SKIN

INTRODUCTION
 The skin is an extensive organ which forms the outer covering of

the body. It is continuous with mucous membrane lining the body

orifices.
The skin has two layers :
 A superficial layer-the epidermis made up of stratified squamous

epithelium; and
 A deeper layer-the dermis made up of connective tissue. The

junction between these two layers is markedly wavy because of

the presence of finger-like extensions from the dermis-the dermal
papillae.
 The downward projections of epidermis (in the intervals between

the dermal papillae) are called epidermal papillae

CHARACTERISTIC FEATURES:
 Skin weight: approximate – 2kgm in an adult & skin bloof flow

depends on :
 The requirements for the maintenance of body temprerature

(mainly) &
 Metablic activity of the skin itself

 The comfortable environmental temperature of approximate –

27c
STRUCTURE OF SKIN
Epidermis
 Epidermis consists of stratified squamous keratinizing

epithelium. There are five layers. From deep to superficial, these

are as follows
 Stratum basale

 Stratum strtum spinosum

 Stratum grnulosum

 Stratum lucidum

 Stratum corneum
1.Stratum Basale
 It is the deepest basal layer of epidermis.

 It is made up of a single layer of columnar cells that rest on a basal

lamina.
 These cells undergo mitotic divisions and give off cells called

keratinocytes, which form the more superficial layers of the

epidermis.
 The basal layer is, therefore, also known as the germinal layer of

stratum germinativum.
2.Stratum Spinosum
 It consists of several layers of polygonal keratinocytes.

 These cells appear to have a number of "spines".

 That is why this layer is called stratum spinosum.

3.Stratum Granulosum

 It consists of 1-5 layers of flattened cells, containing deeply

staining granules in their cytoplasm.

 The granules consist of a protein called keratohyalin.

4.Stratum Lucidum

 This layer appears clear, homogenous, with distinct cell

boundaries
5.Stratum Corneum
 It is the most superficial layer of the epidermis.

 The cells or corneocytes are dead. These have lost their nuclei

and organelles.
 These cells are extremely flattened. These are scale-like

(squames).
 These cells contain keratin.

 They are held together by a layer of lipid, which makes the layer

"waterproof"
Dermis

 This layer is made up of connective tissue.

 There are capillary loops, tactile corpuscles, collagen fibers,

elastic fibers, adipose tissue and plexuses of nerve fibers in the
dermis.
TYPES OF SKIN
There are two types of skin:

Thick or glabrous skin :

 Epidermis is very thick with a thick layer of stratum corneum.

 It is found in palms of hands and soles of feet and has no hair.

Thin or hiry skin:

 The epidermis is very thin.

 It contains hair & is found in ll other parts o body except palms & soles.
BLOOD SUPPLY:
 Skin is highly organ.

 It derives its arterial blood from number o plexuses.

 One plexus o arteries is present over the deep fascia, another plexus

just below the dermis is called reticular plexus; the papillary plexus
lies just below the dermal papilla.
 Capillary loops arising from this plexus pass in to each dermal

papilla.
 The epidermis has no blood supply.

 It derives its nutrition entirely by diffusion from the capillary loops

of the dermal papillae.

 There are numerous arteriovenous anastomoses in the skin, which

have an important role in temperature regulation.

NERVE SUPPLY
 The skin is richly supplied with sensory nerves.

 Dense networks of nerve fibers are seen in the superficial parts of the

dermis.
 Sensory nerves end in relation to various types of specialized terminals like

free nerve endings, Meissner's corpuscles, Pacinian corpuscles and

Ruffini's corpuscles.
 In contrast to blood vessels, some nerve fibers do penetrate into the deeper

parts of the epidermis.

 Apart from sensory nerves, the skin receives autonomic nerves that supply

smooth muscle in the walls of blood vessels; the arrector pilorum muscles,
and myoepithelial cells present in relation to sweat glands.
 They also provide a secretomotor supply to sweat glands. In some regions

(nipple, scrotum), nerve fibers innervate smooth muscle present in the

dermis.
FUNCTIONS OF SKIN
1. Protection:
 It forms an anatomical barrier between external environment

and internal structures of the human body. Langerhans cells

present in the skin are antigen presenting cells.
2.Sensory:
 Nerve endings are present in the skin which help to differentiate

between hot and cold substances and help in perceiving the

sensations of touch, pressure and vibrations.
3. Heat regulation:

 If the body heat is more, then blood vessels present in the dermis
dilate and the heat is lost from the body. On the other hand, if
body needs to conserve heat as in cold weather, the blood vessels
in the dermis constrict so that heat is conserved by the body.

4. Control of evaporation:

 Skin provides an impermeable surface so that water is neither lost

nor imbibed by the body.
5. Storage and synthesis:

 It stores lipids and water and by the action of ultraviolet rays

(present in the sunlight) helps in the synthesis of vitamin D.

6. Excretion:

 It helps in the excretion of urea although amounting to only

1/130th of that of urine.
7. Absorption:
 Oxygen, nitrogen, carbon dioxide can diffuse through epidermis

in small amount. Some medicines can be administered through

skin as they are easily absorbed by this route.
8. Preservation of essential nutrients:
 Skin acts as a barrier to water evaporation from the body so that

essential nutrients are not washed out of the body.

APPENDAGES OF SKIN

They are as follows:

 Hair

 Sebaceous glands

 Sweat glands

 Nails
HAIR
 Hair are present on the skin covering almost all parts of the at

body.
 The sites where hairs are absent are palms, soles, sides of the

fingers and some parts of the external genitalia.

 The length, texture and distribution of hairs are different A in

males and females.

Parts of Hair
 Each hair consists of a part (of variable length) that is seen on the surface

of the body; and a part anchored in the thickness ofthe skin.

 The visible part is called the shaft, and the embedded part is called the root.

 The root has an expanded lower end called the bulb.

 The bulb is in vaginated from below by part of the dermis that constitutes

the hair papilla.

 The root of each hair is surrounded by a tubular sheath called the hair

follicle
 The follicle is made up of several layers of cells that are derived from the

layers of the skin.

 Hair roots are always attached to skin obliquely.

 As a result, the emerging hair is also oblique and easily lies flat on the skin

surface.
Arrector Pili Muscle

 These are bands of smooth mucles, attached at one end to the

dermis, just below the dermal papilla; and, at the other end, to
the hair follicle.

 A sebaceous gland lies in the angle between the hair follicle and
the arrector pili muscle.
Contractionen the muscle has two effects:
 The hair follicle becomes vertical from its original oblique

position; "the hair stands on end.

 The skin surface overlying the attachment of the muscle

becomes depressed;
 the surrounding area is raised. So, the skin has the appearance

of "goose flesh"
 The sebaceous gland, lying between the muscle and the hair

follicle is squeezed; so, its secretions are squeezed out into the
hair follicle.
SEBACEOUS GLANDS
 They are seen in relation to the hair follicles.

 Each gland consists of a number of alveoli, that are connected

to a duct .
 This duct opens into the hair follicle. As mentioned earlier, the

sebaceous gland is situated between the hair follicle and the

arrector pili muscle.
 When the muscle contracts, it squeezes the gland, which

facilitates the discharge of its secretions into the hair follicle.

