Integumentary management for physical therapists Flashcards
what are the two distinct layers of the skin?
epidermis
dermis
what occurs at the dermal-epidermal junction?
basement membrane
what is the layer under the distinct layers of the skin?
subcutaneous aka the hypodermis
what are the layers of the skin in order?
epidermis
dermis
adipose tissue
muscle
bone
what is meant by blanch able and non blanchable skin?
blanch able turns white after pressing on the skin
what is the dermis?
Thin stratified epithelium
Range from 0.06 to 0.6mm
0.4-0.6mm over palms of hands and soles of feet
Gives rise to hard keratinized structures (nails, hair)
Cellular, avascular, water resistant
Composed of 5 layers
90% Keratinocytes (synthesize keratin)
Contains melanin
what are the 5 layers of the epidermis?
stratum corner
stratum lucid
stratum granulosum
stratum spinosum
stratum basale
what are the cells of the epidermis?
keratinocytes
melanocytes
langerhan cells
basal cells
eccrine unit
procaine unit
hair folicles
nails
sebaceous glands
what are the cells of the dermis called?
fibroblasts
collagen
elastin
macrophages
mast cells
lymphatic glands
blood vessels
nerve fibers
what are the cells of the epidermis?
adipose
what is the function of a keratinocyte (squamous cell)
synthesis of keratin
what is the function of melanocytes?
synthesis of melanin
what is the function of langerhan cells
immune responce
what is the function of basal cells?
epidermal production
what is the function of eccrine unit?
thermoregulation by persiratation
what is the function of apocrine unit
sweat production
what is the function of hair follicles?
protection
what is the function of nails?
protection
what is the function of sebaceous glands
produces sebum (oil for lubrication of skin)
what is the function of fibroblasts? where are the found?
collagen synthesis
dermis
what is the function of collagen? where are the found?
insoluble connective tissue proteins
dermis
what is the function of elastin? where are the found?
primary protein in elastic tissues
dermis
what is the function of macrophages? where are the found?
phagoctosis, intimate growth and repair through growth factor production
dermis
what is the function of mast cells? where are the found?
provide histamine for vasodilation
dermis
what is the function of lymphatic glands cells? where are the found?
removal of microbes and intestinal waste
dermis
what is the function of blood vessels cells? where are the found?
thermoregulation provides metabolic skin requirements
dermis
what is the function of nerve fibers? where are the found?
sensory perception
dermis
what is the function of nerve fibers? where are the found?
protection from trauma, energy storage, thermoregulation
subcutaneous
what are the functional components of the epidermis?
stratum corneum
keratinocytes
melanocytes
Merkel cells
Langerhans’ cells
what are keratins?
Insoluble fibrous proteins
Extremely resistant to changes in pH, temperature and enzymatic digestion
Two broad categories
Hard
Soft
how often does the epidermis shed?
Sheds on average every 28-30 days
Until age 60- then every 60 days
what are the functions of the epidermis?
Protection:
infection, shear/friction, water loss, toxic irritants
Vitamin D synthesis
Thermoregulation
Regulation, retention, dissipation
Sensation (light touch)
Pigmentation (melanocytes)
what is the importance of the epidermal-dermal junction and what lies within there?
basement membrane: separates the epidermis form the dermis
rete pegs reduce shearing stress between the epidermis and the dermis
what is the dermis?
Thickest layer of skin (2-4 mm)
20-30X thicker than epidermis
Provides support and nutrition to the epidermis
Responsible for giving skin its bulkiness
Extra-cellular matrix (fibroblasts)
Is vascularized and innervated
Major proteins are collagen and elastin
what are the functional components of the dermis?
Functional components
hair follicles
sweat glands
sebaceous glands
nerve endings
lymph vessels
capillaries
collagen
elastin
what are dermal appendages?
Hair follicles
Sebaceous glands
Sweat glands
Lined with epithelial cells
Epithelial islands
what are subcutaneous tissues
Superficial fascia
Anchors skin to underlying structures
Blood vessels and nerve endings
Fat
Insulates and “pads” underlying structures
how are the muscles aligned in the skin organization
Separated from subcutaneous fat by fascia
Point of contact to bony prominences
Greatest oxygen demand of all tissues
Most sensitive to ischemia
Review what are the three factors the skin provides us? organs of communication and idenfification
provides thermoregulation
sensation
metabolism
Organ of communication and identification
Injury can result in:
Functional change
Physiologic change
Body image change
Facial skin, along with underlying muscles capable of expressions
what are the levels of skin loss?
Wounds are classified by depth of tissue injury
Erosion- loss of superficial epidermis, probably not bleed, redness, repair by local inflammatory response
Partial thickness skin loss- loss of epidermis and part of the dermis, bleed, reepithelization for repair
Full thickness skin loss- loss of epidermis, dermis extending into subcutaneous/hypodermis, secondary intention repair through scar
Full thickness with muscle, tendon, bone
what are the skin changes noticed with aging?
Decreased:
Epidermal/Dermal thickness
Decreased subcutaneous fat
Collagen and elastin
Size of Rete ridges/pegs
Sensation and metabolism
Sweat glands
Circulation
Reduced mast cells
Epidermal regeneration
Up to 4X slower healing than younger populations
