FACULTY OF DENTISTRY

ANATOMY
DDS Y1 0109
By: venugopala@mahsa.edu.my
The Skin and fasciae
 The skin
• The skin is readily accessible and is one of the
best indicators of generalhealth.
• It is considered in the differential diagnosis of
almost every disease.
• The largest organ in the body and is made up
of a superficial epithelium, the epidermis and
a deep connective tissue layer, the dermis.
• Most of the nerve terminals are located in the
dermis.
• The dermis is a dense layer of interlacing collagen
and elastic fibers.
• The predominant pattern of collagen fibers
determines the characteristic tension andwrinkle
lines in the skin.
• The tension lines (also called cleavage lines or
Langer lines) run longitudinally in the limbsand
transversely in the neck andtrunk.
• Tension lines at the elbows, knees, ankles, and
wrists are parallel to the transversecreases that
appear when the limbs areflexed.
The incisions are given
along the cleavagelines
rather than across to
prevent gaping and
minimize the scar.
• The elastic fibers of the dermis deteriorate with
age and are not replaced; So in older people the
skin wrinkles and sags because it loses its
elasticity.
• Along with the sweat glands, the arterioles(small
arteries) in the dermis are involved in the loss or
retention of bodyheat.
• They dilate to fill superficial capillary beds to
radiate heat (skin appears red) or constrict to
minimize surface heat loss.
VASCULARSUPPLY
•The arteries supplying the dermis are generally
derived from branches of arteries supplyingskeletal
muscles in a particular region, but some arteries
supply the skin directly.
• In pregnancy, the abdominal skin is stretched too
far, damaging the collagen fibers in the dermis
forming white stretch marks. (striae gravidarum).
• Tattooing is a permanent coloration of the skin inwhich
a foreign pigment is deposited with a needle into the
dermis.
• About one in five U.S. college students has oneor
more.
• Tattoos are created by injecting ink with a needlethat
punctures the epidermis and moves between 50 and
3000 times per minute as the ink is deposited in the
dermis.
• Since the dermis is stable (unlike the epidermis,which
is shed about every four to six weeks), tattoos are
permanent.
• They may fade in time and can be removed by laser.
 Burns
• 1st degree (superficial) burn-- damage limited
to epidermis
• 2nd degree burn(partial thickness)-- epidermis
and superficial dermis are damaged.
• 3rd degree burn (full thickness)-- the entire
thickness of the skin is damaged and may
extend to the underlyingmuscle
 Rule of nines
• TBSA(total body surface
area) is a measure of
assessment for burns and
for this “rule of nines” is
used.
• The extent of a burn
(percent of total body
surface affected) is
generally more significant
than the degree.
• For skin grafting (in severe burns) a tissue
engineered product called Integra® Dermal
Regeneration Template (DRT)is available.
• It is designed to promote organizedregeneration
of the dermis.
 Superficial fascia
– is found in the subcutis in most regions of
the body, blending with the reticular layer
of the dermis.
– It is comprised mainly of loose areolar
connective tissue and adipose and is the
layer that primarily determines the shapeof
a body.
– This type of fascia surrounds organsand
glands, neurovascular bundles.
– It serves as a storage medium of fat and
water; as a passageway for lymph, nerve
and blood vessels; and as a protective
padding to cushion and insulate.
 Deep fascia
• Underlying the superficial fascia almost
everywhere is the deep fascia.
• The deep fascia is a dense, organized
connective tissue layer, devoid of fat, that
covers most of the body deep to the skin and
subcutaneous tissue.
• It invests deeper structures, such as individual
muscles and neurovascular bundles and called
the investing fascia.
• It forms intermuscular septa (in the limbs) to
separate groups of muscles having similar
nerve supply and actions into compartments.
• Pus may get collected in these compartments.
• It forms the endomysium, perimysium and
epimysium, tendons in the skeletalmuscles.
• It fuses firmly with theperiosteum.
• The deep fascia, contracting muscles, and venous
valves work together as a musculovenous pump
to return blood to the heart, especially in the
lower limbs where blood must move against the
pull of gravity.
• Near certain joints (e.g., wrist and ankle),the
deep fascia thickens, forming a retinaculum
(plural = retinacula) to hold tendons inplace.
• It also forms ligaments in thejoints.
section of the leg

retinacula