Anatomy of the Skin Flashcards

1
Q

2 primary layers of the skin

A

epidermis and dermis

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2
Q

primary role of epidermis

A

protection and moisture retention

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3
Q

what is the epidermis comprised of

A

mostly dead cells

it is avascular;no blood supply

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4
Q

role of the dermis

A

Structural integrity of the integument
 Provide nutrition/hydration to epidermis
 Regulates body temp

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5
Q

what does the dermis contain

A
blood vessels
 nerves
 collagen
 lymphatics
 elastin
 Sebaceous glands
 sweat glands
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6
Q

what is the rete peg region

A

area between epidermal and dermal ridges and

valleys

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7
Q

role of the rete peg region

A

increases the surface area
between these 2 layers

Acts as extra skin to protect against frictional forces

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8
Q

What comprises the subcutaneous layer?

A
Connective tissue
 Fat-adipose tissue
 Blood vessels
 Lymphatics
 Nerves
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9
Q

What is the role of the subcutaneous layer?

A

Blood supply for skin

 Provides insulation/cushioning

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10
Q

What is under subcutaneous layer?

A

Muscles, fascia and bone

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11
Q

What causes the Integument to lose it’s ability to be intact?

A
 Impaired circulation
 Trauma
 Burns
 Pressure
 Friction
 Shear
 Radiation (including sun exposure)
 Edema
 Infection
 Loss of sensation
 Loss of moisture
 Skin disease
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12
Q

intrinsic factors that contribute to skin integrity

A
Age
 Chronic disease
 Oxygenation, blood volume
 Perfusion
 Immunosuppression from HIV, Chemo
 Neuropathy, SCI
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13
Q

extrinsic factors that contribute to skin integrity

A
Medications
 Nutrition
 Hydration
 Radiation and Chemotherapy
 Stress
 Infection
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14
Q

what part of the skin does a superficial wound involve?

A

involves the epidermis

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15
Q

what part of the skin does a partial thickness wound involve?

A

involves the dermis

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16
Q

what part of the skin does a full thickness wound involve?

A

Includes all layers of dermis and extends into

underlying tissues

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17
Q

examples of superficial wounds

A

First degree burns, stage 1 pressure

sores, contusions

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18
Q

examples of partial thickness wounds

A

Abrasions, skin tears, stage II pressure ulcers,

second degree burns

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19
Q

examples of full thickness wounds

A

Third degree burns, wounds that extend
through all layers of the skin and/or muscles,
tendons and bones

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20
Q

how can a superficial wound be identified

A

by redness, swelling, tenderness and warmth

NOT open

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21
Q

how does a superficial would heal

A

by the inflammatory response

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22
Q

how is a partial thickness wound characterized

A

by loss of the dermis
OPEN
looks wet

23
Q

how does a partial thickness wound heal

A

by inflammation and epitheliazation

24
Q

how is a full thickness would characterized

A

by large gaps and wound

edges can’t be approximated

25
Q

how does a full thickness would heal

A

by inflammation, epitheliazation, intention and proliferation

26
Q

what is primary intention healing

A

the edges are approximated and sutured by

surgery

27
Q

what is secondary intention healing

A

contraction and granulation in open full thickness wounds

28
Q

what is tertiary intention healing

A

deeper layers are closed but
subcutaneous are left open, contaminated, infected wounds. Wound edges eventually reapproximated
with sutures and then heals by primary closure

29
Q

what are chronic wounds

A

Wounds that fail to show a decrease of 50% of their volume in 1 month, so closure could not be achieved in 12 weeks

30
Q

what are the wound healing time phases

A

 Inflammatory 2-24 hours or up to 2 weeks
 Epithelialization -2-4 weeks
 Proliferative- 2 weeks to 24 days
 Remodeling-end of proliferative phase ->
2yrs

31
Q

what happens in the inflammatory phase

A

Body’s immune reaction-hemostasis
 Growth factors stimulated
 Controlled tissue degradation

32
Q

 Difference between infection and inflammation?

A

Inflammation- tenderness, changes in skin
color, slight edema, heat

 Infection- streaks of redness extending from
wound, intense pain, drainage thick yellow,
brown or green, malodor

33
Q

what happens during epitheliazation

A
Body protecting itself from invasion
 Epithelial cells at wounds edges
 sebaceous glands & sweat follicles
resurface by moving laterally
 Islands of epidermis may appear on
wound surface
Migrating tissue connects to adjacent skin
& pulls it to cover the wound
 Occurs from multiple directions
 New skin- bright pink may not regain
normal pigmentation
 Forms very thin sheet at first
34
Q

how can epitheliazation be bypassed

A

if a skin graft is used or the wound is too large

35
Q

what is epiboly

A

rolled skin edges that won’t heal any further once it rolls under

36
Q

how does the dermis assist with temp regulation

A

blood vessels constrict to keep the heat at the core. They can also dilate to release heat and decrease core temp

37
Q

how does the dermis provide protection, elimination of waste and homeostatsis

A

it is a thick layer that contains collagen and elastin for protection
it has sebaceous and sweat glands for removal of wastes and keeps fluids regulated for homeostasis via blood vessels and lymphatics

38
Q

do all people heal at the same rate?

A

NO
depends on our age, blood supply, extrinsic factors (medications) nutrition/hydration status., co-morbidities (DM, PVD,PAD)
lifestyle choices, etc.

39
Q

what factor is most related to loss of skin integrity

A

decreased profusion (poor circulation)

40
Q

What is intention healing

A

relates to wounds beyond the inflammatory phase. They are open

41
Q

If the wound has been infected, surgically debrided and closed up a week later what type of wound healing is it

A

TERTIARY because it was infected

42
Q

what happens in the proliferative phase

A

Granulation tissue formation-cavity is filling in to create level surface
 Shows red or pink granulation buds
(collagen and blood vessels)
 Does not replace structures lost
 Overlaps with the inflammatory phase
Yellow fibrinous membrane may appear on top of granulation tissue
 Less susceptible to infection with this membane
 Can be confused with infection
Contraction occurs- wound edges are drawn together
 Contraction reduces the areas needing to close by epithelialization
 The shape the wound assumes is predictive of the speed of contraction

43
Q

how fast do linear wounds close

A

at a quick pace

44
Q

how fast do circular wounds close

A

at a slow pace

45
Q

how fast do square or rectangular wounds close

A

at a moderate pace

46
Q

what happens in the remodeling phase

A

Scar tissue rebuilt to ↑ tensile strength
 ↑’s to 80% of original pre-injury strength at best
 Scar tissue replaced with less vascular tissue
 Scar tissue eventually becomes more flexible

47
Q

what does granulation look like

A

a beefy red

48
Q

what type of wound heals primarily by epitheliazation

A

wounds with a loss of dermis

49
Q

how does a skin tear heal

A

by epitheliazation

50
Q

what phases are needed for epiboly to heal

A

granulation and contraction

51
Q

how does an incision heal

A

by inflammation, granulation, epitheliazation and remodeling

52
Q

an open blister on the heel involves what tissues

A

the epidermis and dermis

53
Q

how would a blister heal

A

inflammation and epitheliazation