 The secretion of sebaceous glands is called "sebum"
Functions of Sebum:

 → Its oily nature helps to keep the skin and hair soft.

 → It prevents drying of skin. It makes the skin resistant to

moisture.
SWEAT GLANDS

Sweat glands produce sweat or perspiration. There are two types of

sweat glands in the body:

1. Typical

2. Atypical
Typical Sweat Glands
 A typical sweat gland consists of a single long tube.

 The lower end of the tube is highly coiled forming the "body" of the

gland .
 It usually lies in the reticular layer of the dermis.

 The part of the tube, connecting the "body" to the skin surface is the

"duct".
 Within the epidermis, it has a spiral course.

 The duct is lined by a single layer of cuboidal epithelium.

 Sweat glands are innervated by cholinergic nerves.

 Secretion of the glands (sweat) has a high water content. Evaporation of

sweat causes cooling of the body. The number and size of the sweat
glands vary in different parts of the body. The palm and soles have the
largest number of sweat glands
Atypical Sweat Glands

 Atypical sweat glands are found in the following regions

 Axilla

 Nipple and areola

 Perianal region

 Glans penis

 Some parts of female external genitalia.

Modified Sweat Glands

 Ceraminous glands of external auditory meatus

 Ciliary glands of eyelids

 Mammary glands
NAILS
 They are solid plates of modified horny cells.

 They form a protective covering on the dorsal surface of fingers and

toes.
Parts of a Nail
 The main part of a nail is called its body. It has a free distal edge.

 The proximal part of the nail is implanted into a groove on the skin-this

is the root of the nail.

 The tissue on which the nail rests is the nail bed. It is highly vascular;

that is why the nail appears pink in color.

 The main function of nails is to provide a firm support for the finger tips.

 This support increases the sensitivity of the fingertips and increases their

efficiency in carrying out delicate functions.

RECEPTORS OF SKIN
Definition
 The peripheral ends of afferent fibers are responsible for receiving

various stimuli and are called receptors.

Cutaneous Receptors or Exteroceptive Receptors
 Cutaneous receptors are concerned with touch, pain, temperature

and pressure. These are also called exteroceptive receptors or

externceptors,
Free nerve endings:
 When terminals of sensory nerves do not show any

specialization of structure, they are called free nerve endings

These types of nerve endings are numerous in relation to hair
follicles. They respond mainly to the deformation of hair.
Tactile corpuscles of Meissner:
 These are small oval or cylindrical structures seen in relation to

dermal papillae in the hand and foot. They are receptors of

touch.
Lamellated corpuscles of Pacini:

 They are large receptors, found in the subcutaneous tissue of

palm, sole and digits. They respond to vibration and pressure.

Tactile menisci or Merkel cell endings:

 These are small disc-like structures seen in relation to

specialized epithelial cells or Merkel cells present in the stratum
spinosum of the epidermis. They are sensitive to pressure.
TEMPERATURE REGULATION

 Man as well as other mammals are said to be homeothermic, their

body temperature will not vary according to the environment.
 The thermoregulatory mechanism helps to keep the body

temperature within a narrow range.

SOURCES OF BODY HEAT
 Heat gain by the body occurs during rest as well as during physical

activities.
 At rest, heat is produced by various metabolic reactions occurring in

our body, including digestion.

 The internal muscular activities like pumping generate heat.

 Also, heat is gained from the environment by radiation and

conduction.
 Brown fat is present in infants, which is an important source of heat

production.
 Brown fat has very high metabolic rate and is located between and

around the scapulae and neck, behind the sternum and around the
kidneys.
CHANNELS OF HEAT LOSS

 Heat is lost from the body through skin by conduction,

convection, radiation and evaporation.

 Heat is also lost through urine, feces and the respiratory tract.
MECHANISMS ACTIVATED BY HEAT
 Heat gain by the body activates the anterior hypothalamus

which causes the following:

Cutaneous vasodilatation:
 By this process, the core heat is brought to the skin surface so

that it can be lost to the surroundings by conduction, convection

and radiation.
Sweating:
 This is the only mechanism of heat loss when a person is

exposed to the environmental temperature greater than the

body temperature.
Anorexia:
 Anorexia or loss of appetite results in decreased food intake and

decreased metabolic reactions, thus causing decreased heat

production.
Behavioral responses:
 This includes moving to a shade or cooler place and decreased

muscular activities. All these decrease the body temperature.

Panting:
 This is seen in certain animals like dogs and not in humans.

Panting means rapid shallow breathing. This can cause

increased evaporation through the mouth and respiratory
passages,
MECHANISMS ACTIVATED BY COLD

Exposure to cold can reduce the body temperature, which

activates the following mechanisms to occur:

 Mechanisms for heat conservation

 Mechanisms for heat production.

Mechanisms for heat conservation
Cutaneous vasoconstriction:
 Activation of posterior hypothalamus increases the sympathetic

discharge, when the body is exposed to a cold atmosphere.

 This can cause marked vasoconstriction of the cutaneous blood

vessels throughout the body, thus decreasing the cutaneous blood

flow.
 As a result, heat loss from the core of the body to the cold

environment is prevented.
Piloerection:
 Cold can induce contraction of erector pili (which is a cutaneous

muscle). The body hairs stand up forming an additional

insulating layer to conserve heat ("Goose Flesh").
Mechanisms for heat production
Shivering:
 Shivering is due to increased discharge from the anterior horn cells

of spinal cord, causing increased muscle tone throughout the body.

This occurs when the cutaneous vasodilatation becomes
insufficient to conserve heat. Shivering can increase the heat
production by 4-5 folds.
Increased catecholamine secretion:
 Cold stimulates secretion of catecholamines (epinephrine and

norepi- nephrine), which may induce chemical thermogenesis, by

increasing the rate of cellular metabolism.
 This can increase the heat production by 10-15%. The heat

production is doubled by this mechanism in infants.

Increased secretion of thyroxine:
 Continuous exposure to severe cold can increase the secretion of

thyroid stimulating hormone (TSH), which can cause hyperplasia

of thyroid gland.
Heat production by the brown fat:
 This occurs in infants in whom shivering does not occur.

Increased metabolism of brown fat in infants causes increased

heat production and this is called non shivering thermogenesis.
NURSING IMPLICATIONS:
Protection from UV radiations:
 The cells of the basal layer and stratum spinosum contain a brown pigment

called melanin. This pigment protects the underlying tissues from the harmful
effects of UV light.
 It forms an important sensory organ.

 Skin has an important role in temperature regulation; there are 2 mechanisms:

(1) By controlling the blood flow and (2) by the production of sweat.
 Storage of water and fat.

 Formation of vitamin D.

 Medicolegal importance: Cells of stratum basale are actively dividing cells.

This is of tremendous importance in forensic medicine. The cells clinging to

the fallen hairs of the criminal or the victim can be used for karyotyping and
isolation of DNA.
Absorption of molecules:

 This is useful in the administration of certain drugs, eg – nitroglycerin, in angina, anti

inflammatory

Color of Skin

Examination an important part of general examination.

 The color of skin is influenced by the amount of melanin presion.

 It is also influenced by some other pigments present in the epidermis; and by pigments
hemoglobin and oxyhemoglobin present in blood circulating through the skin.

