Skin Integrity: Definition, Maintenance, and Restoration Guide

What is skin integrity

Our skin plays an important role in our bodily construction. It provides protection for our muscles and internal organs from external environmental effects. In addition to protection, it takes part in thermoregulation, sensation, and water retention.

Anatomically, the layers of the skin can be divided into three parts.

• The top layer is the Epidermis which provides a waterproof barrier and creates our skin tone.
• The second one is Dermis which contains tough connective tissue, hair follicles, and sweat glands.
• The last one is Subcutaneous layer or hypodermis that is basically fat and connective tissues.

Taken together, these three layers play a role in the integrity of the skin, so it is important to pay attention to keep them intact. However, we can ask ourselves the question: What is skin integrity exactly? The answer is very simple.

The definition of skin integrity is the health of the skin. Once it is compromised we are subject to a lot of health risks. Below we will review what can cause a disruption in skin integrity, how we can care for it, and how we can restore it if needed.

Causes of skin breakdown

Altered skin integrity contributes to the development of injuries and can lead to the chance of infection, limb loss, and even death. There are different risk factors that can alter skin integrity and cause skin breakdown. These factors can be both external and internal.

External factors:

• friction,
• pressure,
• shear,
• falling,
• paralysis,
• surgical procedures.

Internal factors:

• skin diseases,
• malnutrition and the resulting lifestyle disease,
• diabetes,
• vascular diseases.

From these factors, one of the most common causes of skin integrity disruption is pressure.

When a patient spends a lot of time in a certain lying or sitting position, pressure is put on the skin surface, which results in a decrease in blood supply in that area, as well as a lack of oxygen and metabolic disorders in the skin tissues. Poorly blood-supplied parts are not only more easily damaged, but also difficult to regenerate. So when the patient is moved, inverted, lifted for washing, or dressed, the skin stretches and there is a possibility for injuries to occur in the tissues. These injuries usually cause decubitus.

Most often, the lower body regions with bony protrusions or areas with less muscle or adipose tissue are affected. When lying on the back, the sacral region, the heels, the buttocks, even the elbows, and shoulder blades are the most exposed, and when lying on the side, the upper thighs, hips, and ankles are most at risk of bedsores.

We have seen that one of the most common causes of skin breakdown is pressure. So it is no surprise that the possibility of developing pressure ulcers is the highest among bedridden people. Patients usually are bedbound long term because of their treatment and care due to an accident, old age, after surgery, or chronic illnesses. The degree of risk is the highest in case of elderly people. The skin loses its elasticity as it ages, and it is easier to develop injuries that take longer to heal. So it is really important to protect skin integrity properly, if there is damage done to it, assess and treat it properly.

Skin assessment

Assessing tissue integrity is an important task because in this way we can find out how healthy it is. We can treat a developed syndrome properly if we find out the source of the problem in time. This is essential to the path of healing, which involves a complete medical evaluation of the patient.

It is essential in the case of bedridden patients to have skin assessment regularly. This way, if any problems are starting to develop, they can be caught in time. The five most important factors of skin assessment are:

• Color of the skin: Change in the regular color of the patient’s skin can indicate problems. Redness, for example, might be a sign of infection or increased pressure.
• Temperature of the skin: Warmness and coldness both can be caused by an infection.
• Moisture of the skin: Important to check if the skin is wet, dry, or oily. If there are any deviations from the normal, the next step is to check if it is localized or if it affects the whole body.

• Skin integrity: Cracks, openings, bruisings, and lesions can all cause problems. It’s also important to check the thickness of the skin.
• Location of the wound: If there are any changes in the skin color, temperature, moisture, or integrity, the next consideration is the location. The location of the skin change can tell a lot about possible causes.

Skin integrity care plan

In almost all cases, it is better to prevent the problem than to deal with the consequences afterwards, and that applies to our health as well. Skin breakdown can be prevented by proper and regular adherence of simple practices.

People who are bedbound or have limited mobility may develop pressure ulcers.

The following is necessary for their proper skincare:

• Pad and protect vulnerable areas with transparent, hydrocolloid, composite, and/or foam-type dressings.
• Use draw sheets to pull up, transfer, and position the patients and do not drag them.
• Pay attention to the system's fluid intake, healthy diet, and regular bathing.
• Avoid hot water baths as they contribute to dehydration of the skin.
• After the patient is bathed, wipe their skin dry, and use special gels or moisturizers, as it maintains the skin’s hydration. The dermolex skin regenerating gel, recommended by many doctors and nurses, helps you the best.

This product can effectively reduce the risk of bedsores and support permanently bedridden patients with the help of its active ingredients of herbs (Aloe vera, Echinacea purpurea, and several others) which refresh, cool and regenerate the skin. The gel formulation is rapidly absorbed and will not stain the clothes or the bed linen as it does not contain any colourings or fragrances. The product is extremely easy to use: clean, and wipe the area carefully then apply dermolex gel in an even layer and gently massage it into the skin 1-2 times a day. Many healthcare workers and patients swear by the effectiveness of the product.

Restoring skin integrity

Pressure ulcer, also known as bedsores, has four phases and each must be treated differently. While the first stage can be treated even at home, treating the later stages might require the work of an entire health team, consisting of primary care physicians, dermatologists, infectious disease consultants, social workers, psychologists, dietitians, podiatrists, home and wound-care nurses, rehabilitation professionals, and surgeons.

In the first stage, there are no wounds on the skin surface, however, redness occurs, which does not whiten at finger pressure. The skin feels warm and painful. Here, it is still easy to reverse the lesion.

In the second stage, a skin defect appears on the upper epidermis, which resembles abrasion, and small blisters appear. Wounds should be bandaged regularly, several times a day, with wet, smart bandages that can be ordered by a dermatologist, surgeon, or rehabilitation specialist.

When re-binding, the previous cover is rinsed with a saline-like solution, and the dead parts are removed, then covered with hydrochloride and gel to keep the bond wet and prevent the development of infections.

In the third and fourth stages, skin and bone tissue necrosis begins, which is difficult to heal and very painful. The dead tissue is surgically removed by a doctor, followed by wound cleansing and disinfection to get rid of the bacteria and select the appropriate bandage. This is followed by the same procedure as the treatment of the second stage.

Conclusion

Our skin plays a really important part in our life: it protects our organs and muscles. This is why it’s so vital to keep an eye on skin integrity. Skin integrity means the health of our skin.

Maintaining skin integrity is important for everyone, however bedridden and elderly people have a higher chance of developing skin problems. In order to prevent these, regular skin assessment and skincare is advised.