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skin
skin
103
Anatomy
Graduate
11/07/2013

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Term
what are the functions of skin
Definition
protect the rest of the body from trauma and irritants, regulate temperature, signify underlying disease, enable joint motion with good stretchiness and resist it with contracture
Term
what are the 3 layers of skin
Definition
epidermis, dermis, subcutaneous fat layer
Term
what types of stuff do we see in skin?
Definition
nerves, sweat glands, hair follicles, oil glands around hair follicles, blood vessels
Term
what is skin composed of
Definition
a lot of collagen fibers, a lot of elastin fibers
Term
what is the purpose of so many elastin fibers in skin?
Definition
helps skin strain to enable joint motion
Term
how much strain can elastin fibers undergo
Definition
over 100%
Term
how much strain can collagen fibers undergo?
Definition
8-10% strain at failure
Term
what is the physiologic loading strain range for collagen fibers
Definition
4-6%
Term
in a stress-strain curve, on what axis is strain?
Definition
x axis
Term
in a stress-strain curve, on what axis is stress?
Definition
y axis
Term
describe the stress-strain curve of collagen fibers
Definition
the curve goes from 0-10% strain with failure at 10% and a peak around 7%.
Term
describe the stress-strain curve of elastic fibers
Definition
gradual increase in strain and stress up to about 190%, then a sudden increase in stress
Term
what is the collagen fiber orientation in tendon?
Definition
parallel
Term
why is the collagen fiber orientation in tendon parallel?
Definition
to resist the tensile stress that is generated through passive stretching of muscle-tendon untis and active contraction of the sarcomeres in the muscles
Term
what is the collagen fiber orientation in ligament?
Definition
primarily parallel, with some fibers going in random directions
Term
why is the collagen fiber orientation in ligaments primarly parallel with fibers also going in random directions?
Definition
ligaments have to control stress in a variety of conditions
Term
what is the orientation of collagen fibers in skin?
Definition
irregular
Term
why is the orientation of collagen fibers in skin irregular?
Definition
because skin is stretched in a variety of directions and collagen fibers are oriented in all those directions to resist the tensile stress that acts in all those directions
Term
what do collagen fibers have at rest?
Definition
crimp
Term
when is crimp removed from collagen fibers?
Definition
with a little bit of tensile stress
Term
what should you wear while treating skin?
Definition
gloves
Term
what are Langer's Lines?
Definition
the dominant orientation of collagen bundles in the skin
Term
what is the direction of Langer's Lines in extremities?
Definition
longitudinal: shoulder to wrist, hip to foot
Term
where are places where Langer's Lines are oriented medial-laterally?
Definition
posterior elbow, front of knee, palmar and dorsal surfaces of the hand, dorsum of the foot
Term
what is the direction of Langer's Lines in thoracic region?
Definition
circumferential
Term
what is the direction of Langer's Lines in posterior thorax?
Definition
diagonal
Term
what are the clinical implications of langer's lines?
Definition
if there is an incision/cut perpendicular to Langer's lines, it tends to promote hypertrophic scarring, where as cuts parallel to langer's lines have normal scarring
Term
why do we see hypertrophic scarring for open heart or abdominal surgery?
Definition
they go perpendicular to Langer's lines
Term
how are laceratiosn/abrasions classified?
Definition
based on depth
Term
what is the normal result of superficial wounds to epidermis and partial thickness wounds/
Definition
re-epitheliazation
Term
how to promote re-epitheliazationof superficial wounds to the epidermis?
Definition
clean the wound, apply antibiotics, protective dressing
Term
what is needed for healing of full thickness wounds with minimal scarring?
Definition
good opposition of wound edges (sutures, steri-strips, skin glue) to minimize the gap so that you minimize scar tissue and maximize re-epitheliazation
Term
when you have a big, full thickness injury, how does scar tissue/collagen tend to lie down?
Definition
in a circular orientation
Term
what does the circular orientation of collagen in a large wound do?
