wound on arm dressed professionally by community nurses

Author: Rachel Taylor, National Clinical Nurse Educator, Access Group.

The International Skin Tear Advisory Panel (ISTAP) defines a skin tear as a wound caused by shear, friction, and/or blunt force resulting in separation of skin layers 

A skin tear can be a partial thickness (separation of the epidermis from the dermis) or full thickness (separation of both the epidermis and dermis from underlying structures). 

73-80% of all skin tears occur on the upper extremities of the body, such as the biceps area, elbow, forearm and top of the hand. 15% occur on the lower extremities such as the shin, top of the foot. Only 5% occur on the rest of the body.

Unfortunately,  lack of awareness means that skin tears are regularly misidentified, mistreated or even ignored. According to the former President of ISTAP, as many as 50% of skin tears may result in the transition to severe wound infections and hard to heal wounds.  

Skin tears are acute wounds and the populations at highest risk include those at extremes of age and the critically or chronically ill. They can cause an increase in pain and decrease in the quality of life. There is also a higher risk of developing secondary wound infections. 

A full assessment of the wound is required to determine: 

  • Anatomical location and duration of skin tear 
  • Dimensions (length, width depth) 
  • Wound bed characteristics and percentage of viable/non-viable tissue 
  • Type and amount of exudate 
  • Presence of bleeding or haematoma 
  • Degree of flap necrosis 
  • Integrity of surrounding skin 
  • Signs and symptoms of infection 
  • Associated pain

Assessment and Treatment

1. Prepare
  • Control the bleeding 
  • Cleanse the wound 
  • Reapproximate the skin flap
2. Assess and Classify

Skin at Risk – Mature skin is more vulnerable and prone to skin tears 

Type 1: No skin loss : Linear or flap tear that can be repositioned to cover wound bed 

Type 2: Partial flap loss : Partial flap loss that can not be repositioned to cover the wound bed 

Type 3: Total Flap Loss : Total flap loss exposing the entire wound bed 

Risk Reduction 

Skin – iSTAP recommends emollient therapy as a vital part of skin care in clients with aged skin
Mobility – Encourage active involvement, avoid friction and shearing.
General Health – Educate client on skin tear risk and prevention.  

How to choose a dressing? 

  • Ensure dressing is appropriate for the level of exudate, size of skin tear and skin type. 
  • Atraumatic upon removal, not causing any further damage to wound bed and any remaining skin flap. 
  • Moist wound healing and protects periwound skin. 
  • Always draw an arrow on dressing to indicate direction of removal and either date to be changed or date dressed. 
  • If skin tear is on lower leg consider compression therapy, as best practice 

Ideal dressing for skin tears

  • Easy to remove and apply
  • Does not cause trauma on removal 
  • Is non-toxic; provides a protective anti-shear barrier 
  • Creates an optimal environment for healing 
  • Is flexible and moulds to contours 
  • Manages exudate and infection 
  • Can afford extended wear time

Dressings not recommended 

  • Iodine based dressings  
  • Strong adhesives that can cause more skin trauma such as films and hydrocolloids  
  • Adhesive closure strips – expert opinion suggests these are no longer a preferred treatment option for skin tears as they can increase the risk of skin trauma on removal  
  • If adhesive closure strips are used – use minimally on full Thickness flaps, and secure skin-to-skin (not skin-wound-skin), and allow gaps for wound exudate  
  • Avoid staples and suturing on older person’s skin 

 

Focus on compression in lower leg skin tears – our next article  

When managing lower leg skin tears, it is recommended that compression should be considered as a component of treatment.  To ensure that the treatment is effective and cost effective, early assessment and differential diagnosis are key in managing lower leg skin tears. Assessing Ankle Brachial Pressure Index (ABPI) should be considered an essential part of holistic assessment. In the next article we will go into more details around using doppler for assessment and compression treatment, part of  Total Care Health community nursing services.   

 

References 

  • Bank D, Nix D. Preventing skin tears in a nursing and rehabilitation center: an interdisciplinary effort. Ostomy Wound Manage 2006;52(9):38-46 
  • Bryant R. A. Types of Skin Damage and Differential Diagnosis In Bryant, R.A., Nix D.P., Acute and Chronic Wounds: Current Management Concepts, edition 5, St. Louis, Elsevier, 2016 
  • LeBlanc, K., Baranoski, S. et al. Skin Tears: State of the Science: Consensus Statements for the Prevention, Prediction, Assessment, and Treatment of Skin Tears.. Advances in Skin and Wound Care.2011;24(9S). 
  • Carville, K., Lewin, G., et.al. STAR: A consensus for skin tear classification. Prim Intent 2007; 15(1):18-28. 
  • Coloplast: A pathway for treating a person with a skin tear. 
  • International Skin Tear Advisory Panel: Evidence Based Prediction, Prevention, Assessment, and Management of Skin Tears. LeBlanc et al. 
  • Konya C. et al. Skin injuries caused by medical adhesive tape in older people and associated factors. Journal of Clinical Nursing, 2010. 
  • LeBlanc K, Baranoski S. Prevention and management of skin tears. Adv Skin Wound Care 2009;22(7):325-334. 
  • LeBlanc K. et al. Skin tears: The forgotten wound. Nursing Management, 2014. 
  • LeBlanc K et al. Best practice recommendations for the prevention and management of skin tears in aged skin. Wounds International, 2018. Available to download from www.woundsinternational.com. 
  • Malone, L.M.,et al. The Epidemiology of Skin Tears in the Institutionalized Elderly. Journal of the American Geriatrics Society, 1991. 
  • Skin tears and skin tone. LeBlanc K, Dhoonmoon L, Samuriwo R. Made Easy Wounds International. 2024