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Objectives Describe layers of skin. Enlist the functions of skin. Define appendages of skin. Define Fascia. Differentiate between Superficial.

Jan 22, 2016

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Page 1: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 2: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Objectives

Describe layers of skin. Enlist the functions of skin. Define appendages of skin. Define Fascia. Differentiate between Superficial and Deep

Fascia. What are the different types of burns.

Page 3: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Tissues of the body

The tissue: is a group of cells which perform a specific function

There are four basic tissues:1.Epithelium2.Connective tissue3.Muscular tissue4.Nervous tissue

Page 4: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 5: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 6: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Structure of the skin

Page 7: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 8: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 9: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Structure of the skin

EpidermisEpidermis

Keratinized Keratinized stratified stratified squamous squamous epithelium epithelium devoid of blood devoid of blood vesselsvessels

DermisDermis

Connective tissue Connective tissue containing containing (bl. v. (bl. v. lymph v., sensory lymph v., sensory nerve endings, nerve endings, smooth m, hair smooth m, hair follicles, sweat and follicles, sweat and sebaceous glands) sebaceous glands)

In its deep part the In its deep part the collagencollagen bundles bundles are arranged in are arranged in parallel rowsparallel rows

Page 10: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Epidermis

Thickness:The epidermis is generally thin except in :• The palms of the hand.• The soles of the feet.

Why?To protect these parts and withstand friction, wear and tear that occurs in these regions.

Page 11: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Functions of the Skin

1-Protection abrasion, invasion, water loss, UV protection 2-Vitamin D synthesis epidermal keratinocytes when exposed to

UV light helps maintain health of skeleton by

increasing absorption of Ca2+ 3-Sensation receptors for heat, cold, touch, pressure,

vibration and pain

Page 12: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

4- Thermoregulation thermo receptors and sweat glands hypothalamus controls cutaneous

arteries and sweat glands to retain or dissipate heat

5- Psychological and social functions appearance and social acceptance facial expression and nonverbal

communication

Page 13: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Lines of cleavage

• The collagen fibers, arranged in parallel rows, called:

Lines of cleavage (langer’s lines):

• The direction of the rows of collagen fibers in the dermis:

It runs

•Longitudinally in the limbs.•Circumferentially in the neck and the trunk.

Page 14: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Lines of cleavage

These lines are important

to determine the direction

for an incision (cut) during

a surgery to avoid obvious

scars.

Page 15: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

• A surgical incision along or between these lines causes the minimum disruption of collagen so that the wound heals with a small scar.

• Conversely, an incision made across the rows of collagen makes a disruption resulting in the massive production of fresh collagen and the formation of a broad scar.

Page 16: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Skin creases

Folded skin over the

joints.

Skin is thin and is

firmly adherent to

underlying structures.

Page 17: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Skin Color

Due to Melanin, a pigment in the epidermis and Carotene,

a pigment in dermis as well as the blood in the capillaries

of the dermis. Melanin is synthesized in cells called Melanocytes (found in

basal layer). Number of Melanocytes is essentially the same in all races. The differences in skin color is due to the amount of pigment the

melanocytes produce. When skin is exposed to ultraviolet radiation, enzymatic activity

is increased and both the amount and darkness of melanin increase and the skin darkens as a protective measure

Page 18: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

• Nails• Hairs• Sebaceous glands• Sweat glands

The appendages of the skin

Page 19: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

A nail is a flat horny plate on the dorsal surface of tips of the fingers and toes

It has: Root: proximal edge (part

embedded in skin) body: exposed part & has a

free distal edge Nail fold: folds of skin

surround and overlap the nail

• Nail bed is very vascular causing pink color of the nail• The germinative zone lies beneath the root& is responsible for growth of nail

Nails

Page 20: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Cover whole surface of the body except some areas as lips, palms, soles, glans, clitoris, L. minora.

Hairs

Page 21: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Hairs

Hair follicles: invaginations of the epidermis into the dermis, the hair grows out of these follicles (hair shaft).

Hair bulb: the expanded extremity of the follicle, concaved at the end (located deep in the dermis).

Hair papilla: a vascular connective tissue that occupies the concavity of the bulb.

Page 22: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

• A band of smooth muscle

connects the undersurface of the

follicle to the superficial part of

the dermis.

• It is innervated by sympathetic

nerve fibers.

• It is involuntary.

Arrector Pilli muscle

Page 23: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Functions:

•Its contraction causes the hair to move into a more vertical position.

• It compresses the sebaceous gland and causes it to extrude sebum.

Arrector Pilli muscle

Page 24: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Function It secrets sebum to oil

(lubricate) hair and skin.

