Skin and Wound Care

• Skin tears are “a traumatic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through subcutaneous layer).” (LeBlanc et al, 2018)
• Skin tears are traumatic wounds that may result from a variety of mechanical forces such as shearing or frictional forces, including blunt trauma, falls, poor handling, equipment injury or removal of adherent dressings.¹
• In already fragile or vulnerable skin (e.g., in aged or very young skin), less force is required to cause a traumatic injury, meaning that incidence of skin tears is often increased.¹
• Skin tears can occur anywhere on the body, but are particularly common on the extremities.²

• Inspect skin daily
• Avoid use of adhesives on skin; use silicones when appropriate or paper tape
• Hydrate skin with moisturizers twice daily, especially after bathing
• Use warm, not hot, water for bathing
• Use soap-free, no-rinse skin cleansers and/or pH-neutral skin cleansers
• Protect skin from trauma by encouraging patient to wear long sleeves and pants to cover extremities
• Avoid sharp fingernails or jewelry in patient contact (for client and healthcare provider)

The aim is to preserve the skin flap, maintain the surrounding tissue, re-approximate the wound edges, and reduce the risk of infection and further trauma.³

• Control bleeding:
  • Apply pressure and elevate the limb if appropriate
  • Dressing with hemostatic properties may be used to control bleeding (alginates)
• Cleanse and debride:
  • Cleanse with normal saline and remove any debris (including hematoma)
  • Debride skin flap if not viable
• Re-approximate skin flap if viable:
  • Gently ease the flap back into place using a gloved fingertip, dampened cotton-tipped applicator or forceps
  • The flap will act as a biological dressing
  • Never use staples, sutures or skin closure strips to approximate edges 
  • Skin glue can be used to re-approximate skin flap edge
• Manage infection/inflammation:
  • Wound inflammation from trauma needs to be distinguished from wound infection
  • Wound infection can result in pain and delayed healing; determine wound infection based on wound assessment signs and symptoms - appropriate infection control measures should be taken
  • Check tetanus immunization status 
• Consider moisture balance/exudate control:
  • Skin tears tend to be dry, but for some exudate becomes a concern
  • Moisture balance is essential to promote healing and protect peri-wound skin from maceration
  • Consider exudate type and amount to decide on appropriate dressing
• Monitor wound edge/closure:
  • Skin tears are acute wounds that should typically follow an acute healing trajectory of 14-21 days
  • Ensure factors that could affect healing have been addressed (e.g., nutrition, diabetes, vascular supply, edema)
  • Compression therapy should be considered if the wound is on the lower leg