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2.

Explain the pathomechanism of a wound based on its anatomy,


histology and physiology?

a. ANATOMY AND SKIN HISTOLOGY

The skin is the organ that is located at the outermost and


limiting of the human environment. The skin area of an adult is 1.5
m2 and weighs approximately 15% of body weight. The skin has
variations on soft, thin, and thick: loose and elastic skin found on
the palpebra, lips and prepitium.

Thick and tense skin is on the soles of your feet and hands.
Thin skin is on the face, soft and neck and body, and coarse-haired
ones are on the head.

The skin division is broadly composed of 3 main layers:

1) Epidermal layer

2) The dermis layer

3) Subcutting layer

Figure 1. Skin

There is no firm line separating the dermis and


subcutaneously, the subcutaneous is characterized by the
presence of loose connective tissue and the presence of fat cells
and tissues.
1) Epidermal layer
Is the outermost layer of skin. Formed by flattened
layered epithelium. The function of the epidermis is as a
protection against environmental influences and against fluid
loss. The epidermal morphology is avascular. And about 85%
experience keratinization. There are 4 types of cells, namely
keratinocytes, cell langans, cell cells, and melanocyte cells.
The epidermis consists of 5 layers including:

Figure 2. Epidermal layer

a) Stratum corneum (horn layer)


The outermost layer of the skin and consists of several
layers of flat, dead, nucleated cells, and the protoplasm
has turned into keratin (horn substance)
b) Stratum lusidum
Found directly below the corneum layer, is a layer of
nucleus flat cells with protoplasm that turns into a protein
called eleidin. It appears more clearly on the palms and
feet
c) Stratum granulosum (keratohialin layer)
It is 2 or 3 layers of flat cells with coarse-grained
cytoplasm and there is a nucleus between them. These
coarse grains consist of keratohialin. The mucosa
usually does not have this layer. Stratum granulosum is
also evident in the palms of the hands and feet
d) Stratum spinosum (stratum malphigi) / prickle cell layer
(copper layer) Consisting of several cells in the form of
polygonal magnitude varying due to the process of
mitosis. The protoplasm is clear because it contains a lot
of glycogen, and the nucleus is located in the middle.
These cells are getting closer and closer to the surface.
Among the cells of the stratum spinosum there is an
intercellular bridge consisting of protoplasm and tonofibril
/ keratin. The attachment between bridges forms a small
thickening called Nodulus Bizzozero. Among the cells of
the stratum spinosum contain a lot of glycogen.
e) Stratum basale
Consists of cube (columnar) cells arranged vertically on
the dermo-epidermal border lined up like a fence. Is the
lowest layer of the epidermis. These basal cells carry
mitosis and function reductively. This layer consists of 2
types of cells, namely:

i. Columnar cells with oval and large core basophilic


protoplasms, connected by intercellular bridges

ii. Cells form young colored melanin (melanocytes) /


clear cells, with basophilic cytoplasm and dark nuclei,
and contain grain pigments (melanosomes).

2. Dermis layer

The layer beneath the epidermis is much thicker than


the epidermis. This layer consists of elastic and fibrous layers
dense with cellulaer elements and hair follicles. Divided into 2
parts:
Figure 3. Dermis

a. Pars papillary
The part that protrudes into the epidermis, contains the
ends of nerve fibers and blood vessels. Consisting of
loose connective tissue, namely: fibroblast cells,
leukocytes, mast cells, and thin collagen fibers.
b. Pars reticularis
The lower part protrudes into the subcutaneous direction,
this part consists of fibers - supporting fibers for example:
collagen fibers, elastin, and reticuline.

3. Subcutting layer

Continuation of the dermis, consisting of loose connective


tissue containing fat cells in it, fat cells are large, round cells,
with the nucleus pressed to the edge of the increased fat
sioplasm.

These cells form groups separated from one another by


fibrous trabeculae. The layer of fat cells called paniculus
adipose, serves as a food reserve. In these layers there are
end - peripheral nerve endings, blood vessels and lymph. The
thin thickness of fat tissue is not the same, depending on
location.

Vascularity in the skin is regulated by 2 plexus, the plexus


which is located above the dermis (superficial plexus) and is
located in the subcutaneous (deep plexus). The plexus in the
upper dermis carries an anastomosis in the papillary dermis,
the plexus which is located in the subcutaneous and in the
reticulare parse also holds an anastomosis, in this part the
blood vessels are larger. Joining the blood vessels is a lymph
channel.

SKIN ADNECTION

Adnexa of the skin consists of the glands of the skin, hair, and nails.

