WOUND CARE WITH MOIST WOUND DRESSINGS FOR HEALING DIABETIC GANGRENE: SYSTEMATIC REVIEW

Introduction . Wound care with moist wound dressings is an effective and beneficial option for treating diabetic ulcers which often result in healing of old wounds that end in amputation. Writing this literature review aims to identify the effectiveness of the use of wound care with diabetic gangrene moist wound dressing. Method. The literature review writing method goes through several stages: creating questions and keywords namely MESH (Medical Subject Heading) , identification, eligibility, selection of article inclusions, screening, and assessment. The selection process listed in the literature framework resulted in 4 articles. Articles are summarized and assessed using critical appraisal according to the research design in each article. Result&Analysis. The wound care method with moist wound dressings has been proven to significantly help the healing process of diabetic gangrene wounds. The wound care method with the principle of moisture balance, is more effective than conventional methods. Discussion. Modern dressing wound care has been proven to help heal diabetic wounds effectively, this is evidenced by the mechanism of the average decrease in the occurrence of the wound dressing process and an increase in the quality of life of diabetic ulcer wound patients after being treated with modern wound dressing methods.


INTRODUCTION
Diabetes mellitus (DM) is a health problem that needs to be treated thoroughly, uncontrolled DM can cause metabolic complications or long-term vascular complications, namely microangiopathy and macroangiopathy.
Diabetics are also prone to wound infections in the feet, ineffective wound treatment increases the incidence of complications from diabetic gangrene (Buchori, Sukron and Wahyudi, 2020).
The data and information center of the Ministry of Health of the Republic of Indonesia (Kemenkes) explained that in 2021 the most common complication in Diabetes Mellitus cases is neuropathy, which is 54%, where neuropathy decreases sensation in the distal area of the foot so that there is a high risk of foot gangrene and can even lead to infection to amputation (Suprihatin and Purwanti, 2021).Wounds that arise spontaneously or due to trauma can cause open wounds capable of producing gangrenous gas resulting in osteomyelitis (Fitria et al., 2017).Patients with gangrene can be treated by improving peripheral perfusion.
Good perfusion helps in transporting oxygen and blood to damaged tissues thus helping to grow new tissues (Hidayat, 2017).
Previous wound care management using conventional methods is with methods that do not make the wound area moist by using gauze attached to the wound.This is what usually makes gauze will stick to the wound and make the newly grown cells will be damaged during the next wound treatment, causing discomfort at the change of client dressing.For this reason, it is necessary to choose the right wound care method to speed up the wound dressings process.
Currently, wound care has undergone many developments, one of which is the method of wound care with modern dressings, namely by maintaining a moist wound environment to maintain tissue fluid loss and cell death (Handayani, 2016).Proper wound care is an effort to help speed up the wound dressings process so it needs to continue to be developed (Ose, Utami and Damayanti, 2018).Diabetic wounds that do not heal are a risk factor for infection and a leading cause of amputation and death.But diabetes experts estimate that 1/2 to 3/4 amputation events can be avoided with proper foot care (Santoso, Rahayu and Irawan, 2022).The environmental domain in the intervention group before and after modern dressing treatment obtained an average difference of -0.44, meaning that between before and after there was an average increase of 0.44.So the researchers concluded from the results of the research that has been done, there is an effect of wound care with modern dressing methods on the quality of life of diabetic gangrene patients in the intervention group.
The third article shows that the average wound dressing process before and after the use of modern dressings decreases.Where the average before is 34.5 and after 26.9. the average difference was 7.6 with a difference of 5.9 to 9.9 (95% confidence interval of the difference).So the researchers concluded that there was an average decrease in the wound dressing process before the use of modern dressings.

DISCUSSION
The strict setting of criteria on the method greatly affects the number of oxygen supply and vascularization (Kartika, 2015).
The method of wound care that is developing today is using the principle of moisture balance, which is said to be more effective than conventional methods.
Wound care using the principle of moisture balance is known as the modern method of dressing (Kartika, 2015).
In its implementation, wound care to patients in this wound care practice uses the concept of modern wound care with the principle of moisture balance and applies advance dressing.However, the patient will determine the material / dressing to be applied because this is related to financing.Wound care given to patients should be able to improve the process of wound development (Handayani, 2016).
The treatment provided is to provide warmth and moist environment (moist) to the wound.Moist conditions on the wound surface can enhance the process of wound development, prevent tissue dehydration and cell death.(Handayani, 2016).Other studies also state that a humid environment can accelerate the inflammatory response, resulting in faster cell proliferation (Nabila, Efendi and Husni, 2013).
In a humid atmosphere cell metabolism will be better because more

Figure 1 .
Figure 1.Literature review Search Framework articles obtained.The determination of the article taken initially by entering the word lock for each variable that has been selected according to MESH (Medical Subject Heading) then a search is carried out using google scholar After seeing that the number of articles obtained is limited, the criteria for taking further articles, specific in the last 5 years, the results obtained are still too broad to determine articles that can be used.Because it is felt that the results obtained are still too much to be determined, then specified again in the last 3 years.The results of articles obtained from searches by entering keywords and specific in the last 3 years are taken and analyzed which ones meet the inclusion criteria and can be used as articles to be used, with reference to articles related to wound care interventions using modern dressings for diabetic wound dressing.After lowering the criteria in the form of research methods, finally 4 articles were obtained.The results are in line with the results of the research in the article, the results of the study generally state that the method of wound care with modern dresing has indeed proven to be significantly able to help the wound dressing process through the mechanism of the average occurrence of wound dressing process and increasing the quality of life of diabetic gangrene wound patients after treatment with modern dresing methods.Wound dressing is influenced by several factors Some of the factors that affect wound dressing are immunological or immune status, blood sugar levels, wound rehydration and washing, nutrition, blood albumin levels,

Table 1 .
Results of Literature Reviews