 The epidermis is sufficiently translucent for the color of blood to show through, especially in
light-skinned individuals. That is why the skin becomes pale in anemia; blue when oxygenation of
blood is insufficient; pink while blushing and yellow in jaundice.
TERMINOLOGIES
Acne:
 An inflammatory condition of sebaceous glands. Acne is affected by gonadal

hormones and is therefore most common during puberty and adolescence. Pimples
and blackheads on the face, chest, or back are expressions of this condition.
Alopecia
 Loss of hair, baldness. Baldness is accompany old age. It is influenced by usually

due to genetic factors and may improper diet and poor circulation of blood.
Athlete's foot (Tinea pedis)
 A fungus disease of the skin of the foot.

Blister
 A collection of fluid between the epidermis and dermis, caused by excessive

friction or a burn.
Boil
 A localized bacterial infection originating in a hair follicle or skin gland; also termed

a furuncle.
Burns
 A lesion of the integument caused by heat, chemicals, electricity, or solkinpesund Classified I as

first degree (redness or hyperemia in superficial layers of degree (blisters involving deeper
epidermal layers and dermis), or third degree (destruction of areas the integument damage to
underlying tissue).
Callus
 A localized buildup of the stratum corneum on the palm or sole due to excessive friction.

Carbuncle
 Similar to a boil, except involving subcutaneous tissues.

Corn
 A localized buildup of the stratum corneum on the dorsal surface of the foot due to excessive

friction.


Dandruff
 Common dandruff is the continual shedding of epidermal cells of the scalp; it can be controlled by

normal washing and brushing of the hair. Abnormal dandruff may be due to certain skin diseases,
such as seborrhea and psoriasis.
Decubitus ulcer
 A bedsore, or exposed ulcer from continual pressure on a localized portion

of the skin, restricting the blood supply.

Dermatitis
 An inflammation of the skin.

Eczema
 A noncontagious inflammatory condition of the skin marked by red, itching,

vascular lesions that may be crusty or scaly.

Gangrene
 Necrosis (death) of tissue due to obstruction of blood flow; may be

localized or extensive, and perhaps secondarily infected with anaerobic

microorganisms.
Melanoma
 A cancerous tumor of the melanocytes within the epidermis.
Nevus
 A mole or birthmark; congenital pigmentation of a certain area of the skin.

Psoriasis
 Inflammatory skin disease, usually expressed as circular scaly patches of skin.

Pustule
 A small, localized elevation of the skin containing pus.

Seborrhea
 A disease characterized by excessive activity of sebaceous glands and accompanied

by oily skin and dandruff.

Shingles (Herpes zoster)
 A viral infection characterized by clusters of blisters along certain nerve tracts

(dermatomes).
Urticaria (hives)
 A skin eruption consisting of reddish, itchy wheals; may arise from an allergic

reaction or stress.
Wart
 A roughened projection of epidermal cells; caused by a virus.

Erythema:
 redness of the skin caused by dilation of the capillaries due to injury,

irritation, inflammation, or various skin conditions

Hirsutism: the condition of having excessive hair growth
Hyperpigmentation: increase in the melanin of the skin, resulting in an
increase in pigmentation
Hypopigmentation: decrease in the melanin of the skin, resulting in a loss of
pigmentation
Keratin:
 an insoluble, fibrous protein that forms the outer skin layer keratinocytes:

arising from the innermost layer of the epidermis, synthesize the insoluble
protein, keratin
Langerhans cells:
 dendritic clear cells in the epidermis that carry surface receptors for

immunoglobulin and complement and that are active participants in

delayed hypersensitivity of the skin
Melanin: the substance responsible for coloration of the skin
Melanocytes: cells of the skin that produce melanin
Merkel cells: cells of the epidermis that play a role in transmission of
sensory messages
Petechiae: pinpoint red spots that appear on the skin as a result of blood
leakage into the skin
Rete ridges:
 undulations and furrows that appear at the lower edge of the epidermis at

the dermal junction where these two skin layers are cemented together
Sebaceous glands: glands that exist within the epidermis and secrete
Sebum to keep the skin soft and pliable sebum: fatty secretion of the
sebaceous glands
Telangiectasias: venous stars; red marks on the skin caused by
distention of the superficial blood vessels
Vitiligo:
 a localized or widespread condition characterized by destruction of

the melanocytes in circumscribed areas of the skin, resulting in

white patches
Wood light: ultraviolet light used for diagnosing skin conditions

HISTORY COLLECTION
INTRODUCTION:
A complete health history assists in the diagnosis of integumentary
disorders, such as occupationally related contact dermatitis, or in
revealing psychosocial aspects of skin disorders. The medication
history is important because side effects of certain medications
can cause skin changes. The physical examination can confirm
integumentary disorders as well as disclose disorders that the
client may have omitted during the history.
HISTORY
The history includes questions about the
 Chief complaint and current manifestations,
 A review of systems, past health history,
 Past surgical history,
 Allergies,
 Medications,
 Psychosocial history, and
 Family health history.
 Current health
Chief Complaint
 The most common problems related to the integumentry

system are
 Itching (pruritus),
 Dryness,
 Rashes,
 lesions,
 Ecchymoses (small hemorrhagic patches),
 lumps,
 Masses, and
 Cosmetic appearance.
Clinical Manifestations
The assessment information for clinical manifestations specific to
skin complaints.
Pruritus.
 Persistent itching or pruritus is a manifestation that frequently

 The itching is associated with skin lesions and whether it

is localized or generalized.
 Persistent itching without associated lesions could
suggest significant systemic disease such as biliary obstruction,
diabetes mellitus, uremia, lymphoma, or hyperthyroidism.
 If pruritus is associated with skin lesions, consider
scabies, many types of dermatitis, psoriasis, xerosis, and
dermatophytosis in the diagnostic process.
Lesions.
• To assessing any lesion, it is important to inquire about the
time the lesion has been present, any color changes, any exudate,
and any other changes that have occurred.
 • The lesion may have been altered because of scratching,
trauma, or infection and scarring.
 • It is also necessary to establish if the Infection. Skin
infections will prompt clients to seek fur there evaluation,
especially if there is a history of failure at attempts at self-
treatment.
 • As any infection, establish if there has been fever, chills,
the amount and type of exudate, and the presence of pain at the
suspected site of infection.
Review of Systems
To Obtain a complete history of the skin. Specifically, ask about
past problems with unusual
 Itching,

 Dryness,

 Lesions,
 rashes,
 Lumps,
 Ecchymoses, and
 Masses.
Past Medical History
 A recent acute or unresolved Streptococcus infection
might explain diffuse hair loss or an unresolved rash.
 Ask about childhood diseases, and find out about the
vaccination status.
 Various systemic diseases are characterized by
cutaneous manifestations.
Surgical History
 To evaluating previous trauma, procedure sites, and surgical

interventions may explain unusual lesions and/or scars or their

location.
Allergies
 An allergy is an immunologic response that happens
consistently with exposure.
 Irritation can occur unpredictably. Inquire about
substances that may cause local skin irritation or lesions on direct
contact, such as textiles or metals.
 Wool is irritating to most people.
 Jewelry that contains nickel can cause skin discoloration,
irritation, rash, or other problems in people who are sensitive to
this metal.
 Ask the client about allergies to medications, foods,
inhalants, latex, and other chemicals.
 The ingestion of certain foods cause itching, burning, or
eruption of rashes.

