1. Intro The largest organ of the body, ranges from about 1 to 4 mm in thickness and consists of two layers Epidermis and dermis The integument is basically a protective organ, but it also serves a role in temperature control and provides important sensory information regarding the environment.

2. Epidermis – The epidermis ranges from .06 to .1 mm The predominant cells in the epidermis are keratinocytes produced in the basal cell layer. The basal cell layer is also where the epidermis is anchored to the dermis. Keratinocytes take 28 days to complete their epidermal phase and until they are slothed of the most external surface. Other cells are langerhans cells. Merkel cells. Melanocytes. Langerhans cells play a role in the immune response. Merkel cells are sensory receptor cells. Melanocytes synthesize melanin which serves as a primary protection against harmful ultraviolet radiation.

3. Dermis – It varies from 1 to 4 mm in thickness and has 2 subdivisions. 2 divisions are papillary & reticular Papillary dermis is composed of loosely organized collagen and is highly vascular. The junction between these 2 layers provides protection against potentially damaging perturbations such as shearing and deepen the dispersion of the epidermal basal cell layer. The reticular dermis is composed of more densely bundled collagen fibers. The fibrous collagen supplies fortification against mechanical stresses on the skin while still allowing the deformation necessary for movement. Blood vessels and nerves are also found within the dermis. The vascular structure in the dermis is vast and allows typically efficient diffusion of gases and nutrients to promote healthy cell function.

4. Subcutanenous Consists of loose connective tissue containing adipose tissue.

5. Describe the types of facilities you might be working in? (Example. School) As I stated in the prior question we as therapists working with skin would be working with all of the settings a PT can work with. We must asses an injury with percussion, palpation, and other physical measures for the skin as well as treating the skin with heat and ice. We would be working with inpatient, outpatient, hospital, homecare, pediatric, geriatric.

6. Give an overview of what PT’s do when working in this setting. In the Integumentary setting Physical Therapists would be working with patients who have burns, scars from incision, edema, vascular irregularities, multiple skin abnormalities, broken bones, pulled muscles, ulcers and most other conditions to which other PT’s would have to work with. The appropriate intervention would differ depending on what stage of healing the integumentary system was in.

7. During the first two weeks of healing the skin is in the inflammatory phase in which the therapist would start with an overall evaluation of the injury site. After assessing the patient visually, physically and from past history the PT would take care of the injury by teaching the correct cleaning and dressing of the wound. Moving on the therapist would also work with edema management, positioning, splinting, passive range of motion exercises, ambulation and functional activities for everyday life.

8. The next phase in the healing process is the proliferation phase which is the rebuilding of the wound site with collagen protein. During this phase the wound must be handled carefully due to the injury being weak and only being between 15 and 80 percent of normal capacity. During this phase the therapist would use the same interventions as the inflammatory phase but would handle the injury site and adjacent skin carefully based on the delicate area of injury.

9. The third phase of the healing process is the maturation phase which could take up to several months depending on the size and depth of the injury site. The intervention during this phase would be the same as the prior two but the therapist could act more aggressive with manipulation of the wound site as well as moving on to work hardening and conditioning exercises. The therapist can also begin techniques to control scar formation and the prevention of scar tissue.

10. Additional considerations. The variables of repair and patient response to skin wounds include depth and damage, location of the injury, size of wound, healing time, and etiology of disruption. The depth of injury probably had the greatest impact on repair and healing of the wound. Deeper skin damage that destroys much if not all of the epidermal basal cell layer may take weeks to heal or require surgical intervention to hasten repair The size of a wound, often measures as the percentage of total body surface area(TBSA) affected.