Skin tears: Preventing and treating a common condition among elderly patients

October 1, 2008

Untreated skin tears can become complex wounds and demand the care of a dermatologist. Up to 1.5 million skin tears occur annually in adults in healthcare facilities in the United States. Natural changes in the aging process, including diminished elasticity and decreased tensile strength, make the skin more susceptible to a tear.

Key Points

Toronto - Clinicians need to inform patients of simple preventative steps they can take to avoid skin tears from occurring on various sites of the body, an expert says.

Speaking in Toronto at the World Union of Wound Healing Societies, an international gathering of woundcare specialists, Kimberly LeBlanc, B.Sc.N., R.N., E.T., M.N., I.I.W.C.C., describes various therapeutic interventions to respond to skin tears as well as preventative strategies to avoid tears from occurring.

It is estimated that 1.5 million skin tears occur annually in adults in healthcare facilities in the United States. Skin tears occur due to shearing, friction or blunt trauma that causes separation of skin layers.

"We should ultimately be looking at how we can prevent these wounds from happening," she says.

Prevention

While there is no gold standard that exists for the management of skin tears, the Canadian Association of Wound Care has published best-practice recommendations for preventing and treating various wounds, including pressure ulcers, venous leg ulcers and diabetic foot ulcers.

These recommendations are available on the association's Web site at http://www.cawc.net/.

Just as clinicians record a history for health measurements of organs such as the heart, they should record a history for the skin to establish whether patients have a record of skin tears and what the causes of the tears have been.

There are natural changes that occur in the skin with the aging process that make the skin more susceptible to a tear, such as loss of naturally occurring oils, diminished elasticity and decreased tensile strength.

Consequently, elderly patients in long-term care facilities should not be subject to too many baths that will dehydrate the skin and heighten the risk of a tear.

"It's advisable to use a moisturizer on the skin and to minimize bathing," Ms. LeBlanc says.

In addition, a diet that ensures adequate nutrition and hydration will be protective against the development of a skin tear.

Daily risks

Woundcare clinicians need to consider what occurs in daily living activities that can present a risk of skin tears, such as dressing, bathing and repositioning and transferring patients.

This makes patients who are dependent on others at increased risk for developing skin tears.

If patients are repeatedly having skin tears on their lower legs, placing padding on bed rails and furniture may be a means to avoid the tears from occurring.

Ensuring that a living environment has adequate light can help patients avoid accidental bumps.

Clinicians can also consider providing patients with shin guards to decrease repeat skin tears to the lower legs.

Ensuring that patients have shorter nails that are filed to avoid self-injury is also a protective step that clinicians can take. This can ensure that patients don't scratch themselves and tear their skin.

"We also need to look at what we bring to the table," Ms. LeBlanc says, noting that clinicians need to ensure their nails are at an appropriate length and they are not wearing jewelry that may contribute to tearing a patient's skin.

Categorizing tears

When tears do occur, clinicians should categorize the tear according to the extent of trauma.

One of the more popular classification systems for skin tears is the Payne-Martin Classification for Skin Tears.

According to the system, category I tears are those where there has been no tissue loss and the tear is either a full-thickness tear (linear type) or partial-thickness tear (flap type). Tears that are category II tears are those with partial tissue loss, and category III are skin tears with complete tissue loss where the epidermal flap is absent.

Treating tears

When treating skin tears, the ability to heal should be determined, necrotic tissue removed and bacteria controlled. Moist wound-healing should be the principle that guides therapeutic choices and product selection.

For category I skin tears, topical bandages like skin glue, silicone or low-tack foam dressings are typically appropriate therapies to use.

For category II skin tears, silicone or low-tack foam dressings are suitable. If the skin tear is bleeding, alginate underfoam should be used.

Category III skin tears should be treated in the same manner as category II skin tears.

The use of hydrocolloids or traditional transparent film dressings is not suggested, as they can cause stripping if they are not removed correctly, Ms. LeBlanc says.