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CLINICAL APPLIED ANATOMY IN WOUND CARE

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

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  1. Definition of Skin
  2. Function of the Skin
  3. Skin Layers
  4. Skin and Wound

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Content

Wound Care Training Module - National Wound Care Committee

Content

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What is the Skin?

  • Skin is the outer covering of the body and thus provides protection.
  • It is the largest organ; because it consists of different tissues that are joined to perform several essential functions; in our body in term of weight and surface areas.

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What is Skin?

  • Its thickness ranges from 0.5mm to 4.0mm depending on location.
  • It is a dynamic organ in a constant of change; whereby the outer layers are continuously shed and replaced by the inner cells moving to the surface.

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What is Skin?

  • Structurally, the skin consists of 3 principal layers.
    • Epidermis: outer most layer, thinner portion, composed of epithelium.
    • Dermis: middle layer, thicker, consists of connective tissue.
    • Subcutaneous: deepest layer, also known as superficial fascia or hypodermis; consists of areola and adipose tissues.
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What is Skin?

    • Fibers from the dermis extend down into the subcutaneous layer and anchor the skin to it.
    • The subcutaneous layer, in turn, attaches to underlying tissues and organs.

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Layers of the Skin�

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Function of the Skin �

  • Body temperature regulation
  • Protection
  • Sensation
  • Excretion
  • Immune function
  • Blood reservoir
  • Synthesis of Vitamin D

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Epidermis�

  • Epidermis is a labile tissue which is continuously regenerate.
  • It is avascular.
  • Receives nutrients from the dermis below.

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Epidermis

  • Comprised of stratified squamous epithelium and contains four principal types of cells.
      • Keratinocytes- produce proinflammatory mediators, participate in wound healing, and contribute in ultraviolet radiation protection.
      • Melanocytes: modulate skin colour through melanogenesis (melanin production).
      • Langerhan Cell: role in immune response to pathogens.
      • Meckel’s Cell: ” touch cells”- responsible to sensation.

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Dermis

  • The second principal layer of skin.
  • Composed of connective tissue containing collagen, elastic fibers which provides strength, extensibility, and elasticity.
  • Thickness depending on the anatomical site (e.g. very thick in the palms and soles and very thin in the eyelids, penis, and scrotum).

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Dermis

  • Contains nerves, glands, hair follicles and also receptors for heart, cold, pain, pressure, itch and tickle.
  • It is rich in blood supply from vascular plexus in the deep dermis. Through extensive vascular network (ascending arterioles and capillary loops), the blood supply eventually reaches upper layers of dermis.

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Blood supply of the skin

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Subcutaneous Layer�

  • The deepest layer, also known as subcutis or hypodermis.
  • Varies in thickness and depth.
  • Comprised of adipose tissue, connective tissue and blood vessels. Forms a network of collagen and fat cells.
  • Responsible for conserving the body's heat and protects body organs from pressure injury.

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Skin and Wound�

  • Superficial wound that damage the epithelium only, can heal by epithelial regeneration (reconstitute) and may have little scar formation.
  • Deeper wound; incisional and excisional skin wounds that damage the dermis will heal through the formation of a collagen scar.

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Skin and Wound

  • Regeneration requires an intact connective tissue scaffold.
  • Scar formation occur if the extracellular matrix framework is damaged, causing alteration of the tissue architecture.
  • Epidermal appendages do not regenerate and there remains as connective tissue scar.

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TAKE HOME MESSAGES�

  • Blood supply is essential in wound healing.
  • Blood supply is predominantly found in the dermis.

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REFERENCE�

  • Harold Ellis. Clinical Anatomy : A revision and applied anatomy for clinical students, Tenth Edition
  • Henry Gray. ANATOMY, DESCRIPTIVE AND SURGICAL, 1901 EDITION
  • Anne M.R.Agur, Ming J.Lee . Grants Atlas of anatomy Tenth Edition, LIPPINCOT WILLIAM & WILKINS
  • Kenneth S.Saladin, Leslie Miller. Anatomy & Physiology The Unity of Form and Function , Tenth edition�  

 

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THANK YOU

Wound Care Training Module - National Wound Care Committee