1. the skin gland,


The skin gland is in the dermis layer, which consists of:
a. Sweat glands
b. Eccrine gland: small, in the dermis, influenced by cholinergic
nerves, heat factors, and emotional stress
c. Apocrine glands: large, secretions, affected by adrenergic
nerves
d. Sebaceous gland
Located on the entire surface of human skin except the palms
and feet. The sebaceous gland is also called the holocrine gland
because it is not berlumen and secretion of this gland originating
from the decomposition of glandular cells.

b. SKIN PHYSIOLOGY

1. Protection Function

The skin keeps the inside of the body against:

a. Physical / mechanical disturbances eg pressure, friction,


pull
b. Chemical disorders, for example: chemicals, especially
those that are irritants. Examples: lysol, carbolic acid, etc.
c. Heat disorders, eg radiation, ultraviolet light
d. Outside human / bacterial and fungal infections

This is possible because of:

a. Thick fat pads of the skin layer and supporting tissue fibers
that act as a protector against physical disorders.
b. Chemical stimulation protection can occur because the
stratum corneum is impermeable to various chemical
substances and water, dismantling that there is a layer of skin
acidity that protects the contact of chemicals with the skin.
(formed from the results of sweat and sebum)
c. The acidity of the skin causes the pH of the skin to range at
pH 5-6.5, so it is a chemical protection against bacterial and
fungal infections
d. The keratinization process is a mechanical barrier because
the dead cells disengage regularly.

2. Absorption function
Healthy skin is not easy to absorb water, solution and
solid objects, but volatile liquids are more easily absorbed, as
well as fat soluble. Skin permeability to O2, CO2, and water
vapor allows the skin to take part in the function of respiration.
The ability of skin absorption is influenced by the thickness of
the skin, hydration, humidity, metabolism and type of vehicle.
Absorption can take place through a gap between cells,
penetrating epidermal cells or through the mouth of the gland;
but more is through the cells of the epidermis than through the
mouth of the gland.
3. Excretion Function The skin glands secrete useless
substances / metabolic waste in the body in the form of NaCl,
urea, asurat, ammonia.
4. Function of Perception

The skin contains sensory nerve endings in the dermis


and subcutaneous:

a. Against stimulation of the Ruffini bodies in the dermis and


subcutaneousl

b. Against cold stimulation, Krause's bodies in the dermis

c. Against tactile palpable Meissner in the papilla dermis

d. Against coarse palpitations and Raneler in the epidermis

e. Against the pressure of Paccini in the epidermis

5. Function of Body Temperature Regulator

The skin performs this role by sweating and wrinkling


(muscles contracting) the blood vessels of the skin.

6. Pigment Formation Function

Pigment-forming cells (melanocytes), located in the


basal layer, and these cells come from nerve rigi. On the back
of H.E. This cell is clear in shape round and is a dendritic cell,
also called clear cell.

Melanosomes are formed by the Golgi tool with the help


of tyrosinase, Cu and O2 enzymes. Exposure to sunlight
affects the production of melanosomes.

The pigment is spread to the epidermis through the


hands of the dendrites, while the lower layer is carried by the
melanofag (melanofor) cell.
7. Keratinization Function

Keratinocytes starting from basal cells make division, the


other basal cells will move up and change shape to spinosum
cells, the more up the cell becomes more flat and granules into
granulosum cells. The longer the core disappears and the
keratinocytes become amorphous horn cells. This process
lasts a lifetime.

8. Function of Forming Vitamin D

It is possible to change 7 dihydroxy cholesterol with


sunlight. But the body's need for vit.D is not enough just from
that, so systemic vitamin D is still needed.

The mechanism of injury:

1. Incised wounds occur because they are cut by sharp instruments. For
example, what happens as a result of surgery. Clean (aseptic) wounds
usually covered by suture as much as the entire blood vessel that is
wounded (Ligation)
2. Contusion Wound, occurs due to a collision by a pressure and is
characterized by injury to soft tissue, bleeding and swelling.
3. Abraded Wound, occurs due to skin rubbing against other objects that
are usually with objects that are not sharp.
4. Punctured wounds, which occur as a result of objects, such as bullets
or knives that enter into the skin with a small diameter.
5. Lacerated Wound, caused by objects that are sharp like by glass or by
wire.
6. Penetrating Wound, which is a wound that pierces the body's organs
usually at the beginning of the wound in a small diameter but at the
end of the wound usually will widen.
Referensi :
1. Djuanda, Adhi dkk. Ilmu Penyakit Kulit dan Kelamin .Edisi
keenam.2011, Jakarta : Balai penerbit Fakultas Kedokteran
Universitas Indonesia.Hal. 3-5
2. Sloane, E., Anatomi dan Fisiologi Untuk Pemula. 2004, Jakarta:
Penerbit Buku Kedokteran EGC. hal. 266-277