Medications
 The most common type of allergic drug reactions is cutaneous.

 Most of these skin reactions are morbilliform (measles-like rash)

or maculopapular without blistering or pustulation.
 These eruptions can be caused by many drugs, including
penicillins, sulfonamides, nevirapine, and antiseizure medications.
 Photosensitizing drugs (phenothiazines, tetracycline, diuretics,
sulfona- Sc mides) may cause a sunburn-like rash in areas of sun
exposure.
 Topical preparations may include preservatives or active
ingredients that are known sensitizers that frequently produce an
eczematous rash.

Dietary Habits
 supplemental nutrition, such as megavitamins taken orally,

continue to be causes of concern especially with fat-soluble

vitamins.
 one associated with water and fluid intake for the correlation to

xerosis or dry skin conditions. One needs to have almost clinical

dehydra tion before turgor changes become apparent on clinical
examination.
 And while good routine intake of water is a healthy practice for

the genitourinary and other says there is no scientific evidence

that it plays a role in routine hydration of the skin.
 Suspected food allergy can play a role in specific dermatologic

conditions such as atopic dermatitis and urticaria.

Social History
 Occupational history is important because a large number of skin
problems are caused or worsened by exposure to irritants and chemicals in
the home and work environment.

 The travel history can be helpful as well, especially if it includes hiking or

exposure to out- door agents that result in dermatologic disorders, such as
poison ivy, poison sumac, poison oak, or Lyme disease.

 Ask about recent exposure to ticks, other insects, or infections.

Family Health History
 A personal or family health history helps to determine
genetic predisposition to skin disorders as well as a
predisposition to parasitic or other conditions related to the
family's lifestyle and living environment.
 Many dermatologic disorders or systemic disorders with a
dermatologic presentation have a genetic or familial component.
 Genetically transmitted dermatologic conditions include alopecia

(loss of patches of hair), ichthyosis (thickened, scaly skin), atopic

dermatitis, and psoriasis.
 Systemic diseases with dermatologic manifestations include

diabetes mellitus, blood dyscrasia, and collagen-vascular diseases

(lupus erythematosus).
PHYSICAL
EXAMINATION
STRUCTURE NORMAL FINDINGS ABNORMAL FINDINGS

HAIR & SCALP

INSPECTION: Dandruff, scaling, scalp

Hair evenly distributed over lesions, hirsutism
the scalp.
PALPATION
Distribution Hair distributed evenly Hair dry & brittle, alopecia
Thickness ( baldness)
Texture Hair non- oily, resilient,
Lubrication scalp smooth, intact, non-
tender
SCALP:

INSPECTION:
No lesions, excoriations, Present lesions,
lumps absent excoriations, lumps
PALPATION:
STRUCTURE NORMAL FINDINGS ABNORMAL FINDINGS

NAILS Colorless, convex Anemia,hypoxia,

shape clubbing
INSPECTION: Pink color- white client
Darker- dark skinned
Colour & Shape client
Pallor- Anemia
Cyanosis-decreased
ccirculation
Dryness, brittleness,
Texture Smooth, healthy nails peeling, splitting,
& uniform thickness clubbing of nails
Integrity (>160
No inflammation, degree),hypoxia
dryness
Paranychia (nail fold
Thickness infection)

No calluses, corns
calluses, corns present
STRUCTURE NORMAL FINDINGS ABNORMAL FINDINGS

SKIN: Even skin tone, Pallor, cyanosis,

darker on exposed jaundice,
INSPECTION: areas of face, neck, hyperpigmantaion,
arms, lower legs,
Colour lighter on turnk &
back.
Moist, cool& clammy,
Moisture overly dry, scaling,
Healthy, well cracked.
hydrated,
Temperature: Hypothermia &
hyperthermia
Palpation

Texture Uniformly warm

Lumps or unusual
thickening or thinning
Turgor (atrophy)
Smooth, soft,&
resilient
STRUCTURE NORMAL FINDINGS ABNORMAL FINDINGS

Pinched up Normal turgor, elastic Tended

{3 sec normal} {skin elevated- >3
Lightly pinch the skin sec }
over the forearm Decrease with age as
between thumb& the elasticity
index finger, & the
release it.
No edema Edema, tenderness,
Edema

Free of pungent odors Odor present in

Odor: inadequate hygiene
or infection &
drainage
Lesions

No lesions Purpura, petechiae,

Inspection ecchymosis
DANGER SIGNALS FOR ABCDES OF MELANOMA:
DIGNOSTIC
STUDIES
NAME OF THE TEST PURPOSE NURSES
RESPONSIBILITY

1.Biopsy A punch biopsy is done to Apply dressing and

differentiate benign lesions provide information
from skin cancers. about self-care and
An instrument is used to when to return suture
remove a small section of removal
dermis and subcutaneous
fat.
Depending on size, the
incision may be sutured with
a single suture.
An incisional biopsy is
done to differentiate benign
lesions from skin cancers.
An incision is made and
the skin lesion or tumor is
removed for analysis. The
incision is closed with
sutures.
NAME OF THE TEST PURPOSE NURSES
RESPONSIBILITY
2.Culture A culture of scrapings from a Obtain the culture with a
lesion, from drainage, or of sterile C swab and culture
exudate is done to identify tubes. Maintain strict asepsis
fungal, bacterial, or viral skin while obtaining the culture,
infections.

Immunofluorescent studies
of samples from skin and/or No special preparation
3.Immunofluorescent Slides serum may be done to is necessary.
identify IgG antibodies
(present in pemphigus
vulgaris) and to identify
varicella in skin cells (for
herpes zoster). Skin or blood
samples are placed on a slide
and examined
microscopically.
NAME OF THE TEST PURPOSE NURSES
RESPONSIBILITY
4. Oil Slides Oil slides are used to
determine the type of No special preparation
skin infestation is necessary.
present. Scrapings of
the lesion are placed
on a slide with mineral
oil and examined
microscopically.
• determine a specific
5. Patch Test, Scratch allergen.
Test • In a patch test, a small Explain to the patient
amount of the suspected the need to return in
material is placed on the 48 hours to have the
skin under an occlusive patched or scratched
bandage.In a scratch test, areas evaluated.
a needle is used to
"scratch" small amounts
of potentially allergic
materials on the skin
surface.
NAME OF THE TEST PURPOSE NURSES
RESPONSIBILITY

6.Potassium Hydroxide  A specimen from hair or No special preparation is

(KOH) nails is examined for a necessary.
fungal infection.

 The specimen is
obtained by placing
material from a scraping
on a slide, adding a
potassium hydroxide
solution, and examining
it microscopically.
NAME OF THE TEST PURPOSE NURSES
RESPONSIBILITY
7.Tzanck Smear •This test is used to •Explain to the
diagnose herpes patient the need to
infections, but it does col lect fluid and cells
not differentiate from an open vesicle.
herpes simplex from Minor discomfort can
herpes zoster. occur during the
•Fluid and cells from incision to open the
the vesicles are vesicle.
obtained, put on a
slide, stained, and
examined
microscopically.
8.Wood's Lamp Explain to the patient
•This test uses an that the room is
ultraviolet light that darkened to allow
causes certain visualization of
organisms to fluorescence.
fluoresce (such as
Pseudomonas
organisms and fungi).
•The skin is examined
RECONSTRUCTIVE AND
COSMETIC SURGERY
RECONSTRUCTIVE SURGERY

 Reconstructive surgery is a branch of surgery that deals with the correction,

restoration & improvement in shape and appearance of body structures that
are defective, damaged, misshapen by injury diseases or growth.

