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
skin?

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
1mm
The skin is the largest organ of the body it
weighs between 6-8 1bs
It 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 sweat
Helps 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



Communication
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 glands
Baraboski (2003) and Beldon (2006)

How do wounds heal?
19
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
21
Acute wounds
Characterised by:
No underlying aetiology i.e. trauma
Short duration
Normal inflammatory phase
Heal and do not breakdown
22
Chronic wounds
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







HAEMOSTASIS
INFLAMMATION
PROLIFERATION
MATURATION
MINUTES DAYS WEEKS MONTHS / YEARS
Platelets
Fibrin
Neutrophils
Macrophages
Lymphocytes
Proteoglycans
Fibroblasts
Collagen
Angiogenesis
Collagen
remodelling
Scar maturation
(whru)
Haemostasis
Starts immediately after injury.
Blood vessel contraction
(vasoconstriction)


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.
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!
Clinical appearance of wound bed

Colour Physiological State
Black Necrotic
Yellow Sloughy
Red Granulating
Pink Epithelializing
Green Infected?
35
Characteristics of granulation tissue
Healthy tissue
Bright red
Moist
Shiny
Does not bleed
Unhealthy tissue
Dark red
Dehydrated
Dull
Bleeds easily
S
Granulating

(WHRU)
(WHRU)
Necrosis

Slough
Clinical appearance
of
surrounding skin
Maceration
Excoriation
Erythema and oedema
Eczema and dry skin
Exudate
Quantity Small , moderate copious is
dressing containing exudate?
Colour Green? serous?, haemoserrous?
Consistency Thick?Thin,
Pain
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