Definition
causes wound contracture and closure
Term
what do scabs do?
Definition
protect underlying tissue, but delay healing by drying out the wound site
Term
what is the best way to avoid drying out a wound site from scabs
Definition
moist dressings with antibitic topical agent
Term
is scar or skin weaker?
Definition
scar
Term
how and when to release subcutaneous adhesions between skin and subcutaneous tissues?
Definition
Early on, do light massage to relseae adhesions. Othewise, you'll have trouble with independent movement of the skin over underlying tissue, which can be painful and restrict motion.
Term
describe skin glue for skin closure
Definition
same mechanical strength as sutures, similar cosmesis. Being used more and more. Twice as fast to apply than sutures. More expensive substance.
Term
describe steri-strips for skin clusre
Definition
inferior mechanical strength and cosmesis
Term
what is the reuslt of the inferior mechanical strength of steri-strips
Definition
because they are weaker, there will be more scar tissue filling in the gap, leading to poorer cosmesis
Term
describe staples for skin closure
Definition
require special equipment for placement and removal. Sterile technique required with removal.
Term
how is patient satisfaction for skin glue vs sutures vs staples
Definition
simiar
Term
how to increase hypertrophic scarring after suture removal
Definition
paper tape that goes along the length of the incision.
Term
how do suture/staples work?
Definition
when they put the sutures in, they pull the skin together tightly first. Really tight, such that along the incision, it's all raised and bumpy and nasty looking. These sutures become miniature force vectors pulling the skin together tightly so that the skin at the incision doesn't feel the laterally pulling forces of the rest of the skin in the body. The sutures provide stress shielding
Term
how does paper tape decrease incidence of hypertrophic scarring after suture removal
Definition
paper tape decreases multidirectional forces imposed on the incision site = the tensile stress pulling on the skin that rquires the skin to strengthen the incision site and produce a hypertrophic scar
Term
how to apply and use paper tape to reduce scarring?
Definition
strip of paper tape along the length of the incision. Carefully peel off the paper tape, dry the incision, and put on a fresh strip of paper tape for 12 weeks
Term
does the type of dressing you use make a difference?
Definition
yes, choice of dressings has a major impact on blistering and healing outcomes in orthopedic patients
Term
what dressings are best for incision covers
Definition
occlusive dressings such as OpSite PostOp = they have high moisture vapor transmission rates which provide better covers with less exudate and reduced rates of blistering
Term
what is an occlusive dressing
Definition
a dressing that allows no transmission from the outside into the wound
Term
what is a hematoma?
Definition
a bleed from blunt trauma to skin or from injury to subcutaneous tissues
Term
what is ecchymoses
Definition
bleed that penetrates to the skin
Term
what is needed if blood collets into a confined space such as under a fingernail
Definition
pressure relief
Term
what modality to apply initially to limit bleeding
Definition
ice and compression
Term
what modality to apply later to aid in blood resorption
Definition
heat
Term
what is a subungual hemorrhage
Definition
blood under the nail, uncomfortable
Term
can PTs drain a subungual hemorrage
Definition
no, but they can tell patients how to do it
Term
how to drain a subungual hemorrhage
Definition
drill a hole through nail with exacto knife twilled or burn a hole with heated paper clip so that the blood can come out
Term
what to address for subungual hemorrhage
Definition
shoe toe box and sock wear
Term
what is a dirt tattoo
Definition
entrapment of dirt or particles under the epidermis
Term
why are dirt tattoos bad
Definition
risk of infection: monitor for redness, irritation, tenderness
Term
what is a piezogenic papule
Definition
herniation of fat pad particles through the skin
Term
what is the problem with piezogenic papules
Definition
they may or may not cause pain, but they are unsightly
Term
how to treat piezogenic papules
Definition
treat with external constraint of gel-like heel cup to fill in space and put pressure all around the heel. Can also tape to do the same thing
Term
what if heel cup or tape doesn't get rid of piezogenic papule?
