KEY POINTS:
- Skin tears are common as skin becomes thinner and drier with aging.
- Careful wound care and infection prevention can keep a skin tear from becoming a chronic wound.
- Home healthcare nurses can work with your wound care doctor to ensure the best possible wound care in the comfort of your home.
James, an 88-year-old man, fell after tripping over his wheelchair pedal, sustaining bruising and skin tears along his right arm and leg. Nancy, his wife, took him to the hospital for emergency care. The wounds were bandaged, and James was given the option of being admitted to a skilled nursing facility until he recovered or receiving home health care. James was adamant about returning home. Nancy took him home and contacted local home health agencies to arrange for twice-weekly home care to clean, debride, and bandage his wounds. Unfortunately, none of the home health care agencies accepted their insurance.
Nancy called their primary care physician, who was also unable to secure home health care for James. They agreed that Nancy would bring James to the office weekly for wound checks and to manage his care. On follow-up a week later, it was clear that things were not going well. James had an increased margin of redness surrounding the wound, indicating a skin infection.
James was given a referral to see a wound care specialist.
What causes skin tears?
Aging skin thins and loses its elasticity. Dryness and a lack of collagen cause thin, papery skin on the arms and legs. Shear forces, friction, and pressure cause delicate skin to come apart with brief, light pressure. Any bump, injury, or even removing a bandage can cause a skin tear. The smallest injuries can cause bruising.
The epidermis, the outer layer of the skin, separates from the dermis (inner layer). Sometimes, both layers separate from deeper tissue.
Why aging skin tears:
- With aging, there is a 20% loss in dermal thickness.
- The fatty layer beneath the skin becomes thinner.
- A loss of collagen causes the skin to be less resilient.
- The junction between the upper and middle layers of skin flattens, making it easier for them to separate.
- Loss of elastin reduces the skin’s ability to stretch.
- Blood vessels in the skin become thinner and more fragile.
- A decrease in sweat glands leads to dryness.
- Decreased pain sensation increases the incidence of trauma and injury.
- Increased skin surface pH increases the risk of infection.
- Decreased lipids in the skin cells lead to drying.
- Medications, such as diuretics, can also cause skin dryness.
What are the stages of a skin tear?
Skin tears are an avulsion injury, meaning the upper layer of the skin is torn off.
- CATEGORY 1: the skin flap fully covers the wound and appears pink and healthy; takes an average of 10 days to heal.
- CATEGORY 2: the skin flap is damaged and does not reach the edges of the wound, the skin flap may or may not be healthy; takes an average of 14 days to heal.
- CATEGORY 3: the skin flap is completely gone; takes an average of 21 days to heal.
If a skin tear has not healed significantly within four weeks or completely in eight weeks, it is considered a chronic wound.
James had three skin tears. Two of them were category 2, and one was category 3. The category three wound was painful and still had significant drainage when Nancy called Sunland Home Care & Medical for assistance.
How do you fix skin tears?
When caring for skin tears, the goal is to keep the wound free from infection, protect the surrounding skin, and keep the wound moist to promote healing.
- Wash your hands.
- Control the bleeding by elevating the limb and applying pressure.
- Clean the wound and the skin flap using saline or mild soap and water.
- Pat dry and gently cover the wound with the skin flap using a cotton tip swab or a gloved finger.
- Apply bandages as directed. Choose one that does not cause further skin trauma when it is removed and maintains a moist environment for optimal healing.
- Mark the bandage to indicate which way it should be removed to preserve the skin flap.
- Apply emollient cream around the wound to protect it from any drainage.
What not to do when treating skin tears
Some products can impede healing and should be avoided when cleaning and bandaging skin tears. Do not use:
- Adhesive dressings or tape.
- Aqueous creams.
- Harsh and drying soaps.
- Products with added fragrance.
- Iodine-based dressings.
- Alcohol or Merthiolate products on open wounds.
Are skin tears serious?
Skin tears can be serious, especially if they get infected. Watch for:
- Redness, pus, or a foul odor coming from the wound
- Increased swelling or pain
- A wound that tears open again
- A fever
- Pale or dark color to the skin flap or surrounding skin which may indicate dying skin
How to prevent skin tears
Skin tears occur in 2.1% of men and 4.6% of women living in the community, and 9% of residents in skilled nursing facilities. Prevention of skin tears means making the environment as safe as possible and protecting the skin.
Skin protection strategies:
- Drink plenty of water to keep your skin as hydrated as possible.
- Wear long sleeves and pants to protect the skin.
- Avoid the use of steroid creams.
- Avoid excessive sun exposure.
- Apply emollients to the skin twice daily to moisten and protect it. Dry skin tears more easily and takes longer to heal. Emollients hydrate the skin by preventing evaporating of water and drawing water from the dermis to the skin surface. Emollients typically have a neutral to low pH and have anti-inflammatory properties. Try an emollient with 10% urea content.
Environmental factors:
- Keep the environment well lit. Use light sensors that come on with motion.
- Remove loose rugs and any obstacles on the floor.
- Pad sharp corners on furniture, beds, and wheelchairs.
How can home health care help you with your skin tears?
Skin tears can be challenging to treat. Caregivers must watch for signs of infection or dead skin, change bandages as directed, and report any concerns to their wound doctor.
Nancy was uneasy while caring for James’ wounds. She was concerned that his wounds might become infected under her care and that he would become seriously ill.
She contacted Sunland Home Care & Medical and arranged for nursing care. The nurse who was assigned to James spoke with his wound care doctors and followed their instructions. James’ wound healed significantly over the next three weeks. After three weeks of professional nursing care, Nancy felt that his wounds had healed well enough for her to manage. James was able to remain in his home, and Nancy received the support she needed.
Sunland Home Care & Medical can:
- Monitor skin for signs of infection or dead tissue.
- Clean wounds and change bandages.
- Work with your wound care doctors.
- Provide help when your family cannot.
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