Skin Tears
a review of current management
therapies and their application
Trudie Young
3m Road Show
Care of the Older Person’s Skin:
Meeting the Challenge
Skin Tear Definition
Fleck 2007
• “Skin tears are
traumatic wounds
that result from a
separation of the
two major layers of
the human skin,
the epidermis and
the dermis.”
Skin Tears
• USA - mandatory
reporting of skin tears
(Pennsylvania)
• Residents identified as at
risk for skin tears should
be placed on a
prevention protocol,
treatment protocols
should also be in place
Skin Tear Classification System
Payne Martin 1993
• Category 1 – skin tears without tissue loss,
• linear type or flap type
• Category 2 – skin tears with partial tissue loss,
described as 25% more or less of skin loss
• Category 3 – skin tear with full-thickness tissue
loss. The epidermal flap or tissue is absent in
this type of skin tear
Skin Tears – sites and risk factors
Malone 1991, McGough-Csarny 1998,
Meuleneire 2002
• Main site - upper extremities – forearm
• Risk factors – medication (sedating,
dehydrating or long term steroid use), sensory
loss, history of previous skin tears,
compromised nutrition, joint stiffness,
contractures, cognitive impairment,
dependency, poor lighting, low furniture
Skin Tears – Causes
Malone 1991, McGough-Csarny 1998,
Meuleneire 2002
• For many injuries the cause was unknown
although some happened during episodes of
nursing care
• Known causes – falls, wheelchairs, restraints,
transfers, violent behaviour, bed rails, jewellery,
fingernails, taking blood, tape removal, taking off
and putting on socks and tights, tight clothing,
bandage application and slippage
Pretibial lacerations
Davis 2004
• Postal questionnaire to A & E units
• Incidence 5.2 per 1,000 attendees
• Treatments – adhesive tape, dressings (including
dry dressings), sutures!!!!!!!!!!!!
Treatment Issues
• Historical options –
drying the flap out,
Bactroban
• Ritualistic options –
antiseptic use despite no
signs of infection
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
Assessment should
be carried out to
determine the cause
of the skin tear and
this should be
removed to prevent
further injury
Early detection of
skin trauma through
identification of the
cause may prevent
further skin
breakdown
Health records have
evidence that
assessment has
been carried out to
determine the cause
of the skin tear, and
that this has been
removed
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
The skin tear should
be classified
according to the
degree of tissue
damage
Classification of the
damage enables
correct and suitable
treatment and
intervention to be
initiated and
maintained
Health records show that
individuals with a skin tear
have had a full assessment
and that a plan of
management has been
developed, which
incorporates review of the
wound and continuity of
care between different
care settings
Best Practice Statement 2006
Statement
Reason
Management of skin Wounds which are
tears should
managed following
consider:
the principles of
Stopping bleeding if it is moist wound
persistent
healing, result in
•Preventing infection
enhanced healing
•Minimising pain and
rates and reduced
discomfort
infection rates
•Recovering skin
integrity
How to demonstrate
statement is being
achieved
Evidence of initial
and ongoing
management to
prevent further
tissue damage
should be recorded
within the
individual’s health
records
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
Management of
wounds involves
maintaining skin
integrity:
If the skin tear has
dried out, it should
be removed using a
sterile technique
Wounds which are
managed following
the principles of
moist wound
healing, result in
enhanced healing
rates and reduced
infection rates
Treatment
interventions and a
plan of care should
be evident within
the individual’s
health records
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
If the skin flap is still
viable, cleanse with
warm, saline or tap
water, and roll the
flap back into place
to obtain optimum
skin cover
Wounds which are
managed following
the principles of
moist wound
healing, result in
enhanced healing
rates and reduced
infection rates
Treatment
interventions and a
plan of care should
be evident within
the individual’s
health records
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
If the skin tear is
viable, secure using
one of the
suggested methods:
Wounds which are
managed following
the principles of
moist wound
healing, result in
enhanced healing
rates and reduced
infection rates
Treatment
interventions and a
plan of care should
be evident within
the individual’s
health records
•Adhesive wound
closure strips
•Skin glue
•Silicone non-adhesive
dressings
Best Practice Statement 2006
Statement
Reason
How to demonstrate
statement is being
achieved
The method of skin
application will still
require the
application of an
appropriate
secondary dressing
to provide further
protection
Wounds which are
managed following
the principles of
moist wound
healing, result in
enhanced healing
rates and reduced
infection rates
Treatment
interventions and a
plan of care should
be evident within
the individual’s
health records
Treatment Issues
• Lower limb - Localised oedema - compression therapy,
consider ABPI, pulse oximetry
• Arrow on outer dressing to orientate flap position
• Analgesia
• Use of adhesive and fixation products
Preventative options
•
•
•
•
•
•
•
•
•
•
Protective gloves, short nails, no jewellery (carer & client)
Padding to wheelchair arm and foot rests
Correct manual handling and transfer techniques
Long sleeve clothes and trousers, padded garments
Keep the individual and thus their skin well nourished and
hydrated
Frequent application of emollients
Adhesive removers
Moving and handling techniques
Barrier preparations/ skin protectants – IV fixation
Environmental awareness