1. Dr. Rashmi Malhotra Associate Professor
Skin and Fascia
Dr. Rashmi Malhotra Associate Professor

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

3. Tissues of the body
The tissue: is a group of cells which perform a specific function
There are four basic tissues:
1.Epithelium
2.Connective tissue
3.Muscular tissue
4.Nervous tissue

4. Skin

5. IMPORTANCE OF SKIN Normal skin is a very complex organ
The skin is one of the largest organs of the body: 76oo sq cm

6. FUNCTIONS OF THE SKIN 1-Protection
continuous and covers the body as well as protects the deep tissues
 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+

7. 3-Sensation
 receptors for heat, cold, touch, pressure, vibration and pain
4- Thermoregulation
 thermo receptors and sweat glands
 hypothalamus controls cutaneous arteries and sweat glands to retain or dissipate heat

8. 5- Excretion
through the secretion of sweat.
6- Psychological and social functions
 appearance and social acceptance
 facial expression and nonverbal communication

11. Keratinized stratified squamous epithelium devoid of blood vessels
epidermis
Dermis
Connective tissue containing (bl. v. lymph v., sensory nerve endings, smooth m, hair follicles, sweat and sebaceous glands)
In its deep part the collagen bundles are arranged in parallel rows

12. The Epidermis

13. Cells of the Epidermis
Keratinocytes (90%)- waterproofs & protects skin, nails, hair, stratum corneum
Melanocytes (8%)- produce melanin
Merkel Cells- slow mechanoreceptors
Langerhans’ Cells- immunological defense

14. Layers of the Epidermis
Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale- (Germinativum)

15. Layers of the Epidermis

16. Epidermis Thickness is increased: Why?
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.

17. The Dermis
Dermis

18. Layers of the Dermis
papillary dermis
reticular dermis

19. Components of the Dermis
a. Cellular
Fibroblasts (synthesize collagen, elastin, and reticulin), histiocytes, endothelial cells, perivascular macrophages and dendritic cells, mast cells, smooth muscle, and cells of peripheral nerves
b. Fibrous
Collagen & reticulin - provide tensile strength
Elastic fibers- provide for restoration of shape after a deformation
c. Ground substance
glycosaminoglycans: hyaluronic acid, chondroitin sulfate, and dermatan sulfate.

20. The Hypodermis Hypodermis
This layer contains adipose tissue and serves to attach the dermis to its underlying tissues.

21. Lines of cleavage (langer’s lines):
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.

22. Lines of cleavage
These lines are important to determine the direction for an incision (cut) during a surgery to avoid obvious scars.

23. 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.

24. Skin creases Folded skin over the joints. Skin is thin and is
firmly adherent to
underlying structures.

25. Skin Color Some variations in human skin color
Sub-Saharan African, Indian, Southern European, Northwest European

26. Skin Color Due to Melanin, a pigment in the epidermis and Carotene,
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.

27. Skin Color Conditions
Cyanotic
Jaundice
Erythema
Pallor

28. Skin/Hair Color: Pigmentation
Pigmentation levels usually increase with age.
- exception: premature graying
Normal pigmentation may be altered by genetic defects or by acquired diseases.
-Hyperpigmentation- age spots
-Hypopigmentation- vitiligo,
albinism

29. Skin/Hair Color: Pigmentation
External agents can also alter skin color.
lightening agents
carotene
dyes
Some internal compounds--such as the byproducts of hemoglobin metabolism--may color the skin.
                            

30. SKIN IN ANAEMIA

33. CHICKEN POX

34. SKIN ERUPTIONS

35. ACNE

36. 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.

