As the body’s largest organ, skin protects you from invasion by microorganisms and from losing necessary fluids and drying out. Along with touch, skin adheres to many other vital functions like regulating body temperature and allowing the exchange of warmth, air and fluids. Skin is on a 24/7 shift. In order to become a better clinician, you need to understand the skin and the changes it undergoes with aging. Critical thinking will come naturally with a greater understanding of the skin’s anatomy and the next thing you know, determining the type of wound and dressing selection will also become second nature.
Let’s start with a breakdown of the skin’s anatomy. The skin is composed of three layers including the epidermis, the dermis and the hypodermis.
This is the outermost layer of the skin that you can see and is responsible for the sensory nerves and contains melanocyte cells, which is what gives skin its unique colour. Varying in thickness, the epidermis is dependent of the dermis for nourishment and oxygen supply as it has no blood supply of its own. Composed of five layers, the inner most layer cells are pushed upwards and eventually the dead cells are cast off with every day activity, such as showering. This process of the skin takes approximately 25-28 days, although minor injuries such as sunburns and minor abrasions can affect this layer. In between the epidermis and the dermis is the basal membrane zone which has ridges that anchor the two layers together.
The second and thickest layer is the dermis and is responsible for temperature regulation, giving the epidermis nutrient-saturated blood, and containing specialized cells and structures. The dermis is held together by collagen, which is a durable, insoluble protein in connective tissue. It is synthesized by cells called fibroblasts which gives skin its strength and resilient powers. Finally, elastin is the other protein in the dermis that gives your skin bounce and flexibility. Partial-thickness wounds extend through the epidermis and into the dermis, where hair follicles and other appendages are still present. These wounds mostly heal through regeneration.
Lying right below the dermis as the innermost layer of the skin if the hypodermis. It is mainly composed of adipose and connective tissue with collagen and fat producing cells residing there. The hypodermis is responsible for absorbing shock and insulating your skin while acting a receptacle for storage in the form of fat which stores nutrients and energy.
Not only are there local and systematic barriers in wound management, there are also the imminent changes of aging skin. As bodies pass the sixth decade of life, the skin begins to experience delays in the wound healing process. There is a decrease in dermal thickness causing the skin to thin, collagen and elastin fibers, fatty layers creating less protection, the basal membrane zone changes in size and starts to flatten out, and the body experiences changes in circulation, sensation and metabolism.
So how does that information relate to managing our patients’ wounds? Having an understanding of the skin’s structure allows us to appreciate the importance of collaboration in care in wound management. As wound clinicians, we are dealing with barriers such as diabetes, effects of medications, nutrition, hydration, mobility, and on top of that, we must apply the skin changes as the body ages including delayed healing rates, less protection and circulation, and increased incidence for pressure injuries.
Managing the body’s largest organ makes us begin to realize that this job is too big to us to take on without the support of as many resources as we can take advantage of. That is why the Trust Robin Wound Care app was created, a precision surgical instrument that dials further into the finer details of wound care. After all, all wound care practitioners deserve easy access to reliable resources whenever they need it. Download the Trust Robin Wound Care app today and receive a FREE 30-day trial!