dr. Elida Ilyas, SpRM
INTRODUCTION Skin is a complex organ whose basic function is holocrine secretion for it self Being composed of epidermis and dermis Its 20.000 cm square of surface in an adult and its average thickness 2,5 cm Regulated decease produces the cornified layer and replace by mitosis of basal layer cells
Anatomy Skin consist of epidermis, dermis, subdermis Epidermis : consist 5 layers : 1. 2. 3. 4. 5. Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum germinativum/basal layer
Dermis : consist of : Major cellular type like fibroblast, histiocyles, chromaffin cell and mast cell Collagen, elastin and reticuler fiber Fibroblast will lay down this system of fibers in a matrix containing sulfated mucopoly sacharide
- Skin appendages are : Sweat glands Sebaceous glands M. erector pilorum Plexus capillary Free nerve ending
Skin function : Water retaining Body thermo regulation Protection the inside structure of the body Keeping out particulate foreign bodies Keeping out pathogen organs Keeping out chemical Keeping out radiation Letting in sunlight Letting in sensation Letting out heat
Self Replication : The epidermis cells are in the process of constant self replication There are being added from the basal layer by mitosis activity : and while being lost from the horny layer
Respons to injury Non penetrating trauma In the form of pressure that cause direct and indirect vascular reaction Direct response : vasocontriction vascular reaction manifest by white line effect Indirect response : alteration in capillary permeability manifest by erythematous effect
Non penetrating trauma with cell loss Stripping of the epidermal surface (excoriasis) Burst of mitosis activity in the basal layer Reconstitution of epidermal and stratum corneum (skin healing by replication)
Skin healing by : Replication occurs it the injury in the epidermal Substitution of scar tissue occurs if the epidermal structure are lost and injury penetrate into the dermis
Penetrating injury In the form of the incised skin wound The end of healing process is substitution of scan tissue
Wound healing process Consist : 1. Inflamatory respons phase 2. Fibroplastic repair phase 3. Maturation remodelling phase
1. Inflamatory respons phase Vascular reaction involve : Vascular constriction Blood coagulation Growth of fibrous tissue Chemical mediator Histamin release : vasodilatation and increation permeability swelling Leucotaxin release : supplying leucocytes to the injured area Necrosin release : responsible for phagocytic activity
Cellular respons : Leucocyt and phago cytic cells delivery to injury tissue, to dispose of injury by product (e.g damage cell, blood) through phagocytosis
2. Fibroblastic repair phase Fibroblastic periode : proliterative activity leading to scar formation Lack of oxygen stimulated growth of capillary called granulation tissue, that consist : fibroblast, collagen and capillary Fibroblastic cell begin to synthesize extra cellular matrix collagen fibers Collagen fibers tensile strength tensile strength fibroblast
3. Maturation remodelling phase This phase featuring remodelling of the collagen fiber that make up the scar tissue according to the tensile forces A firm, strong, contracted scar exist approximately 3 weeks
The role of therapeutic modalities in medical rehabilitation program to facilitate wound healing Modalities to facilitate wound healing Cold and superficial hot Ultra sound Laser Ultra violet light Electrical stimulation
Cold modalities/cryotherapie Produce vasocontriction, it is effective in reduce fluid filtration and reduce the potential for oedema develop Various type of cold modalities are : ice bag, cold packs, ice massage Used during the inflamatory phase
Heat modalities Induces vasodilatation ; provides : Increased blood supply Improved tissue oxygenation Stimulation of fibroblast Improved phagocytic activity Used during inflamatory and fibroblastic phase Various type of heat modalities are : Hot pack Infra red lamp Ultra sound Diatermis
Hydrotherapy Delivering superficial heat or cold to facilitate wound healing by immersing the affected limb in hydrotherapy tank filled warm or cold water Effect : Removes necrotic tissue Soften the eschar Chauging local circulation Reduction patient perception of pain Used during inflamatory phase
Ultra violet light Light of shorter wave length (180 250 nm) named ultra violet light C (UVC) is the type of ultra violet light most commonly used in facilitate wound healing Effect : Politeration cell Release chemical mediators Stimulated local blood flow Bacteri cidal effect for : Methicillen Resistant Staphylococus Aureus (MRSA) Vancomycin Resistant Entercocus Faecalis Reduce carcinogenic effect of UVA UVB Used during inflamatory phase
Laser Effect therapi : Leucoyte proliferatif Phagocytosis Increased collagen deposition Release inflamatory mediator (histamin) Using in inflamatory and fibroblast repair phase
Ultrasound Effect therapy : Stimulation phagocytic activity cells such as macrophay, neurtrophils Stimulating fibroblast Using in inflamatory and fibroblast repair phase
Electrostimulation Effect : Induce cell migration to the site of injury Release chemical mediators Induce inflamatory cell proliferative Reduce oedema Improved fibroblast and collagen deposition Activated epidermal cell Improved granulation tissue