7 May 2021
Patients with aged and fragile skin are at increased risk of skin tears, a significant problem for patients and the healthcare professionals who treat them. The right dressing is essential to better management.
What is a skin tear?
A skin tear is defined as a 'traumatic wound cause by mechanical forces, including the removal of adhesives'. A common example is the 'pulling off' of a dressing or band-aid that also removes skin with it. Skin tears can be classified into different categories depending on how much skin is lost.
Up to 80% of skin tears occur on hands and arms, making it an important concern for Hand Therapists. The skin on a hand can be thinner, often not covered by clothing, with less blood flow and our hands are in constant use. A skin tear injury can lead to infection or progress to a chronic, complex wound.
Skin tears can result in partial or full separation of the skin's outer layers, commonly creating a skin flap. Partial separation is when just the top layer separates (the epidermis). Full separation is when the top layer and the lower layer (the dermis) separate. They do not go down to the subcutaneous layer - this will be identified as a different type of wound.
They can be classed from Category Type 1-3.
- Type 1: no skin loss (skin flap can be replaced to cover the wound).
- Type 2: partial skin loss (skin flap can be replaced but won't fully cover the wound).
- Type 3: total skin loss (no skin flap and wound open).
Treatment of a skin tear
What's the big deal? Just whack a band-aid on?! Skin tears can very quickly become chronic wounds. The fragile, exposed skin that caused the tear in the first place is not always a great place to get good wound healing. It is essential that a great technique is used and the right dressing is chosen. This is important as if it is done right, we can leave a skin flap to heal over a week without any intervention. If a bad job is done, it may mean taking a dressing off and ruining all the skins new growth. Active Hand Therapy Hand Therapists folllow the below treatment guidelines:
- Assessment of the wound and the surrounding tissue. Including size, exudate, colour, skin flap loss and presence of infection
- Application of appropriate wound care including: controlling any bleeding by applying gentle pressure and decontaminating the area as required.
- Closure of the wound flap via appropriate method. Large, extensive, full thickness wounds may require surgical intervention.
- Appropriate application of wound dressings to be applied. Minimising use of tapes and films. Silicone, foam, hydrogels and light bandages can all be used for various categories.
- Prevention of further skin tears and management of any medical concerns. eg oedema
- Reassessment of the wound.
As the most common wound in older adults, good management will lead to reduced complications.
Written by David Coles and Dee Coles