What are skin tears?
Identification, prevention, care

What are skin tears?

Skin tears are traumatic wounds that are caused by blunt force, friction, and shearing.[1] A skin tear is defined as the partial or full separation or peeling back of the skin’s layers. They are one of the most common skin complications in 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 the expected rate of the normal wound healing process (approx. 4 weeks). [2]
• A full thickness skin tear is when the top and deeper layers of skin separate from the underlying tissue (hypodermis). They are typically more complex or ‘complicated’ and may require more than 4 weeks to heal.[3]

They can occur anywhere on the body where there is particularly fragile skin, which is why they are most frequently seen on the arms, hands, and legs.

What are skin tears? Identification, Prevention, Care

Patients suffering from skin tears often complain of pain and stress that significantly affects their quality of life. Managing skin tears early and appropriately reduces the chances of them developing various complications such as infection, sepsis, and delayed wound healing.

What are skin tears? Identification, Prevention, Care

Who is at risk of skin tears?

Although skin tears can occur in those with immature skin (e.g. neonates and premature babies), they are most prevalent in older adults.[4]

As we age, the skin experiences structural changes. These changes can be accelerated by prolonged sun exposure, which can damage skin cells, and lead to a reduction of collagen production and a thinning of the skin’s top layer. These changes impact the skin’s capacity to regenerate, which increases its susceptibility to skin tears.[5]

They are more common in elderly patients with impaired mobility, because they require assistance moving around or washing by carers or equipment (e.g. wheelchairs). This risk increases even further in patients with other underlying illnesses or those taking certain medications that affect the skin’s integrity (e.g. steroids).[6]

How to prevent skin tears?

Prevention requires a two-pronged approach: identifying risk and minimising risk. This involves a full holistic skin evaluation and an assessment of any environmental risk factors.

Identifying patients at risk of skin tears is a fundamental part of prevention. This assessment considers factors such as the patient’s skin, medical history, and any behaviours that may make them more vulnerable.[7]

Once at-risk patients are identified, steps to minimise external risks must be taken to prevent avoidable skin tears. Measures can be taken to maintain skin health and create a safer environment to reduces incidences of skin tears:
• 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 improve patient outcomes.

The primary objectives of this treatment are to preserve the skin flap, reapproximate the edges without unnecessary stretching, and to protect the surrounding tissue.[9]

To achieve this, it is crucial to pay attention to the following factors to create the optimal conditions for healing and prevent the tear transitioning from an acute wound into 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 and clean the wound with warm saline water. Once the wound is clean and dry, realign the flap if possible and apply the appropriate dressing.

It is very important to select a dressing that allows for a moist healing environment, an extended wear time, and atraumatic removal. Dressings with strong adhesives such as steri-strips are usually not recommended due to the fragility of the skin. The right dressing will ensure that the wound bed will remain as undisturbed as possible during the wound healing process.

Keep an eye out for symptoms of infection such as pain, swelling, heat, exudate, and odour.
With the correct care, small skin tears will normally heal comfortably on their own within a month. It is vital for those with larger or infected tears to seek medical advice.

What are skin tears? Identification, Prevention, Care
References:
  1. LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008 (1): 20
  2. Ibid: 3
  3. Ibid: 3
  4. Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 13
  5. Ibid: 13
  6. Ibid: 13
  7. LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 6
  8. Ibid: 5
  9. Carville, K., Stephen-Haynes, J. Skin Tears Made Easy. Wounds International 2011; 2(1): 4

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