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Advanced Wound Care

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  University of AlexandriaFaculty of Nursing   Doctorate Program  2005-2006   The Integumentary System Te s!in is largest organ in te ody# $t as many functions including %rotection&  containment and tem%erature control# The two principle parts of the skin: Dermis   '%idermis (outer layer) as five layers  *tratum corneum+ ardened& flattened dead cells ,ic are constantly eing sed *tratum lucidum+ denucleated cells ut not com%letely ard*tratum granulosum+ cells ave a distinct nucleus ut cell mem ranes are dying*tratum s%inosum+ cells are living and mem ranes are intact*tratum germinativum+ %rimary site of mitosis in te s!in contains melanin# The functions of all the structures contained within the dermis    specialized    cells   : fibroblasts:  %roduce areolar tissue& collagen and elastin damaged y U. ligt# Mast cells:  %roduce istamine as an allergic res%onse and e%arin& an anticoagulant#  Histiocytes + also %roduce istamine 2   Leucocytes: /ite lood cells ,ic el% figt infection and disease#   Nerve endings:  Alert te rain to eat& cold& %ressure and %ain#     Sweat glands :  t,o !inds+ - eccrine+ excrete ,atery s,eat and control   ody tem%erature# -a%ocrine+ excrete mil!y fluid found in groin and axilla#   Hair follicles + travel troug te dermis and te e%idermis erector %ili muscles %ull airs u%rigt to tra% eat and tus control ody tem%erature#   Sebaceous glands + connected ,it air follicles %roduce se um& a fatty acid ,ic lu ricates air safts and el% to regulate te % of te s!in (%15#6-6#5)   Blood supply + a system of lood vessels including microsco%ic ca%illaries ,ic are one cell tic!#   Lymphatic capillary + ,or!s in conunction ,it te lood su%%ly to collect excess fluidand lea!ed %lasma %roteins from te cells and return te su stances to te circulatory system#   Papilla :  *mall& conical %roections at te ase of te air containing lood vessels and nerves ,ic su%%ly te air ,it nutrients# WO! H#$LI!% Te entire ,ound ealing %rocess is a com%lex series of events tat egins at te moment of inury and can continue for monts to year# $t leads to restoration of tissue continuity# &hases of wound healing: 3#$nflammatory %ase#2#Proliferative %ase#4#aturation and emodeling %ase# '( Inflammatory phase: $nitial res%onse to tissue inury& it ta!es 3-7 or 5 days& it includes+ 4  a-Hemostasis: $t is te %rocess of sto%%ing leeding y+ o 'xtravasations o $nitiation of %latelet activities and lood coagulation# o .asoconstriction o 8eucocytes b-nflammation: o elease of %rostaglandins and activated com%lement %roteins o Attraction of neutro%ils and monocytes to te ,ound # o Activation of neutro%ils o onocytes undergo a %enoty%ic cange to te activated macro%age )( &roliferati*e phase   : -$t is te gro,t or re%roduction of ne, connective tissue (granulation tissue)#-$t starts after first stage and lasts a out 4 ,ee!s (or longer)#-Formation ne, ty%e of cell called fibroblast   y te macro%ages# -Fi ro last %roduces a net,or! of collagen  surrounding te neovasculture of te ,ound#-9ranulation tissue formation eings after several days#-During %roliferation& t,o oter %rocesses are ta!ing %lace simultaneously& e%iteli:ation and contraction#- '%iteli:ation ; resurfaces te ,ound y regenerating of e%itelium# - /ound retraction ; decrease te si:e of ,ound +,Maturation and -emodeling phase: -$s te final stage of ealing& ,ic egins rougly 4 ,ee!s after inury#-$s a %rocess of remodeling of te collagen fi ers laid do,n during te %roliferation  %ase#-During tis %ase& ty%e $$$ collagen& a soft gelatinous collagen& is gradually re%laced ,it stronger& more igly organi:ed collagen# 7
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