What are the 5 most important steps
of skin tear management?

Following the appropriate skin tear management protocols is crucial to securing the best patient outcomes.

Several guidelines, classifications, risk assessments, and products are available to help at-risk people. To lower the occurrence of skin tears and promote healing, it is vital to regularly assess the effectiveness of prevention strategies and treatments in both domestic and clinical settings.

Skin tears are generally classified as acute wounds. An acute wound is one that heals within a normal healing timeframe (approximately 1 month).

Acute wounds can often be closed by primary intention. Sutures, staples, and adhesive strips are frequently used on these types of wounds.

Neonates and older people are at a higher risk of skin tears. This is because their skin tends to be more fragile than the average person’s skin. As such, the more traditional methods of closing wounds by primary intention are far too aggressive, and therefore, unfeasible.

Skin tear management requires the use of different treatment methods to accommodate the structure of the wound and the fragility of the skin.

Skin tear treatment should focus on preserving the skin flap, reapproximating the wound edges, preventing infection, and protecting the periwound.[1]

STEP 1. Control the bleeding

• If necessary, apply pressure and elevate the limb to reduce blood flow to the injured area.
• Pre-select a dressing that supports haemostasis.

STEP 2. Cleanse and debride the wound

• Cleanse the wound and remove any leftover debris or blood. Then, carefully pat the wound dry to avoid further trauma.
• If there is a remaining skin flap, but it is necrotic, it is likely that it will need to be debrided. Extra care should be taken during debridement to maintain skin integrity and protect the surrounding skin.
• If the skin flap is viable, reapproximate it by slowly easing it back into place using gloved fingertips.

STEP 3. Control inflammation and infection

• It is important to distinguish between inflammation that is caused by the natural wound healing process and inflammation that is caused by infection.
• Wound infections can cause patient discomfort and delay wound healing. If an infection is suspected, a clinical evaluation should be performed and the appropriate management measures should be implemented.

STEP 5. Monitor the skin flap and wound edge

• Skin tears are acute wounds that require immediate treatment to promote healing within the normal wound healing timeframe.
• Make sure that all intrinsic and extrinsic factors that may delay healing are being treated simultaneously.
• If the skin tear is on the leg, conduct a full lower limb and vascular assessment to determine if compression therapy is required.

References:

1. LeBlanc K et al. Best practice recommendations for the prevention and management of skin tears in aged skin. Wounds International 2018: 11-12