What are skin tears?
Identification, prevention, care
What are skin tears?
Skin tears are traumatic wounds caused by blunt force, friction, and shear.[1] Skin tears involve the partial or full separation of the skin’s layers. They are one of the most common skin complications among older people.
Although they resemble large cuts and scrapes, there is usually a remaining skin flap that must be preserved, if possible. They can also vary in severity from patient to patient:
• A partial-thickness skin tear is when the top layer of the skin (the epidermis) separates from the deeper layer of the skin (the dermis). Partial-thickness tears are considered acute or ‘uncomplicated’ wounds, meaning that they will generally heal within a normal healing timeframe (approx. 4 weeks). [2]
• A full-thickness skin tear occurs when the first and second layers of skin separate from the underlying tissue (hypodermis). These skin tears are typically more complex or ‘complicated’ and may require more than 4 weeks to heal.[3]
They can occur anywhere on the body where the skin is particularly fragile. This is why they are most frequently seen on the arms, hands, and legs.
Patients with skin tears often complain of pain and stress significantly affecting their quality of life. Managing skin tears early and appropriately minimises the risk complications such as infection and delayed wound healing.
Who is at risk of skin tears?
Although skin tears can occur in those with immature skin (i.e., neonates and premature babies), they are most prevalent in older adults.[4]
As we age, the skin undergoes certain structural changes. This includes skin thinning, a loss of collagen and increased dryness. These skin changes can be accelerated by lifestyle choices (i.e., smoking), comorbidities and prolonged sun exposure, which ultimately impact its ability to heal and regenerate.[5]
Skin tears are more common in elderly patients with impaired mobility. This is because they generally require more assistance moving around and may use equipment (i.e., wheelchairs). The risk is even greater in patients with other underlying illnesses that require taking certain drugs known to affect the skin’s integrity (i.e., steroids).[6]
How to prevent skin tears?
Prevention requires a two-pronged approach: identifying risk and minimising risk. This should involve a thorough risk assessment that takes into account the patient’s health and any environmental risk factors.
Identifying patients at risk of skin tears is a fundamental part of prevention. This assessment should consider factors such as the patient’s skin, medical history, and any behaviours that may make them more vulnerable.[7]
Once vulnerable patients are identified, steps to minimise external risk factors must be taken to prevent avoidable skin tears. Measures that can be taken to maintain skin health and create a safer environment include:
• Stay hydrated (tears are more likely to occur in dry skin)
• Moisturise the skin
• Bathe using pH-balanced and soapless cleansing products (reducing loss of moisture in the skin)
• Improve nutrition
• Pad sharp objects and furniture that a patient may bump into
• Ensure adequate lighting and remove physical obstacles (vital for visually impaired patients)
• Wear protective clothing such as long sleeves and skin guards
• Avoid the use of strong adhesives on fragile skin
How to care for skin tears?
The appropriate skin tear treatment must begin as soon as possible to achieve good patient outcomes.
The primary objectives of this treatment are to preserve the skin flap, reapproximate the edges and protect the surrounding tissue.[9]
It is important to follow these protocols to prevent the skin tear from becoming a chronic wound:
• Control the bleeding
• Clean the wound
• Identify the severity of the tear
• Select the appropriate dressing[s]
• Monitor the wound bed
Apply light pressure and elevate the affected limb to control the bleeding. Once the bleeding has stopped, clean the wound with water or saline. Follow by realigning the flap (if possible) and applying the appropriate dressing.
It is very important to select a dressing that creates a moist healing environment, provides an extended wear time and atraumatic removal. Dressings with strong adhesives such as steri-strips are not recommended due to the fragility of the skin. Choosing a soft silicone dressing will ensure that the wound will remain as undisturbed as possible during the healing process.
Keep an eye out for any symptoms of infection such as pain, swelling, heat, exudate or odour.
With the correct care, small skin tears will normally heal on their own within a month. It is vital for those with larger or infected tears to seek medical advice.
References:
- LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008 (1): 20
- Ibid: 3
- Ibid: 3
- Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 13
- Ibid: 13
- Ibid: 13
- LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 6
- Ibid: 5
- Carville, K., Stephen-Haynes, J. Skin Tears Made Easy. Wounds International 2011; 2(1): 4
Useful videos:
How to apply and remove dressings for skin tears
ISTAP skin classification
Environmental risk factors
Useful articles:
What are skin tears? – Download this article
A guide to skin tear management best practice
A breakdown of the key benefits of silicone dressings for skin tears
Disclaimer:
Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.