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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.

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Presentation on theme: "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."— Presentation transcript:

1 Anatomy of the skin

2 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

3 Anatomy of the skin

4 Is it important to know the Structure and functions of the skin?

5 How many layers does the skin consist of?

6 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.

7 Does the skin vary in depth?

8 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.

9 What are the functions of the skin?

10 Protection of internal structures – physical barrier to microorganisms and foreign matter. Acid PH helps to prevent infection

11 Sensory perception- Allows you to feel pain, pressure heat this helps us to identify potential dangers and avoid injury

12 Thermoregulation- Blood vessels constrict or dilate to raise or lower body temperature. Sweat production promotes cooling

13 Excretion – Transmits small amounts of water and body waste via sweat Helps to prevent dehydration.

14 Metabolism-Photochemical reaction in the skin produces Vitamin D essential for metabolism of calcium

15 Absorption-Some substances can be absorbed directly into blood stream

16 Communication

17 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)

18 How do wounds heal?

19 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

20 Wounds characterised by whether they are acute or chronic

21 21 Acute wounds Characterised by: No underlying aetiology i.e. trauma Short duration Normal inflammatory phase Heal and do not breakdown

22 22 Chronic wounds Characterised by: Underlying pathology e.g. venous insufficiency Prolonged duration Hyperactive state Persistent state of inflammation

23 Wounds go through 4 distinct phases

24 Normal Wound Healing Response HAEMOSTASIS INFLAMMATION PROLIFERATION MATURATION MINUTESDAYSWEEKSMONTHS / YEARS Platelets Fibrin Neutrophils Macrophages Lymphocytes Proteoglycans Fibroblasts Collagen Angiogenesis Collagen remodelling Scar maturation (whru)

25 Haemostasis Starts immediately after injury. Blood vessel contraction (vasoconstriction)

26 Inflammatory phase Occurs between 0-3 days

27 Proliferation 0-24 days

28 Maturation 20 days – 2 years Closure of wound and re-epithelisation. Scar maturation

29 What factors may affect wound healing?

30 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

31 Factors affecting healing Local Factors Blood supply Denervation Haematoma Local Infection Duration Wound bed condition Anatomical site Size of wound

32 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.

33 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!

34 Clinical appearance of wound bed Colour Physiological State Black Necrotic Yellow Sloughy Red Granulating Pink Epithelializing Green Infected?

35 35 Characteristics of granulation tissue Healthy tissue Bright red Moist Shiny Does not bleed Unhealthy tissue Dark red Dehydrated Dull Bleeds easily S

36 Granulating (WHRU)

37 Necrosis

38 Slough

39 Clinical appearance of surrounding skin

40 Maceration

41 Excoriation

42 Erythema and oedema

43 Eczema and dry skin

44 Exudate Quantity – Small, moderate copious is dressing containing exudate? Colour – Green? serous?, haemoserrous? Consistency – Thick?Thin,

45 Pain When does it occur? How bad (intense) is it? How does the patient describe it? What makes it better?

46 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

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