 It is performed to correct function, but in some cases may be used to

generate a more normal appearance.

 Common procedures include tumor removal, facial reconstruction, hand

repair, breast reduction and breast reconstruction (after a mastectomy).
Plastic surgery
 It is defined as any procedure used to correct or restore either

form or function to a body part.

 It deals with body modification and reconstructive surgery as

well as surgery for esthetically pleasing purposes.

 Body reconstruction surgery was done as early as 2000 Before

Christ (BC) by the famous Indian surgeon, Sushruta.

 Nose and ear reconstruction were the first procedures done.
Skin grafting:

 A skin graft is the replacement of a patient's skin.

 It is required after major skin loss from a burn, major trauma or

infection. Generally, plastic surgeons are called in to do skin
grafts.

 They plan their cut lines on the patients and of ski close and
remove sutures or staples in a particular sequence in order to
minimize scarring.
Thickness of skin grafts:
 Epidermal skin graft; thickness is 0.15 to 0.25 mm, with

papillary layer of the epidermis and some dermis. Easily

survive, but less quality
 Intermediate split thickness skin graft; thickness is 0.3 to 0.75

mm, with epidermis and 1/3 to ½ of the dermis. Full thick skin
graft; more than 0.75 mm is best quality.
Skin graft:
Ways of skin grafting:
(i) Whole sheet skin grafting;
(ii) Mesh grafting;
(iii) Stamp grafting
Skin flap transplantation treatment of IV° burns:
 • Flap with blood supply from the skin and subcutaneous tissue.

 Suitable for repairing severe skin defects with exposed blood

vessels, tendons, nerves, blood vessels of the depth wound.

 • Flaps can repair the wound with good function and appearance
Light Emitted Diode (LED)
 The burns treated with LED showed higher epithelization, with

keratinocytes and fibroblasts proliferation, increased collagen

synthesis, decreased pain, and pruritus.
 there was a faster clinical improvement in the irradiated limbs.

Systemic red light therapy was effective to promote wound

healing of deep-thickness burn wounds and other similar acute
wounds. Simultaneously, it is efficacious in pain relief and safe for
those patients.
Reconstructive surgery

It is a branch of surgery that deals with the correction, restoration

and improvement in shape and appearance of body structures that
are defective, damaged, misshapen by injury, diseases or growth.

Techniques of Reconstructive Surgeries

• Skin graft

• Tissue expansion

• Flap surgery
Skin graft
 It involves taking a healthy patch of skin from one area of the

body, known as the donor site, and using it to cover another area
where skin is missing or damaged.

 The piece of skin that is moved is entirely disconnected, and

requires blood vessels to grow into it when placed in the recipient
site.
 Surgical procedure in which skin is placed over a non- healing

wound/burn purposes to provide wound covering and

permanently replace damaged or missing skin.
Tissue expansion

 The procedure that enables the body to grow extra skin for use
in reconstructive procedures.

 This is accomplished by inserting an instrument known as a

balloon expander under the skin near the area in need of repair.

 This balloon will be gradually filled with saline solution,

slowly causing the skin to stretch and grow.
CONDITIONS TREATED WITH
RECONSTRUCTIVE SURGERY.
CONGENITAL ACQUIRED

 Cleft lip and palate Cancer

Trauma
 Vascular anomalies

 Hypospadias Infections

 Prominent/constricted ears Burns

 Craniofacial conditions Miscellaneous

Flap surgery:

 Flap is partially or completely isolated segment of tissue perfused

with its own blood supply.
 It may consist of skin, subcutaneous fat, fascia, muscle, bone or

viscera.
 There are three main types of flap that is local flap, regional flap

and free flap.

Local flap surgery
 It is a piece of skin and underlying tissue that lie near to the

wound is used.
 The flap remains attached at one end so that it continues to be

nourished by its original blood supply and is repositioned over

the wounded area.
 It is created by freeing a layer of tissue and then stretching it to

fill a defect.
Local flap is further classified into three categories are
 advancement flap,

 rotational flap and

 transposition flap.
Regional flap

 It uses a section of tissue that is attached by a specific blood

vessel. These flaps are not immediately adjacent to the defect.

 The freed tissue 'island' is moved over or underneath normal

tissue with the blood supply still connected to the donor site via
pedicle.

 It can be removed later on after new blood supply has formed.

Free flap or microsurgery:
Free flap reconstruction also involves the transfer of living tissue
from one part of the body to another, along with the blood vessel
that keeps it alive.
'Vascular dissection and detachment of an isolated and specific
region of the body, e.g., skin, fat, muscle, bone and transfer of said
tissue to another region of the body with anastomosis of the divided
artery and vein to a separate artery and vein located at the site of the
defect.
Microsurgery:

 The reconstruction of missing tissues usually by the transfer of

tissue from another part of the body.

 It is called as microsurgery because the doctor uses a

microscope in order to see the vessels and fiber needs to connect
after the tissue has been transferred.
Cosmetic surgery:

It is deal with enhancement of appearance for non-medical reasons.

It includes any lifting, augmentation or implant insertion.

Nose, jaw, face lifts, face lifts, botox, collagen injections, breast
augmentation and tummy tuck are the most common.
Difference between the cosmetic and reconstructive surgery
Cosmetic surgery

 Performed on normal structures of the body to improve appearance.

Reconstructive surgery

 Performed on abnormal structures of the body to improve function or

approximate normal appearance.

Body modification:
 It is similar to cosmetic surgery, it is the deliberate altering of the human body

for non-medical reasons.

 The difference is that it may not be done for a more pleasing appearance.
RECONSTRUCTIVE AND
COSMETIC SURGERIES
CONGENITAL DEFOEMITIES
1. Cleft Lip and Palate Repair:
Purpose:
 To repair congenital openings in the lip (cleft lip) or the roof of

the mouth (cleft palate) to improve function (such as feeding and

speech) and appearance.
Procedure:
 Typically performed in stages, starting with initial repairs in

infancy and possibly followed by additional surgeries as the child

grows. Techniques involve stitching the cleft together and
possibly using grafts to restore normal anatomy.
2. Ear Reconstruction:
Purpose:
 To create or reconstruct an ear for individuals born with microtia

(underdeveloped ear) or other ear deformities.

Procedure:
 Techniques often involve using cartilage from the patient’s rib or

synthetic materials to construct a new ear. The new ear is then

surgically attached to the side of the head. This surgery is usually
performed in multiple stages.
3. Hand Surgery:
Purpose:
 To address congenital conditions such as polydactyly (extra

fingers) or syndactyly (fused fingers).

