksana KD. Pada beberapa studi yang menggunakan klasifikasi PEDIS dapat memprediksi perlunya perawatan kasus KD di RS dan perkiraan angka amputasi yang hanya di tinjau dari aspek Infection saja. Namun hubungan kriteria PEDIS secara keseluruhan yang dapat memengaruhi outcome belum diketahui. Atas dasar itu perlu dilakukan penelitian untuk mengetahui gambaran KD berdasarkan penilaian PEDIS yang dilakukan tindakan débridement. Metode penelitian: Kohort retrospektif. Hasil penelitian: Didapatkan hubungan bermakna kriteria PEDIS dengan sembuh tidak diamputasi; Perfusi derajat 1 [OR=38,46; p<0,05]. Perfusi derajat 2 [OR=26,86; p<0,05]. Depth derajat 1 [OR=107,25; p<0,05]. Depth derajat 2 [OR=20,20; p<0,05]. Infeksi derajat 2 [OR=18,00; p<0,05]. Infeksi derajat 3 [OR=2,67; p<0,05]. Didapatkan juga hubungan bermakna kriteria PEDIS dengan sembuh diamputasi; Perfusi derajat 3 [OR=0,03; p<0,05]. Depth derajat 3 [OR=0,01; p<0,05]. Dari kategori sensasi [OR=0,29; p<0,05]. Rerata lama rawat subkategori infeksi derajat 1,2,3 dan 4 bermakna (p<0,05). Kesimpulan: Semakin tingginya tingkat keparahan atau derajat dari setiap subkategori kriteria PEDIS, secara statistik bermakna kecenderungan ke arah meningkatnya risiko buruknya outcome. ABSTRACT Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome.;Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome., Background: Diabetic foot (DF) is one of the chronic complications of Diabetes Mellitus (DM). It often lead to disability due to the high number of amputations and even ended in mortality. WHO recommended classification of Perfusion, Extent / Size, Depth / Tissue Loss, Infection, Sensation (PEDIS) as the means of diagnosis and to help determine the treatment of DF. In some studies using PEDIS classification could predict the need for hospital care in cases of diabetic foot and predict the rate of amputations in review to Infection aspect only. However, the overall relationship PEDIS criteria that could influence the outcome is not yet known. Based on that, it is necessary to study the distribution of DF based on PEDIS assessment which undergone debridement. Method: Retrospective cohort. Results: In this study we found a significant association of PEDIS criteria toward the patients outcome recover without amputation with; Perfusion grade 1 [OR=38,46; p<0,05]. Perfusion grade 2 [OR=26,86; p<0,05]. Depth grade 1 [OR=107,25; p<0,05]. Depth grade 2 [OR=20,20; p<0,05]. Infection grade 2 [OR=18,00; p<0,05]. Infection grade 3 [OR=2,67; p<0,05]. The others found a significant associated PEDIS criteria toward the patients outcome were cured in amputation is; Perfusion grade 3 [OR=0,03; p<0,05]. Depth grade 3 [OR=0,01; p<0,05]. From sensation category [OR=0,29; p<0,05]. There are significant differences in the average length of stay of patients from infection subcategories grade 1, 2, 3 and 4 (p<0,05). Conclusions: With increasing of severity or grade of each subcategory of PEDIS criteria, there was a statistically significant trend toward increased risk for adverse outcome.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Kana Fajar
"Debridement merupakan salah satu cara perawatan pada luka kronik. Penelitian ini bertujuan untuk mengetahui tentang gambaran tingkat pengetahuan perawat Indonesia tentang metode debridement luka kronik. Desain penelitian ini mengunakan deskriptif analitik dengan pendekatan potongan lintang (cross-sectional) menggunakan sample perawat  yang mengikuti pelatihan perawatan luka selama 4 hari denga jumlah sampel sebanyak  110 responden yang dipilih dengan tehnik purposive sampling. Hasil penelitian dianalisis menggunakan analisis unvariat. Rata-rata hasil penelitian gambaran tingkat pengetahuan perawat tentang metode debridement pada luka kronik dengan pengetahuan kurang sebanyak 79.1%. Penelitian ini dapat menjadi bahan pengembangan penelitian selanjutnya mengenai metode debridement pada luka kronik dimasa yang akan datang. 

