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

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

Several guidelines, classifications, risk assessments, and products to help manage high-risk people are available. 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 the normal healing timeframe, which is approximately 1 month.

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

Neonates and older people are at a high 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 and reapproximating it to the edges of the wound, reducing the risk of infection, and protecting the periwound.[1]

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

What are the overall goals of skin tear management?

• Treat the cause
• Implement prevention strategies
• Maintain a moist healing environment
• Avoid further trauma
• Protect periwound skin
• Control exudate
• Prevent infection
• Reduce pain

What are the critical first steps of skin tear treatment?

As with all wound care, treatment should begin as soon as the wound occurs to reduce the risk of any complications that may cause a skin tear to progress from an acute wound into a chronic wound.

When a patient has a skin tear, a full holistic evaluation of the patient and the wound is necessary to determine the treatment plan to suit the severity of a particular tear.

STEP 1. Control the bleeding

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

STEP 2. Cleanse and debride the wound

• Cleanse the wound according to standard protocol and remove any leftover debris or blood clots. Then, pat the wound dry gently 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 is required during debridement to maintain skin integrity and protect the surrounding skin.
• If the skin flap is completely viable, reapproximate it by gently easing it back into place using gloved fingertips.

STEP 3. Control inflammation and infection

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

STEP 4. Maintain moisture balance

• Skin tears are normally dry wounds, but if there is any exudate, it is important to maintain an adequate moisture balance to prevent the skin from macerating.
• Take into account the amount of exudate when selecting a dressing. For example, if exudate control is necessary, consider selecting a soft silicone primary wound contact layer.
silicone dressing

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 trajectory.
• Make sure that all intrinsic factors that may potentially delay or exacerbate the wound healing process are being treated simultaneously.
• In the event that the skin tear is on the leg, conduct a full leg 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
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