37. Ring worm

38. Skin Cancer Malignant melanoma 2% of all cancers Risks: Skin type
Sun exposure
Family history
Age
Immunological status
                            
Normal mole Melanoma
A= asymmetry
B= border
C= color
D= diameter

39. Skin Cancers

40. The appendages of the skin
Nails
Hairs
Sebaceous glands
Sweat glands

41. Nails
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

42. Hair
Cover whole surface of the body except some areas as lips, palms, soles, some genital areas

43. Hair
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.

44. Arrector Pilli muscle
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.

45. Arrector Pilli muscle Functions:
Its contraction causes the hair to move into a more vertical position.
It compresses the sebaceous gland and causes it to extrude sebum.

46. Sebaceous glands 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.

47. Sebaceous cyst
It occurs because of the obstruction (blocking) of the sebaceous duct.

48. Sweat glands 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.

49. Skin burns Superficial Deep Heals rapidly from the edges,.
Heals quickly.
Doesn’t need a skin graft.
Heals slowly from the edges.
Usually needs skin grafting.

50. Burns What to Do: Seek Medical Help Immediately If:
You think your child has a second- or third-degree burn.
The burned area is large, even if it seems like a minor burn. For any burn that appears to cover more than 15% to 20% of the body, call for medical assistance. And don't use wet compresses because they can cause the child's body temperature to drop. Instead, cover the area with a clean, soft cloth or towel.
The burn comes from a fire, an electrical wire or socket, or chemicals.
The burn is on the face, scalp, hands, joint surfaces, or genitals.
The burn looks infected (with swelling, pus, increasing redness, or red streaking of the skin near the wound).
For First-Degree Burns:
Remove clothing from the burned area immediately.
Run cool (not cold) water over the burned area (if water isn't available, any cold, drinkable fluid can be used) or hold a clean, cold compress on the burn until pain subsides (do not use ice, as it may cause the burn to take longer to heal).
Do not apply butter, grease, powder, or any other remedies to the burn, as these increase the risk of infection.
If the burned area is small, loosely cover it with a sterile gauze pad or bandage.
Give your child acetaminophen or ibuprofen for pain.
If the area affected is small (the size of a quarter or smaller), keep the area clean and continue to use cool compresses and a loose dressing over the next 24 hours. You can also apply antibiotic cream two to three times a day, although this isn't absolutely necessary.
For Second- and Third-Degree Burns:
Seek emergency medical care, then follow these steps until medical personnel arrive:
Keep your child lying down with the burned area elevated.
Follow the instructions for first-degree burns.
Remove all jewelry and clothing from around the burn (in case there's any swelling after the injury), except for clothing that's stuck to the skin. If you're having difficulty removing clothing, you may need to cut it off or wait until medical assistance arrives.
Do not break any blisters.
Put wet, sterile bandages on the burned area until help arrives.

51. Clinical notes Graft is transferring tissue from one site to another.
Skin graft is needed when the skin is damaged ( usually by deep burning )

52. Split thickness grafting Full thickness grafting
Clinical notes
Skin Graft
Split thickness grafting
Full thickness grafting
Transferring both epidermis and dermis.
Transferring epidermis only

53. Fascia

54. Collection of connective tissue
Fascia
Collection of connective tissue
Superficial fascia
Deep fascia

55. Superficial fascia

56. Deep Fascia

57. Superficial fascia Superficial fascia: Functions:
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 (devoid of adipose tissue).
Functions:
Facilitates movement of skin over underlying structures.
Passage for cutaneous vessels, nerves.
Protects the body against heat loss.

58. Superficial fascia

59. Deep fascia It is more dense than superficial fascia
Collagenous bundles are more compact and more regularly arranged
It is usually present in the form of membranes

60. Examples of deep fascia
Intermuscular septa
lie between muscles dividing the limb into compartments

61. Examples of deep fascia
B. Investing fascia
Covers the surfaces of muscles
In the neck: it forms well-defined layers, bounds fascial spaces so limits spread of infection or determine the path of infection
In the abdomen: it is thin
In the limbs: forms a definite sheath around the muscles

63. Examples of deep fascia
C. Retinacula
Localized thickening of deep fascia around joints, hold the tendons in place, prevent bowstringing of tendons

64. Thank you