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Anatomy of the skin
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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
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Anatomy of the skin
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Is it important to know the Structure and functions of the
skin?
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• How many layers does the skin consist of?
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• 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.
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• Does the skin vary in depth?
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• 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.
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What are the functions of the skin?
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• Protection of internal structures – physical barrier to microorganisms and foreign matter.
• Acid PH helps to prevent infection
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• Sensory perception- Allows you to feel pain, pressure heat this helps us to identify potential dangers and avoid injury
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• Thermoregulation- Blood vessels constrict or dilate to raise or lower body temperature. Sweat production promotes cooling
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• Excretion –Transmits small amounts of water and body waste via sweatHelps to prevent dehydration.
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• Metabolism-Photochemical reaction in the skin produces Vitamin D essential for metabolism of calcium
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• Absorption-Some substances can be absorbed directly into blood stream
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• Communication
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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)
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How do wounds heal?
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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
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• Wounds characterised by whether they are acute or chronic
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Acute wounds
Characterised by:• No underlying aetiology i.e. trauma• Short duration• Normal inflammatory phase• Heal and do not breakdown
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Chronic wounds
Characterised by:• Underlying pathology e.g. venous
insufficiency• Prolonged duration• Hyperactive state• Persistent state of inflammation
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• Wounds go through 4 distinct phases
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Normal Wound Healing Response
HAEMOSTASIS
INFLAMMATION
PROLIFERATION
MATURATION
MINUTES DAYS WEEKS MONTHS / YEARS
Platelets
Fibrin
Neutrophils
Macrophages
Lymphocytes
Proteoglycans
Fibroblasts
Collagen
Angiogenesis
Collagen remodelling
Scar maturation
(whru)
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Haemostasis• Starts immediately after injury.• Blood vessel contraction
(vasoconstriction)
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Inflammatory phase• Occurs between 0-3 days
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Proliferation• 0-24 days
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Maturation• 20 days – 2 years• Closure of wound and re-epithelisation.• Scar maturation
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What factors may affect wound healing?
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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
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Factors affecting healing Local Factors
•Blood supply•Denervation•Haematoma•Local Infection•Duration•Wound bed condition•Anatomical site•Size of wound
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• 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.
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Remember
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!
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Clinical appearance of wound bed
Colour Physiological StateBlack Necrotic Yellow SloughyRed GranulatingPink EpithelializingGreen Infected?
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Characteristics of granulation tissue
Healthy tissue
Bright red
Moist
Shiny
Does not bleed
Unhealthy tissue
Dark red
Dehydrated
Dull
Bleeds easily
S
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Granulating
(WHRU)
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(WHRU)
Necrosis
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Slough
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Clinical appearance of
surrounding skin
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Maceration
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Excoriation
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Erythema and oedema
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Eczema and dry skin
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Exudate
• Quantity – Small , moderate copious is dressing containing exudate?
• Colour – Green? serous?, haemoserrous?• Consistency – Thick?Thin,
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Pain
• When does it occur?• How bad (intense) is it?• How does the patient describe it?• What makes it better?
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• 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