The debridement is one of treatment in chronic wounds. This study aims to determine the level of knowledge about the Indonesian nurses in chronic wound debridement methods. This study design using descriptive analytical approach cross section (cross-sectional) using a sample of nurses who trained wound care premises for 4 days total sample of 110 respondents were selected by purposive sampling technique. The results of the study were analyzed using univarite analysis. The average level overview of the research about nurse knowledge in chronic wound debridement methods  with lack of knowledge are 79.1%. This research can be use as material  development for future research in methods of  debridement chronic wounds."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2014
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UI - Skripsi Membership  Universitas Indonesia Library
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Khoeruni Aulia Saida
"Spondilitis tuberkulosis manifestasi tuberkulosis ekstrapulmoner hasil dari penyebaran hematogen tuberkulosis ke vertebral melalui aliran darah dan paling sering melibatkan persimpangan thorakolumbar. Tanda-tanda lanjutan penyakit ini adalah paraparesis dan paraplegia, kejadian ini dilaporkan pada 4% sampai 30% kasus. Pasien spondilitis tuberkulosis mengalami gangguan neuromuskuler sehingga mengalami gangguan mobilitas dan sangat rentan terhadap perkembangan ulkus dekubitus akibat jaringan terlalu lama terpapar oleh tekanan. Analisis dilakukan pada pasien laki-laki berusia 55 yang mengalami paraparesis akibat spondilitis tuberkulosis sehingga muncul ulkus dekubitus dan menjalani operasi debridement ulkus. Masalah keperawatan yang muncul adalah risiko infeksi, risiko ketidakseimbangan elektrolit, ketidakseimbangan nutrisi:kurang dari kebutuhn tubuh. Tujuan penulisan ini yaitu memaparkan hasil analisis asuhan keperawatan dengan perawatan luka menggunakan honey dressing pada pasien spondilitis tuberkulosis dan post debridement ulkus dekubitus. Penerapan perawatan luka dengan honey dressing ini dilakukan dari tanggal 18-20 April 2023, balutan diganti sehari sekali. Dari penerapan intervensi ini, terbukti menurunkan skor PUSH tool (Pressure Ulcer Scale for Healing) namun, perlu penilaian dengan durasi lebih lama untuk melihat kemajuan luka. Kesimpulannya perawatan luka dengan honey dressing dapat dilakukan untuk meningkatkan kesembuhan luka, selain itu honey dressing ini mudah dicari, efektif, dan ekonomis.

