Skin Basics

As seen in the Consultant Connection January / February 2013 Issue
by Susan M Cleveland BSN, RN, WCC
Wound prevention is and should be the number one concern in our skin care protocol arsenals for long term care. But when it comes to wound healing, a knowledge of fundamentals is essential. Basic anatomy and physiology takes priority, then an understanding of the functions of the skin and third the phases of wound healing.
Skin being the largest organ of the body comprises about 10% of the adult’s total body weight-2 square yards for the average adult. It is made up of two major layers-the epidermis and the dermis-each with different functions.
The skin acts as a physical barrier to microorganisms and other foreign matter protecting against infections and excessive loss of fluids for one function. Regulating the body temperature through vasoconstriction, vasodilation, and sweating as well as excretion of certain waste materials is another function. A third function of metabolism for example happens as the synthesis of vitamin D occurs when skin is exposed to sunlight. Skin performs cosmetic, identification, communication roles in its function of body image. Finally the skin is a portal to the immune system with resident immune cells in both the epidermis and the dermis. In addition the dermis provides strength, support, blood, and oxygen to the epidermis. So you can see with the age related changes our skin goes through outside of disease processes, paying attention to the skin is vitally important and becomes even more important with illness compounding aging.
Wound healing occurs in four phases beginning with hemostasis. Hemostasis is immediately after the injury occurs and platelets come to release cytokines. Then the inflammatory phase begins, also called the defensive or reactive phase, it typically lasting 4-6 days. Proliferative phase follows and can last several weeks. In an open wound, granulation tissue forms as red, beefy buds of tissue. During the fourth and final phase, maturation or remodeling, collagen fibers reorganize, remodel, and mature, gaining tensile strength. This phase can last up to 21 days and continues until the scar tissue regains about 80% of the skin’s original strength and is always at risk for breakdown.
Always remember two things:
  1. It is not about the hole in the resident, it is about whole resident.
  2. Once a wound, always a wound.
Contact your wound care consultant for further information on skin care prevention and treatments.
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