Sebum An oily material that

keeps the flexibility of the hair and oils the epidermis around the mouth of the follicle.

Sebaceous glands

Page 25: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

It occurs because of the

obstruction (blocking) of the

sebaceous duct.

Sebaceous cyst

Page 26: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

• long tubular glands with deep coiled part.

• All over the body except red margins of lips, nail beds, glans penis and clitoris.

• The most deeply penetrated structure.

Sweat glands

Page 27: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Skin infections

Pathogenic organisms can enter to the tissue through :• Nail Folds

• Hair Follicles

• Sebaceous Glands

Staphylococcus:

A type of bacteria that causes skin infections.

Page 28: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Skin infections

•Paronychia, infection between the nail and nail fold

•Boil, Infection of the hair follicle and sebaceous glands

•Carbuncle, infection in the superficial fascia affecting single or group of hair follicles

Page 29: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

CARBUNCLE

Page 30: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Par/onych/ia :

par- : throughonych- :nail-ia :abnormal condition

Page 31: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Rule of NineRule of Nine

Page 32: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Burns

1st degree burn: Damages only epidermis (sunburn with reddening of the skin). 2nd degree burn: Damages much of the epidermis but leaves some epidermal remnant.

Re-growth from remnants is possible. Blisters are common and pain is often severe since the skin

nerves are irritated by the products of cellular destruction.

Page 33: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Burns

3rd Degree burn:

It reaches to and through dermis (May expose muscle

and bone. No epidermal remnants are present. Little or no feeling of pain because of destruction of

nerves. Treatment requires skin grafts to provide epidermal

cells.

Page 34: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Major Problems of Burns

Infection. Maintaining fluid. Maintaining electrolyte balance which requires food

and fluid intake. Contractures of skin and underlying connective tissue

and muscle due to intense scarring.

Page 35: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 36: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Skin burns

DeepDeepSuperficialSuperficial

Heals slowly from the edges.

Usually needs skin grafting.

Heals rapidly from the edges, cells of HF and glands.

Heals quickly.

Doesn’t need a skin graft.

Page 37: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Clinical notes

Graft is transferring tissue from one site to another.

Skin graft is needed when the skin is damaged ( usually by deep

burning )

Page 38: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Clinical notes

Full thickness graftingFull thickness graftingSplit thickness graftingSplit thickness grafting

Transferring epidermis only Transferring both epidermis and dermis.

Skin GraftSkin Graft

Page 39: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Clinical notes

shows goosefleshshows goosefleshPalePale

ShockShock

Page 40: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 41: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Fascia

Collection of connective tissueCollection of connective tissue

Deep fasciaDeep fasciaSuperficial fasciaSuperficial fascia

Page 42: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Superficial fascia

Page 43: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Deep Fascia

Page 44: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Superficial fascia

Superficial fascia:• Loose, mixture of adipose and loose areolar tissues.• It unites the skin to the underlying structures.• It is dense in some places as scalp, palm of hand and sole of foot

and contains collagen bundles• It is thin in the eyelids, auricle, scrotum, penis and clitoris

(devoid of adipose tissue).

Functions:• Facilitates movement of skin over underlying structures.• Passage for cutaneous vessels, nerves…• Protects the body against heat loss.

Page 45: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Superficial fascia

Page 46: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

It is It is more dense more dense than than superficial fasciasuperficial fascia

Collagenous bundles are Collagenous bundles are more compact and more more compact and more regularly arrangedregularly arranged

It is usually present in the It is usually present in the form of form of membranesmembranes

Deep fascia

Page 47: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

A. Intermuscular septa

lie between muscles lie between muscles

dividing the limb dividing the limb into compartmentsinto compartments

Examples of deep fascia

Page 48: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

B. Investing fascia

• Covers the surfaces of musclesCovers the surfaces of muscles• In the In the neckneck: it forms well-defined layers, : it forms well-defined layers,

bounds fascial spaces so limits spread of bounds fascial spaces so limits spread of infection or determine the path of infectioninfection or determine the path of infection

• In the In the abdomenabdomen: it is thin: it is thin• In the In the limbslimbs: forms a definite sheath around the : forms a definite sheath around the

musclesmuscles

Examples of deep fascia

Page 49: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.
Page 50: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.

Localized thickening of deep fascia around joints, hold the tendons in place, prevent bowstringing of tendons

Examples of deep fascia

C. Retinacula

Page 51: Objectives  Describe layers of skin.  Enlist the functions of skin.  Define appendages of skin.  Define Fascia.  Differentiate between Superficial.