Procedure:
 Involves separating fused fingers or removing extra digits while

preserving as much function and appearance as possible. The

timing and approach depend on the specific deformity and its
impact on hand function.
4. Facial Reconstruction:
Purpose:
 To correct congenital facial deformities such as craniosynostosis

(early closure of skull sutures) or facial clefts.

Procedure:
 Often requires complex techniques to reshape and reconstruct

the facial bones and soft tissues. It may involve a combination of

surgeries to achieve both functional and aesthetic results.
5. Reconstruction of Other Body Parts:
 To address congenital issues with body parts such as the

genitalia or feet. For example, reconstructive procedures might

correct conditions like hypospadias (abnormal placement of the
urethral opening) or clubfoot.
COSMETIC SURGERY
1. Rhinoplasty:
Purpose:
 To reshape the nose for aesthetic reasons or to correct structural

issues, including those present from birth.

Procedure:
 Can involve reshaping the bone and cartilage, correcting

deviations, and enhancing nasal appearance. This surgery can

also be functional if there are breathing issues.
2. Otoplasty:

Purpose:
 To correct protruding or misshapen ears.

Procedure:

 Typically involves reshaping the cartilage of the ear and pinning

it closer to the head. This can be performed in children as young
as 5-6 years old, or in adults.
3. Dermal Fillers and Botox:
Purpose:
 Though not typically used for congenital deformities, these

treatments can be used to enhance facial appearance or correct

minor asymmetries.
Procedure:
 Involves injecting substances to fill wrinkles or alter facial

contours. These are generally non-surgical and temporary.

RECONSTRUCTIVE AND
COSMETIC SURGERIES
INJURIES
Reconstructive Surgery

Purpose:

o To restore function and appearance following trauma, congenital

anomalies, or disease.
o To repair physical damage and reconstruct body parts to improve
functionality and aesthetics.
Procedures:
1.Skin Grafts and Flaps:
Transferring skin from one part of the body to cover damaged
areas.
2.Bone Reconstruction:
Using bone grafts, plates, or other materials to repair fractured or
lost bone structure.
3.Facial Reconstruction:
Rebuilding facial structures affected by trauma or disease, often
using bone and tissue grafts, or implants.
4.Microsurgery:
Repairing small blood vessels and nerves, often necessary for
complex injuries like those involving limbs areas.
Goals:

 Restore normal function and movement.

 Improve or restore the original appearance as much as possible.

 Address any psychological impacts by improving self-image and

confidence.
Cosmetic SurgeryPurpose:

 To enhance appearance and improve aesthetics, often focusing

on non-medical, elective procedures.

 To address visible issues after injuries, aiming for an improved

appearance rather than slowely functional repair.
Common Procedures:
1.Scar Revision: Minimizing the scars from injuries through
techniques like laser treatments or surgical revision.
2.Facial Implants: Enhancing or reshaping facial features, often
used to correct asymmetries or deformities post-injury.
3.Body Contouring: Improving the appearance of body contours
after injuries that cause deformities or asymmetries.
4.Dermal Fillers and Botox: Used to address wrinkles, volume
loss, or other signs of aging that may be more noticeable after an
injury.
Goals:
 Enhance appearance according to personal preferences.

 Improve self-esteem and satisfaction with one’s appearance.

 Address aesthetic concerns that remain after the primary

reconstructive work is completed.
RECONSTRUCTIVE AND
COSMETIC SURGERY
PURPOSES
Reconstructive SurgeryPurpose
1.Restoration of Function: The main goal is to restore normal
function to damaged body parts. This is crucial for areas affecting
movement, sensation, or vital functions.
2.Repair of Physical Damage: To address injuries, trauma,
congenital anomalies, or diseases that have caused physical
deformities or loss of body parts.
3.Improvement of Appearance Post-Injury: To repair visible
damage resulting from injuries or surgery, aiming to restore a more
natural appearance and improve psychological well-being.
4.Reconstruction After Disease: To reconstruct areas affected by
disease, such as breast reconstruction after mastectomy for breast
cancer, or repair after skin cancer excision.
Common Condtions:
 After trauma or accidents (e.g., facial injuries, limb injuries).

 Birth defects (e.g., cleft palate, congenital hand deformities).

 Cancer treatments (e.g., reconstruction after breast or skin cancer

removal).

 Severe burns (e.g., skin grafting and scar revision).

Cosmetic Surgery Purpose:
1.Enhancement of Appearance: To improve or alter physical features
to meet personal aesthetic preferences or societal standards of beauty.
2.Boost of Self-Esteem: To enhance self-image and confidence by
addressing areas of the body that individuals are unhappy with or feel
self-conscious about.
3.Aging Concerns: To address and reduce signs of aging, such as
wrinkles or sagging skin, to maintain or improve youthful
appearance.
4.Body Contouring: To reshape body areas affected by factors like
weight loss, genetics, or aging, even if there is no underlying injury
or disease.
Common Procedures:

 Facial Procedures: Rhinoplasty (nose ), facelift, eyelid surgery

(blepharoplasty), and chin augmentation.

 Body Procedures: Liposuction, breast augmentation/reduction,

tummy tuck (abdominoplasty), and body lift.

 Non-Surgical Enhancements: Botox, dermal fillers, and laser

treatments for skin rejuvenation.
RECONSTRUCTIVE AND
COSMETIC SURGERY
GENDER REASSIGNMENT
Reconstructive AspectsPurpose:
1.Restoration of Function: To create or reconstruct anatomical
features that are functional and consistent with the individual's
gender identity.
This is crucial for both physical function and personal comfort.
2.Creation of Gender-Consistent Anatomy: To construct body
parts that the individual’s gender identity, which may involve
significant anatomical reconstruction.
Common Procedures:
Transgender Women ( Male-to-Female):

1.Vaginoplasty: Reconstruction of a functional vagina, including

the creation of a vaginal canal and external genitalia.

2.Breast Augmentation: Often performed to enhance breast

volume, which might be considered reconstructive in the context of
achieving gender congruence.

3.Facial Feminization Surgery: Includes various procedures to

modify facial features to align more closely with typical female
characteristics, such as rhinoplasty (nose reshaping), brow lift, and
jaw contouring.
Transgender Men ( Female-to-Male):

1.Phalloplasty: Construction of a functional penis, which may include

urethral lengthening to enable urination while standing.

2.Metoidoplasty: A less complex procedure than phalloplasty, involving

the creation from existing genital tissue.

3.Chest Masculinization Surgery (Top Surgery): Removal of breast

tissue to create a masculine chest contour.

4.Hysterectomy: Removal of the uterus and ovaries, often performed as

part of the transition process.
Cosmetic AspectsPurpose:

Enhancement of Appearance: To modify or enhance physical

features to align with the individual’s gender identity and aesthetic
preferences.

Personal Satisfaction: To improve self-image and confidence by

achieving physical characteristics that align with one’s gender
identity.
Common Procedures:

1. Transgender Women:

Breast Augmentation: To achieve a more feminine breast contour.

Facial Feminization Surgery: Includes cosmetic adjustments such

as cheek implants or lip enhancements to achieve a more
traditionally feminine appearance.
2.Transgender Men:

Body Contouring: Such as liposuction or fat transfer to achieve a

more traditionally masculine body shape.

Facial Surgery: Procedures to create a more masculine facial

structure, such as chin implants or jaw contouring.
Legal and ethical
aspects
 Informed written consent after explain the procedure by their
own language.

