WOUND CLOSURE AND SUTURING
One of the body's defenses is the integumentary system, the skin. A wound is a
break in the continuity of the tissues of the skin. A small, surface wound may heal by
itself. A larger, deeper wound may require closure and suturing. Information about
wound closure and suturing will help you to deal with these more serious wounds.
REVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE INTEGUMENTARY
a. The integumentary system consists of the skin and its derivatives. This is the
largest and one of the most complex systems of the body. The surface area of the skin
covers about 1.8 square meters (16.2 square feet) of the body of the average male
adult. The skin weighs about six pounds and receives roughly one-third of all blood
circulating through the body. It is difficult to think of the skin as a system, but it is a
complex of organs (sweat glands, oil glands, and so forth). The skin is elastic,
regenerates, and functions in protection, thermoregulation, and sensation.
b. The protection, sensations, secretions, and the other functions which the
integument gives to the rest of the body are essential for life. Changes in the normal
appearance of the skin often indicate abnormalities or disease of body function.
c. Skin consists of three distinct layers: the epidermis, the dermis, and the
subcutaneous layer. The top layer, the epidermis, is attached to the second layer, the
dermis. The dermis is thick, connective tissue. Individuals with thick skin have a
relatively thick epidermis. Persons with thin skin have a thin epidermis. The
subcutaneous layer, the third layer of skin, is located beneath the dermis and consists
of areolar (minute spaces in tissue) and adipose (fat) tissues. The first skin layer is
fixed to the second skin layer as though the two were glued together. The second and
third skin layers are attached in a different way. Fibers from the second layer (the
dermis) extend down into the third layer (subcutaneous), anchoring the two layers
together. The third layer is firmly attached to underlying deep fasciae. See figure 2-1.
(1) Epidermis. The epidermis is composed of stratified, squamous (scale-
like), epithelial cells which are organized in four or five layers. The number of cell layers
depends on the location of the skin on the body. The epidermis has five layers on the
palms of the hands and the soles of the feet because these areas have more wear and
tear. Skin on other parts of the body has four layers of epidermis because there is less
exposure to frictions. These are the layers of the epidermis from the deepest to the