Definition
send to dermatologist/podiatrist
Term
how will a podiatrist treat piezogenic papules?
Definition
with steroid/anesthetic injection, since the steroid will destroy the fat pad
Term
what are common locations of piezogenic papules
Definition
heels, anterior leg, wrist
Term
in what population is acne mechanica common?
Definition
athletes
Term
what causes acne mechanica
Definition
friction, pressure, and heat form equipment that produce an entrapment of oils in oil glands. The gland becomes infected
Term
how to treat acne mechanica
Definition
wear underwear that wicks moisture, scrub with soap, apply topical agents
Term
what is an ingrown toenail
Definition
medial or lateral edge of nail grows down into skin producing irritation, bleeding, swelling
Term
how to treat ingrown toenail
Definition
rmeove the nail tha tis growing in the downward fashion, elevate the nail edge with cotton wool, and trim a "V" into center of nail to encourage central rather than lateral growth
Term
what causes blisters
Definition
friction.
Term
what is friction
Definition
coefficient of friction x normal force
Term
how to reduce friction
Definition
reduce the coefficient of friction or reduce the force
Term
what happens in a blister?
Definition
friction between epidermis and dermis separates epidermis from dermis. Gap fills in with fluid and sometimes blood.
Term
what causes the friction between the epidermis and dermis
Definition
friction between epidermis and outside
Term
how to treat blisters
Definition
drain with a steril needle, keep epidermis layer in place, cover with protective dressing
Term
how to prevent blisters
Definition
Spenco 2nd skin prophylactically, vaseline to decrease coefficient of friction, 2 layers of socks, protective gloves, socks that wick away moisture, and fix what is causing the friction!
Term
what might be the cause of friction
Definition
pronating too much? Otherwise creating exttra movment or slideing?
Term
what happens when you get a callus
Definition
it forms more callus
Term
why does callus beget callus?
Definition
the callus creates more pressure an dmore normal force. In the presence of friction, if you have more normal force you will produce more callus
Term
what exactly is a callus?
Definition
hyperkeratosis secondary to excessive friction
Term
what to think of when treating callus
Definition
what is causing the extra movement/friction?
Term
how to get rid of callus
Definition
soak and then use pumice stone, graters, scalpel to remove extra tissue; salicylic acid preparations
Term
what is pitted keratolyisis
Definition
fungal infection
Term
what does pitted keratolysis look like at first
Definition
little dried patches along the posterior rim of the heel
Term
what does pitted keratolysis look like over time
Definition
more dry, cracked, pitted, deeper lesions, green/brown discoloration
Term
what causes pitted keratolysis
Definition
moisture, heat
Term
what is the most common location for pitted keratolysis
Definition
heel of the foot
Term
how to treat pitted keratolysis
Definition
educate the patient, recommend that they go to podiatrist or dermatoligist
Term
how will a podiatrist treat pitted keratolysis
Definition
topical antibiotic, botox injection, antibacterial soap scrub, cotton socks or other absorbent material
Term
what is tinea pedis
Definition
athlete's foot
Term
what is athlete's foot
Definition
fungal infection
Term
where is athlete's foot often contracted
Definition
communal areas
Term
how to treat tinea pedis
Definition
keep area dry with powders, use topical anti-fungal agents
Term
what are plantar warts
Definition
viral infection
Term
how are plantar warts spread?
Definition
from other plantar warts: auto-infection or communal infection
Term
what does a plantar wart look like
Definition
a rough, raised circular lesion with surrouding smooth hard border that may have central discoloration
Term
how to know it's a plantar's wart and not a callus
Definition
plantar warts are more tender to pinching and less tender to pressure
Term
how to get rid of plantar wart
Definition
topical acid, cryotherapy, laser, surgical excision
Term
what causes hypertrophic/keloid scarring
Definition
individual differnces, racial influences, Langer's Lines
Term
how to prevent hypertrophic scarring
Definition
try taping initially, massage with cocoa butter, cortison injection, laser resurfacing
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