 Explain about the adverse effects of the surgical procedure.

 Properly maintain the documentation to avoid litigation( a

judicial contest to determine and enforce legal rights).

 Reconstructive the appearance. surgery used for therapeutic and

improve the self esteem.
 It should activities like change the appearance to do the illegal
activities like theft, terrarium. Respect for transgendered persons
like using the form pronoun he or of address and she chooses.
The person presents are the person's social identity and should be
honored
 Protecting privacy, especially with regard to roommate, if there

is one.
 Private rooms are nice but not always possible.

 No one taking care of the patient should be surprised, confidence

must be held carefully
In some cases, if both patient and clinician are to be protected from
litigation, it is mandatory to:
 Re-assess the proposed procedure (more than one interview with

the patient)
 Discuss any anticipated adverse clinical outcomes (e.g.,scar

outcomes)
 Use professional and empathic communication skills combined

with written documentation of all clinical conversations and

patient responses.
SPECIAL THERPIES
1.LAD (Limbal Autograft Surgery)
Purpose:
 Limbal Autograft Surgery is primarily used to treat limbal stem

cell deficiency, which can be caused by severe chemical burns,

thermal burns, or other ocular injuries.
 The procedure involves harvesting a small piece of healthy limbal

tissue (from the edge of the cornea) from one eye (usually the
unaffected eye) and transplanting it to the injured eye to restore
corneal health and vision.
Procedure:

I. Harvesting: A small section of limbal tissue is taken from the

patient's healthy eye.

II. Transplantation: The harvested limbal tissue is then

transplanted onto the affected eye.

III. Recovery: The eye is monitored for healing and integration of

the graft.
2.VACUUMED DRESSING FOR BURNS

 Vacuum-assisted closure (VAC) therapy, also known as negative

pressure wound therapy (NPWT), is a technique used in the
management of burns and other types of wounds.

 This advanced dressing method helps promote wound healing and

can be particularly effective for burns that involve significant
tissue loss or are slow to heal.
Purpose:
 Promote Wound Healing: By applying negative pressure, VAC

therapy stimulates blood flow and helps remove excess fluid from
the wound area.
 Reduce Edema: The therapy helps to decrease swelling around the

wound.
 Prevent Infection: The sealed environment created by the VAC

dressing helps protect the wound from external contaminants.

 Facilitate Tissue Regeneration: Negative pressure promotes the

growth of new granulation tissue, which is crucial for wound

closure.
Components:

1. Foam Dressing: A special foam dressing is cut to fit the wound

and placed directly on the burn or wound.

2. Adhesive Film: An adhesive film is used to seal the dressing

and ensure that the vacuum pressure can be maintained.

3. Vacuum Pump: A vacuum pump is connected to the dressing

via a drainage tube, which creates negative pressure.
Procedure:
a) Preparation: The wound is cleaned and any necrotic tissue is removed. The
foam dressing is then placed over the wound.

b) Sealing: The wound is sealed with an adhesive film to ensure no air can
escape and that the vacuum pressure is maintained.

c) Application of Negative Pressure: The vacuum pump is turned on, creating a

controlled negative pressure environment that helps draw out excess fluid
and promote blood flow.

d) Monitoring and Maintenance: The dressing is typically changed every 48-72

hours, depending on the wound’s condition and the specific protocol. The
wound is monitored for signs of infection or other complications.
Benefits:
i. Enhanced Wound Healing: By promoting blood flow and
granulation tissue formation, VAC therapy can accelerate the
healing process.
ii. Reduced Swelling and Pain: The negative pressure helps to
reduce edema and can alleviate discomfort associated with the
burn.
iii. Improved Wound Care: The dressing keeps the wound
environment moist and free of contaminants, which is essential
for optimal healing.
3.LASER FOR BURNS

Laser therapy is increasingly used in the management of burns,

particularly for addressing scars and improving skin appearance after
initial wound healing.
Types of Lasers Used for Burn Treatment
1.Fractional Lasers:
Purpose:
These lasers are used to improve the texture and appearance of
burn scars by targeting only a fraction of the skin at a time. This
promotes the regeneration of healthy skin while minimizing
downtime.
Types:
Fractional CO2 Lasers: Useful for resurfacing and treating
deeper scars.
Fractional Erbium Lasers: More gentle than CO2 lasers, often
used for superficial skin resurfacing.
2.Pulsed Dye Lasers (PDL):

Purpose:
These are used to treat redness and vascular issues in burn scars.
They target blood vessels to reduce redness and improve skin tone.

Mechanism:
They work by emitting a wavelength of light that is absorbed by
hemoglobin in the blood, reducing vascular redness and helping
with pigmentation issue
3.NdLasers:
Purpose:
Used for deeper vascular lesions and for more invasive scar
revision.
They can penetrate deeper into the skin compared to other lasers.

Mechanism:
Emits a wavelength of light that targets deeper tissues, including
vascular structures.
Applications of Laser Therapy for Burns
1.Scar Reduction:

 Texture Improvement: Lasers can smooth out raised or uneven

scars, helping to blend them with the surrounding skin.

 Color Correction: Lasers can help in correcting discoloration

and improving the pigmentation of scars, making them less
noticeable.
2.Functional Improvement:
Mobility and Flexibility:
Laser treatments can help in reducing scar contractures, which can
improve the range of motion in areas affected by burn scars.

3.Psychological Benefits:
Aesthetic Enhancement:
Improved appearance of scars can significantly boost self-esteem
and psychological well-being.
NURSING CARE
Post-Treatment Care:
1.Healing: The treated area may be red, swollen, and sensitive
immediately after the procedure. Recovery time varies but often
involves a few days to a week of minor discomfort.
2.Follow-Up: Multiple sessions may be required for optimal results.
Regular follow-up appointments are essential to monitor progress
and adjust treatment as needed.
3Aftercare:Sun Protection: It’s important to protect the treated area
from sun exposure to avoid pigmentation changes and ensure proper
healing.
4.Moisturization: Keeping the skin hydrated can help with the
healing process and improve results.
4.LIPOSUCTION
 Liposuction, also called lipoplasty, liposculpture suction or
liposuction.
 Liposuction is a type of cosmetic surgery.

 Liposuction permanently removes fat cells, altering the shape of

the body.
 Liposuction is the surgical aspiration of subcutaneous fat by use

of a cannula attached to a vacuum pump.

 These fat deposits are usually present at abdomen, arms, back,

breasts, buttocks, thighs and legs.

 Liposuction procedures vary depending on the location of fat to

be removed, type of fat, goals of the patient, plastic surgeon's

recommendation, laser-assisted liposuction, Tumescent
liposuction, suction-assisted liposuction, power-assisted
liposuction and ultrasonic-assisted liposuction.
Eligible Criteria for Liposuction

 Above 18 years

 Good health condition

 Able to follow good diet and exercise

 No health complications like diabetes, hypertension

Techniques of Liposuction

 Dry liposuction

 Wet liposuction

 Super wet liposuction

 Tumescent liposuction
Mechanisms of Liposuction
1.Suction-assisted liposuction: It is a standard method of
liposuction. A small cannula is inserted into the fat deposited area
and it is attached to a vacuum to suck out the fat.
2.Ultrasound-assisted liposuction: It involves a cannula that
produces ultrasonic energy. It has ability to remove large volumes
of fat, to break up tough and fibrous fats in areas of the body.
3.Power-assisted liposuction: It uses a powerized cannula which
moves through the fat tissue in a rapid motion. Fibrous tissue can
be easily treated.
4.External ultrasound assisted liposuction: Ultrasound energy is
applied from outside the body through the skin. It causes less
discomfort for the patient, both during the procedure and
afterwords, decreased blood loss, allow better access through scar
tissue and treat larger areas.

