anatomy of the skin. aims and objectives to understand the underlying structures of the skin to gain...
Embed Size (px)
Anatomy of the skin
Aims and objectives
• To understand the underlying structures of the skin
• To gain a basic understanding of the process of wound healing.
• To be able to identify different tissue types in areas such as the wound bed, wound edge and surrounding skin
Anatomy of the skin
Is it important to know the Structure and functions of the
• How many layers does the skin consist of?
• Largest and most visible organ• Made up of two main layers: Epidermis – very thin layer and is
firmly attached to the dermis at the dermo- epidermal junction.
Dermis- made up of two layers comprising of fibrous proteins, collagen and elastin which give skin its strength and elasticity.
Below dermis is subcutaneous layer , this provides support to the dermis and stores fat which protects the internal structures.
• Does the skin vary in depth?
• Thinnest over eyelids -O.1mm • Thickest over palms and soles of the feet –
1mmThe skin is the largest organ of the body it weighs between 6-8 1bsIt has a surface area of 20 square feet.
What are the functions of the skin?
• Protection of internal structures – physical barrier to microorganisms and foreign matter.
• Acid PH helps to prevent infection
• Sensory perception- Allows you to feel pain, pressure heat this helps us to identify potential dangers and avoid injury
• Thermoregulation- Blood vessels constrict or dilate to raise or lower body temperature. Sweat production promotes cooling
• Excretion –Transmits small amounts of water and body waste via sweatHelps to prevent dehydration.
• Metabolism-Photochemical reaction in the skin produces Vitamin D essential for metabolism of calcium
• Absorption-Some substances can be absorbed directly into blood stream
Functions of the skin that declines with age.
• Flattening of the dermal-epidermal junction, increased susceptibility to friction/ shearing forces resulting in blistering.
• Decreased sensitivity to pain perception• Epidermis becomes thinner and flatter , uneven distribution
of melanocytes leading to uneven pigmentation.• Skin becomes wrinkled due to depletion of elastic fibres.• Skin becomes dry as a result of atrophy of sebaceous glandsBaraboski (2003) and Beldon (2006)
How do wounds heal?
Classification of wound healing
• Wounds that heal by primary intention e.g. incisional wounds
• Wounds that heal by secondary intention e.g. pressure ulcers
• Wounds that heal by tertiary intention e.g. delayed suture
• Wounds characterised by whether they are acute or chronic
Characterised by:• No underlying aetiology i.e. trauma• Short duration• Normal inflammatory phase• Heal and do not breakdown
Characterised by:• Underlying pathology e.g. venous
insufficiency• Prolonged duration• Hyperactive state• Persistent state of inflammation
• Wounds go through 4 distinct phases
Normal Wound Healing Response
MINUTES DAYS WEEKS MONTHS / YEARS
Haemostasis• Starts immediately after injury.• Blood vessel contraction
Inflammatory phase• Occurs between 0-3 days
Proliferation• 0-24 days
Maturation• 20 days – 2 years• Closure of wound and re-epithelisation.• Scar maturation
What factors may affect wound healing?
Factors Affecting Healing Systemic
•Age •Anaemia•Nutrition• Medications e.g.: Anti inflammatory, Cytotoxic drugs, steroids •Chronic health conditions eg :Diabetes Mellitus•Systemic infection (Bowler & Davies, 1999)•Oxygenation•Smoking•Psychological factors•Temperature
Factors affecting healing Local Factors
•Blood supply•Denervation•Haematoma•Local Infection•Duration•Wound bed condition•Anatomical site•Size of wound
• Assessment of a wound is the responsibility of the qualified member of staff
• You should ensure that this has been undertaken and a treatment plan has been established.
The selection of dressings or bandages without accurately undertaking a wound assessment taking into account underlying factors that may delay wound healing may result in costly treatments that are inappropriate and are not successful!
Clinical appearance of wound bed
Colour Physiological StateBlack Necrotic Yellow SloughyRed GranulatingPink EpithelializingGreen Infected?
Characteristics of granulation tissue
Does not bleed
Clinical appearance of
Erythema and oedema
Eczema and dry skin
• Quantity – Small , moderate copious is dressing containing exudate?
• Colour – Green? serous?, haemoserrous?• Consistency – Thick?Thin,
• When does it occur?• How bad (intense) is it?• How does the patient describe it?• What makes it better?
• If there are any changes in the wound report immediately to your nurse in charge
• Any delay in a reassessment may result in inappropriate treatment