Tuberculosis spondylitis is manifestations of extrapulmonary tuberculosis result from hematogenous spread of tuberculosis to the vertebrae via the bloodstream and most commonly involve the thoracolumbar junction. Later signs of the disease are paraparesis and paraplegia, which have been reported in 4% to 30% of cases. Patients with tuberculosis spondylitis have neuromuscular disorders that cause impaired mobility and are highly susceptible to the development of decubitus ulcers due to prolonged tissue exposure to pressure. The analysis was performed on a 55-year-old male patient who had paraparesis due to tuberculosis spondylitis resulting in decubitus ulcers and underwent ulcer debridement surgery. The problems that arise are the risk of infection, the risk of electrolyte imbalance, nutritional imbalance: less than the body's needs. The purpose of this paper is to present the results of an analysis of wound care using honey dressing in patients with tuberculosis spondylitis and decubitus ulcer post debridement. The implementation of wound care with honey dressing is carried out from April 18-20 2023, the dressing is changed once a day. From the implementation of this intervention, it is proven to reduce the score of the PUSH (Pressure Ulcer Scale for Healing) tool but requires an assessment with a longer duration to see the progress of the wound. In conclusion, wound care with honey dressing can be done to improve wound healing, besides that honey dressing is easy to find, effective, and economical."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Ratih Meireva Soeroso
"Diabetes melitus merupakan suatu penyakit kronik yang tidak dapat disembuhkan serta dapat menimbulkan komplikasi serius antara lain gangren diabetik. Gangren diabetik dapat menyebabkan infeksi berat sehingga memerlukan tindakan debridement. Debridement dianggap sebagai metode yang paling cepat dan efisien dalam menangani gangren diabetik. Hal ini menyebabkan pasien perlu rawat inap sehingga membutuhkan banyak uang dan perawatan dalam jangka waktu lama. Hari perawatan yang semakin panjang dan biaya pengobatan yang mahal menjadi salah satu masalah yang harus mendapat perhatian khusus. Penelitian ini merupakan penelitian deskriptif non-eksperimental retrospektif yang bertujuan untuk menganalisis faktor- faktor yang berhubungan dengan tagihan pelayanan debridement gangren diabetik di RS Aisyiyah Bojonegoro tahun 2021. Dari 151 pasien yang memenuhi kriteria didapatkan bahwa pasien gangren diabetik yang menjalani tindakan debridement terbanyak berusia dibawah 60 tahun (66,2%), dengan jenis kelamin terbanyak adalah perempuan (53%), dan derajat terbanyak adalah derajat 1 (51,7%). Rata-rata lama hari rawat sebesar 4,72 hari. Dengan minimal lama rawat 2 hari dan maksimal lama rawat 13 hari. Dari hasil penelitian didapatkan tagihan lebih dibanding ina-cbgs sebesar 37 kasus pada derajat I, 6 kasus pada derajat II, dan 24 kasus pada derajat III. Sehingga dari jumlah 151 pasien yang dirawat dengan debridement gangren diabetik didapatkan 67 kasus dimana tagihan rumah sakit lebih tinggi (defisit) dibanding ina-cbgs. Hasil defisit tersebut terdapat pada semua kelas perawatan dan semua tingkat keparahan kecuali pada kelas 2 derajat I dan III serta pada kelas 1 derajat II dimana didapatkan hasil surplus dibanding ina-cbgs. Berdasarkan hasil penelitian didapatkan P-Value <0,05 adalah pada tingkat keparahan, kepatuhan fornas, lama rawat dan DPJP yang berarti bahwa terdapat hubungan yang bermakna antara tingkat keparahan, kepatuhan fornas, lama rawatan, dan DPJP dengan total tagihan rill pasien debridement gangren diabetik. Variabel yang paling dominan mempengaruhi total tagihan pasien adalah lama rawat yang memiliki nilai Exp (β) 13.108 artinya semakin lama pasien dirawat maka akan semakin menaikan total tagihan riil pasien debridement gangren diabetik.

