Skin and subcutaneous tissue
Download
1 / 37

SKIN AND SUBCUTANEOUS TISSUE - PowerPoint PPT Presentation


  • 314 Views
  • Updated On :
  • Presentation posted in: General

SKIN AND SUBCUTANEOUS TISSUE. I. Introduction A. Function 1. Protection 2. Thermoregulation 3. Sensory. B. Anatomy 1. Epidermis – most cellular layer a. keratinocytes – most numerous and forms a mechanical barrier b.Langerhan’s – immunologic function

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha

Download Presentation

SKIN AND SUBCUTANEOUS TISSUE

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


SKIN AND SUBCUTANEOUS TISSUE


I. Introduction

A. Function

1. Protection

2. Thermoregulation

3. Sensory


B. Anatomy

1. Epidermis – most cellular layer

a. keratinocytes – most numerous

and forms a mechanical barrier

b.Langerhan’s – immunologic function

c. Melanocytes – pigment


2. Dermis – supporting layer, mostly fibroblast which produce collagen

3. Basement layer – dermal epidermal junction

- first layer where blood vessel and lymphatics are present

- if lesion has not crossed this layer, it is called an “in-situ” lesion


II. Pathology

A. Trauma

1. Dirty and infected wounds – debridement and closed by secondary intention

2. Lacerations – closed primarily


LACERATIONS


B. Decubitus Ulcer or Pressure Ulcer

- excessive, unrelieved pressure (60 cm Hg applied for 1 hour)

- muscle more sensitive than skin to ischemia

- Tx. – debridement and grafting


DECUBITUS ULCER


C. Keloid and Hypetrophic Scar

- over abundance of deposition of collagen

1. Hypertrophic scar – nodularity remains within the incision

- no treatment necessary

2. Keloid – nodularity goes beyond the incision

- seen more in children and across sternum

- treated with triamcinolone


KELOID


D. Infections

1. Folliculitis – infected hair follicle

- caused by Staph. sp.

- leads to furuncle  carbuncle

- Tx. – incision and drainage and antibiotics

2. Hidradenitis suppuritiva

- plugged apocrine gland in axilla and inguinal area

- Tx. – warm compress, hygiene, discontinuation of deodorants, open drainage if recurrent


3. Pilonidal disease – infected pilosebaceous cysts in the saccrococygeal area, lined by granulation tissue

- Tx. – drainage, currete


4. Staphyloccocal Scalded Skin Syndrome

- erythema, bullae formation, loss of epidermis

- caused by exotoxin from staphyloccocal infection

- similar to partial thickness burn

-cleavage is in the granular layer

- Tx. – replace fluid, electrolytes, skin care,

antibiotics


STAPHYLOCOCCAL SCALDED SKIN SYNDROME


5. Toxic Epidermal Necrolysis

- Immunologic reaction to certain drugs such as sulfonamides, phenytoin, barbituates, and tetracycline

- Tx. – same as SSSS

6. Viral – verruca vulgaris, associated with pappiloma virus

- associated with squamous cell ca

- Tx. – chemical, electrocautery, surgery


E. Benign Tumors

Cysts

1. epidermal – sebaceous cysts, most common

2. Trichilemmal – occurs more commonly in females

3. Dermoid – results from epithelium trapped during midline closure in fetal development

- Tx. - excision


F. Nevi

1. Acquired

a. Junctional – epidermis

b. Compound – migrates partially

down to the dermis

c. Dermal – cells at dermal layer

- involutes


ACQUIRED NEVI


2. Congenital – rare

- large and may contain hair

- occurs in bathing trunks distribution

- Tx. - excision


CONGENITAL NEVI


G. Vascular

1. Hemangioma

a. capillary (strawberry)

- compressible, vascular lesion with sharp borders

- located mostly in the face, scalp, and shoulder - observe, 90% involute


b. Cavernous

- bright red or purple, with spongy consistency

- Tx. – excision

2. Vascular malformation

- enlarged vascular spaces lined with non proliferating endothelial cells

a. portwine stain – capillary malformation

- Tx. – embolization

b. glomus tumor – painful blue –gray nodules

- arises from the glomus body or Sucquet-Hoyer canal found in the dermis and contributes to thermal regulation

- may lead to glomangiosarcoma

- Tx. - excision


GLOMUS TUMOR


H. Soft Tissue Tumors ( achrocordons, lipomas, dermatofibromas)

- Tx. – excision

I. Neural

- Neurofibromas (café-au-lait spots)

- associated with von Reklinghausen’s disease


J. Malignant Tumors

1. Epidemiology

a. malignant radiation

b. chemicals

c. viral

d. chronic irritation

e. immunosuppresion


2. Types

a. basal cell carcinoma

- most common

- slow growing, rare metastases

- excision with 2-4 mm margin


BASAL CELL CARCINOM


b. squamous cell carcinoma

- metastasizes faster

- Bowen’s disease – ca-in-situ

- Erythroplasia of Queyrat – ca of the penis

- lesion more than 1 cm has 50% chance of metastasis

- Tx. – excision with 1 cm margin

- Moh’s technique – serial excision to preserve skin


SQUAMOUS CELL CARCINOMA


ERYTHROPLASI OF QUEYRAT


c. malignant melanoma

- arises from dysplastic melanocytes

i. superficial spreading

- most common (70%)

- flat with areas of regression


ii. nodular – 15-20%

- dark, slightly raised

- growth more vertical than radial

iii. lentigo malignant 5-10%

- best prognosis

- occurs in areas of high solar degeneration


MELANOMA


b. prognostication

i. Clark

ii. Breslow

iii other factors

- anatomic location – extremities better than trunk or face

- ulceration


- inflammatory infitrates

- sex

- histologic type

c. treatment

- still primarily surgical

i. in-situ - .5 to 1 cm margin

ii. T1 (smaller than .76 mm)

- 1-2 cm

iii. thicker lesion – 3 cm margin

- excision is up to the deep fascia

- chemotherapy

- palpable nodes are removed by regional dissection


ad
  • Login