1. Fundamentals of Anatomy & Physiology
Eleventh Edition
Chapter 5
The Integumentary System
Lecture Presentation by
Deborah A. Hutchinson
Seattle University
© 2018 Pearson Education, Inc.

2. © 2018 Pearson Education, Inc.

3. 5-9 Repair of the Integument
Repair of the integument following an injury
Bleeding, swelling, and pain occur
Mast cells trigger inflammatory response
A scab (dried blood clot) stabilizes and protects the area
Macrophages clean the area
Fibroblasts and endothelial cells divide, producing granulation tissue
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4. Figure 5–16 Repair of Injury to the Integument (Part 1 of 4).
Inflammation Phase
Bleeding occurs at the site
of injury immediately after
the injury, and mast cells
in the region trigger an
inflammatory response.
Epidermis
Dermis
Mast cells
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5. Figure 4–21 Inflammation and Regeneration (Part 3 of 5).
Inflammation produces several familiar indications of injury. These indications
are the so-called cardinal signs of inflammation: redness, heat (warmth), swelling,
pain, and sometimes loss of function. Inflammation may also result from the
presence of pathogens, such as harmful bacteria, within the tissues. The presence
of these pathogens constitutes an infection.
Increased Blood Flow
Increased Vessel Permeability
Pain
In response to the
released chemicals,
blood vessels dilate,
increasing blood flow
through the damaged
tissue.
Vessel dilation is accompanied by
an increase in the permeability of
the capillary walls. Plasma now
diffuses into the injured tissue, so
the area becomes swollen.
The abnormal conditions
within the tissue and the
chemicals released by
mast cells stimulate nerve
endings that produce the
sensation of pain.
PAIN
Increased Local
Temperature
Increased Oxygen
and Nutrients
Increased
Phagocytosis
Removal of Toxins
and Wastes
The increased
blood flow and
permeability
cause the tissue
to become warm
and red.
Vessel dilation,
increased blood
flow, and increased
vessel permeability
result in enhanced
delivery of oxygen
and nutrients.
Phagocytes in
the tissue are
activated, and
they begin
engulfing tissue
debris and
pathogens.
Enhanced circulation
carries away toxins and
wastes, distributing
them to the kidneys for
excretion, or to the liver
for inactivation. O2
Toxins
and wastes
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6. Figure 5–16 Repair of Injury to the Integument (Part 2 of 4).
Migration Phase
After several hours, a scab has formed
and cells of the stratum basale are
migrating along the edges of the
wound. Phagocytic cells are removing
debris, and more of these cells are
arriving with the enhanced circulation
in the area. Clotting around the edges of
the affected area partially isolates the
region.
Migrating
epithelial
cells
Macrophages
and fibroblasts
Granulation
tissue
© 2018 Pearson Education, Inc.

7. Figure 5–16 Repair of Injury to the Integument (Part 3 of 4).
Proliferation Phase
About a week after the injury, the
scab has been undermined by
epidermal cells migrating over the
collagen fiber meshwork produced
by fibroblast proliferation and
activity. Phagocytic activity around
the site has almost ended, and the
fibrin clot is dissolving.
Fibroblasts
© 2018 Pearson Education, Inc.

8. Figure 5–16 Repair of Injury to the Integument (Part 4 of 4).
Scarring Phase
After several weeks, the scab
has been shed, and the
epidermis is complete. A shallow
depression marks the injury site,
but fibroblasts in the dermis
continue to create scar tissue
that will gradually elevate the
overlying epidermis.
Scar
tissue
© 2018 Pearson Education, Inc.

9. 5-9 Repair of the Integument
Repair of the integument following an injury
Clot begins to dissolve
Number of capillaries declines
Non-cellular scar tissue is produced
A raised keloid may form
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10. Figure 5–17 A Keloid.
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12. Clinical Note 5-4 Burns and Grafts.
Partial-Thickness Burns
Full-Thickness Burns
Erythema
In a first-degree burn or partial-
thickness burn, only the surface of
the epidermis is damaged. In this
type of burn, which includes most
sunburns, the skin reddens and
can be painful. The redness, a sign
called erythema (er-i-THĒ-muh),
results from inflammation of the
sun-damaged tissues.
In a second-degree burn or partial-
thickness burn, the entire epidermis
and perhaps some of the dermis are
damaged. Hair follicles and glands are
usually not affected, but blistering, pain,
and swelling occur. If the blisters rupture,
infection can easily develop. Healing
typically takes one to two weeks, and
some scar tissue may form.
Third-degree burns, or full-thickness
burns, destroy the epidermis and dermis,
extending into the subcutaneous layer.
Despite swelling, these burns are less
painful than second-degree burns,
because sensory nerves are destroyed.
These burns cannot repair themselves,
because granulation tissue cannot form
and epithelial cells cannot cover the injury
site. Skin grafting is usually necessary.
© 2018 Pearson Education, Inc.

13. Clinical Note 5-4 Burns and Grafts (Part 1 of 4).
Partial-Thickness Burns
Erythema
In a first-degree burn or partial-
thickness burn, only the surface of
the epidermis is damaged. In this
type of burn, which includes most
sunburns, the skin reddens and
can be painful. The redness, a sign
called erythema (er-i-THĒ-muh),
results from inflammation of the
sun-damaged tissues.
© 2018 Pearson Education, Inc.

15. Superficial Partial Thickness

16. Clinical Note 5-4 Burns and Grafts (Part 2 of 4).
Partial-Thickness Burns
In a second-degree burn or partial-
thickness burn, the entire epidermis
and perhaps some of the dermis are
damaged. Hair follicles and glands
are usually not affected, but blistering,
pain, and swelling occur. If the blisters
rupture, infection can easily develop.
Healing typically takes one to two
weeks, and some scar tissue may form.
© 2018 Pearson Education, Inc.

18. Deep Partial Thickness

19. Clinical Note 5-4 Burns and Grafts (Part 3 of 4).
Full-Thickness Burns
Third-degree burns, or full-thickness burns,
destroy the epidermis and dermis, extending
into the subcutaneous layer. Despite swelling,
these burns are less painful than second-
degree burns, because sensory nerves are
destroyed. These burns cannot repair them-
selves, because granulation tissue cannot
form and epithelial cells cannot cover the
injury site. Skin grafting is usually necessary.
© 2018 Pearson Education, Inc.

21. Deep Full Thickness

22. Severity of Burn Injury
Superficial or First Degree – Epidermis – No Blisters
2. Partial Thickness or Second Degree – Deeper dermal layers – Blisters
3. Full Thickness or Third Degree – Full skin thickness – Charring
4. Full Thickness – Full thickness involving bones and muscles

23. What is the Rule of Nines?

24. Adult Rule of Nines
􀁺   Head and neck 9% 􀁺   Front torso 18% 􀁺   Back torso 18% 􀁺   Upper extremities 9% Each 􀁺   Lower extremities 18% Each 􀁺   Genitalia 1%
􀁺   Total 100%

25. Rule of Nines

26. Pediatric Rule of Nines
􀁺 Head and Neck 18% 􀁺 Front torso 18% 􀁺 Back torso 18% 􀁺 Upper Extremities 9% 􀁺 Lower Extremities13.5% each 􀁺 Genitalia 1%
􀁺 Total 100%