Diabetes mellitus is a chronic disease that cannot be cured and can cause serious complications, including diabetic gangrene. Diabetic gangrene can cause severe infection that requiring debridement. Debridement is considered the fastest and most efficient method of treating diabetic gangrene. This causes the patient to be hospitalized, which requires a lot of money and long-term care. Longer treatment days and expensive medical expenses are problems that need special attention. This research is a retrospective non- experimental descriptive study that aims to analyze factors related to the bill for diabetic gangrene debridement services at Aisyiyah Bojonegoro Hospital in 2021. Of the 151 patients who met the criteria, it was found that most diabetic gangrene patients who underwent debridement were aged under 60 years (66.2%), with the most sex being female (53%), and the most degree being grade 1 (51.7%). The average length of stay was 4.72 days. With a minimum length of stay of 2 days and a maximum length of stay of 13 days. From the results of the study, it was found that the bill was more than ina- cbgs by 37 cases at degree I, 6 cases at degree II, and 24 cases at degree III. So that from a total of 151 patients treated with diabetic gangrene debridement, there were 67 cases where hospital bills were higher (deficit) than ina-cbgs. The deficit results were found in all treatment classes and all levels of severity except in class 2 degrees I and III and in class 1 degree II where a surplus was obtained compared to ina-cbgs. Based on the results of the study, it was found that P-Value <0.05 was at the level of severity, fornas compliance, length of stay and DPJP which means that there was a significant relationship between severity, fornas compliance, length of stay, and DPJP with the total real bills of diabetic gangrene debridement patients. The most dominant variable affecting the patient's total bill is the length of stay which has an Exp (β) value of 13,108 meaning that the longer the patient is treated, the more the total real bill will increase in patients with diabetic gangrene debridement."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Farindra Ridhalhi
"Abses tuberkulosis spinal merupakan salah satu komplikasi serius dari infeksi tuberkulosis yang dapat menyebabkan kerusakan neurologis dan sulitnya eradikasi kuman. Tata laksana operatif dengan debridemen terbuka sering kali dipilih. Namun, teknik minimal invasif telah mulai dikembangkan, termasuk Teknik Evakuasi Abses Sistem Tertutup (EAST), meski datanya masih terbatas. Penelitian ini bertujuan untuk menilai luaran klinis dan laboratoris pada pasien yang menjalani EAST dibandingkan debridemen terbuka. Penelitian retrospektif ini melibatkan 48 pasien yang menjalani salah satu dari kedua teknik tersebut. Hasil menunjukkan bahwa EAST menghasilkan nyeri pascaoperasi lebih rendah (VAS 2 vs. 4; p<0,001) dan panjang jaringan parut lebih kecil (0 cm vs. 12 cm; p<0,001) dibandingkan debridemen terbuka. Durasi rawat inap lebih singkat secara median pada kelompok EAST, meski tidak signifikan (2 vs. 3 hari; p=0,06). Namun, angka rekurensi lebih tinggi pada teknik EAST (2 kasus vs. 0). Kedua teknik menunjukkan hasil serupa dalam kadar CRP dan Oswestry Disability Index (ODI). Hasil ini menunjukkan bahwa EAST menawarkan alternatif minimal invasif dengan hasil klinis lebih baik, tetapi memerlukan perhatian terhadap risiko rekurensi. Studi lebih lanjut diperlukan untuk memastikan temuan ini dan mengevaluasi keamanan jangka panjang teknik EAST.

Spinal tuberculosis abscess is one of the serious complications of tuberculosis infection that can lead to neurological damage and difficulty in eradicating the pathogen. Open debridement surgery is often chosen. However, minimally invasive techniques, including closed system abscess evacuation (CSAE), have been developed, although data remains limited. This study was conducted to evaluate the clinical and laboratory outcomes of patients undergoing CSAE compared to open debridement. This study aims to compare the clinical and radiological outcomes between the Closed Abscess Evacuation System (CSAE) technique and open debridement in spinal tuberculosis abscess cases. This retrospective study involved 48 patients who underwent one of the two techniques. Results showed that CSAE yielded lower postoperative pain (VAS 2 vs. 4; p<0.001) and smaller scar length (0 cm vs. 12 cm; p<0.001) compared to open debridement. Median hospital stay was shorter in the CSAE group, although not statistically significant (2 vs. 3 days; p=0.06). However, the recurrence rate was higher with CSAE (2 cases vs. 0). Both techniques showed similar results in C-reactive protein (CRP) levels and Oswestry Disability Index (ODI). These findings suggest that CSAE offers a minimally invasive alternative with better clinical outcomes but requires attention to the risk of recurrence. Further studies are needed to validate these findings and evaluate the long-term safety of the CSAE technique."
Depok: Fakultas Kedokteran Universitas Indonesia, 2024
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library