5.Laser liposuction: Lasers are using with traditional liposuction

methods. It is extremely painless, increases the safety standards
of the procedure, helps to skin tighten.
Preparation of Liposuction Procedure

 The patient should not take anticoagulants, aspirin, vitamin E

for two weeks before the surgery.

 Fast should to midnight if used for general anesthesia. Fasting

not required for local anesthesia.

 Smoking must be avoided for prior to two months of surgery.

Management to Improve Recovery
 Drink enough water to prevent dehydration.

 Avoid alcohol for a couple of days, both before and after surgery

 Avoid using ice packs or heating pads on the treated areas.

 Postpone any submersion in water for at least a week (bathtub,

swimming pool, river,...)

 If any dizziness is experienced, the patient should take it easy, stand up

slowly, get some help for the shower, remove the compression garment
slowly, etc.
5.SKIN REJUVENATION
 Skin rejuvenation refers to a range of techniques and treatments

designed to restore the skin’s youthful appearance and improve

its overall health. The goal is to enhance skin texture, tone, and
elasticity, reduce signs of aging like wrinkles and fine lines, and
address issues such as pigmentation, scars, and uneven skin
tone.
 Laser and intense pulse light (IPL) treatments: Used to remove
discoloration and/or tighten sagging skin

 Chemical peels: Various acid peels used in different

combinations to remove damaged outer skin layers

 Ablative laser treatments (Fractional, CO, lasers):Remove outer

layers of skin to smooth lines and wrinkles

 Mechanical ablation (Dermabrasion, Dermaplaning):Surgical

scraping methods to soften skin surfaceirregularities
 Non-ablative treatments (Microdermabrasion, micro GEN
needling, light acid peels): Minimally invasive sanding methods
to treat light scarring and discolorations
 Dermal fillers: Dermal fillers are gel-like substances that are

injected beneath the skin to restore lost volume, smooth lines

and softetherskin to restenhance facial Male contours.
 Botulinum toxin type A treatments: Blocks nerve or contraction

to relax wrinkles
 Spider vein treatment (Sclerotherapy): Injections to collapse

unsightly surface veins.

SKIN REJUVENATION AND RESURFACING
The following are some of the conditions that different skin rejuvenation
approaches can address:
 Static wrinkles: These wrinkles are visible at all times and do not change in
appearance with facial movements,

 Dynamic wrinkles: These are expression lines that may appear as folds when
the skin is not moving, and deepen with facial movements or expressions.

 Pigmentation: Freckles, sun spots, or other darkened patches of skin result

mainly from sun exposure.

 Scars: As the result of acne or injury to the skin, scars may be rolling (a wavy
appearance to the skin), pitted, discolored, or have raised borders.
 Vascular conditions: Blood vessels visible on the surface of the
skin, vascular lesions that appear as tiny blood-filled blisters or
even a constant flush of facial redness.

 Loss of skin tone: Weakening of the supportive skin structures

(collagen and elastin fibers) that result in a loss of skin firmness
or the development of cellulite.

 Dull skin: Skin that has lost the vibrant glow from a build up of
dead skin cells and clogged pores.
SIMPLE NATURAL SKIN REJUVENATION

 Papaya face mask:

Mash 2 tsp of papaya pulp with 2 tsp of honey and apply it to skin
in circular motions. Rest for 15 minutes and wash face with water.
Papaya is rich in alpha hydroxy acids that acts as natural scrub for
the skin care and nourishes skin.

Watermelon and cucumber pack:

 Prepare a face pack by mixing grated cucumber, grated

watermelon, and a few drops of lemon juice. Apply it to face and

wash off with lukewarm water for an oil free, ravishing skin.
 Banana mash:
Mash a medium-sized banana; add about 2 tsp honey and few drops of
olive oil to the mashed fruit to prepare a face pack. Wash off after 20
minutes to show off a supple and visibly smooth and radiant skin. This
yellow- skinned fruit is a powerhouse of vitamin C and vitamin B6,
both which aid in maintaining the elasticity and suppleness of the skin.
 Tomatoes pack:

Mix 3 tbsp of tomato juice with 1 tbsp of lemon juice. Add 2 tbsp of
milk cream. Make a smooth paste. Apply in circular motion to the
skin; keep for 15 minutes and wash. Tomatoes contain Lycopene that
rejuvenates and tightens the skin. They also have astringent properties
that leave your skin fresh. Give skin a commendable dose of
antioxidants by using tomatoes-internally and externally.
6.USES OF DERMA FILTERS IN BURNS

 Dermal fillers, though not typically used for the initial treatment
of burns, can be valuable in the later stages of burn recovery,
particularly for addressing aesthetic and functional issues related
to scarring.
1.Scar Remodeling and Volume Restoration:
Purpose: Dermal fillers can be used to improve the appearance of
atrophic scars (sunken or indented scars) by restoring lost volume
and contouring the affected area.
Application: Injecting fillers into the scarred area can help level
out depressed scars, making them less noticeable and improving
the overall appearance of the skin.
2.Improving Skin Texture and Elasticity:
 Purpose: Some fillers can stimulate collagen production in

addition to adding volume. This can improve skin texture and

elasticity around burn scars.
 Types: Fillers containing hyaluronic acid or poly-L-lactic acid

can encourage the production of new collagen, which helps in

smoothing and rejuvenating the skin over time.
3.Enhancing Aesthetic Outcomes Post-Reconstruction:
 Purpose: After surgical reconstruction or skin grafting, dermal

fillers can be used to refine and enhance the results, addressing

any residual contour irregularities or unevenness.
 Application: Fillers can be used to blend grafted skin with

surrounding tissue, improving the cosmetic outcome of

reconstructive surgeries.
4.Functional Improvement:
Purpose: For some burn scars that cause functional issues (e.g.,
restricting movement or causing contractures), dermal fillers can
provide temporary relief by improving skin flexibility and
reducing tightness.
Application: Fillers can help in managing the appearance of
contractures by adding volume and reducing the visual impact of
tight or puckered skin.
Types of Dermal Fillers Used
1.Hyaluronic Acid Fillers:
 Examples: Juvederm, Restylane.

 Characteristics: Provide immediate volume and hydration. They

are commonly used for facial contouring and can improve skin
texture.
2.Calcium Hydroxylapatite Fillers:
 Examples: Radiesse.

 Characteristics: Stimulate collagen production and provide

longer-lasting volume correction. They are suitable for deeper

scars and more significant volume loss.
3.Poly-L-lactic Acid Fillers:
Examples: Sculptra.
Characteristics: Stimulate collagen production gradually over
time, making them useful for long-term improvement in skin
texture and volume.