Skin tears are painful wounds common in older adults whose skin has lost elasticity and become thinner.
NOTE: Skin tears are a serious condition that can lead to hospitalization if untreated. Skin wounds should be assessed and treated as soon as possible by a medical professional.
The simplest definition of a skin tear is a wound that separates the top layer of the skin from one or more of the underlying layers. The principal causes of skin tears are mechanical trauma, often from wheelchair injuries, removal of adhesive tapes or dressing, transfers and falls, though sometimes no apparent cause is found. They are most often seen on arms, top of the hands, and lower legs.
Because skin tears are so common and don’t require stitches, they may be considered minor injuries. However, they can be slow to heal and become painful and costly. Every skin tear should be treated as a potentially serious injury.
Risk factors for Skin Tears
Risk factors for Skin Tears can include, among others:
- Age >75 years
- Gender (more common in females)
- History of:
- skin tears
- aggressive behavior
- Thinning skin
- decreased levels of collagen, elastin, and glycosaminoglycans
- atrophy and contraction of the dermis (wrinkles and folds)
- thinning blood vessel walls which decrease blood supply to arms and legs
- Dehydrated skin
- decreased activity of sweat glands and sebaceous glands
- Impaired mobility
- Reliance on others for activities of daily living
- Cognitive or sensory impairment (dementia, vision problems)
- Poor nutrition and hydration
- Some medications (e.g., steroids)
- Conditions such as diabetes, anaemia, and postural hypotension
Assessment and Classification of Skin Tears
To family caregivers, all wounds may look alike–messy, bloody, and scary. There are important differences, however, and knowing what kind of wound you are dealing with is the first step in proper treatment and prevention.
- Category 1 No skin loss – A skin tear without loss of tissue, either linear or with a flap that closes the tear to within 1mm of the wound edges.
- Category 2 Partial flap loss – Partial tissue loss is considered scant when tissue loss is <25 percent and moderate or large when the tissue loss is >25 percent.
- Category 3 Complete tissue loss – Resulting in no epidermal flap covering the injury.
In general, skin tears are considered to be uncomplicated if they heal within four weeks or complicated (complex/chronic) if they take longer than a month to heal.
If you or the person you care for has a skin tear, it is important you seek medical attention as soon as possible.
The following video describes how to care for skin tears and offers some suggestions for prevention.
Preventing Skin Tears
You can minimize the risk of developing skin tears by taking measures such as:
- Keeping fingernails trimmed and not wearing jewellery
- Padding and/or removing any potentially dangerous furniture or devices (e.g. bed rails and wheelchairs)
- Covering skin with appropriate clothing, shin guards, or retention bandages/stockinette in vulnerable patients
- Protecting the skin’s general integrity by using skin-friendly (pH balanced) products and preventative emollients
Sources: IndependentNurse.co.uk; AARP Answers; Woundsinternational.com
We hope this information is helpful to you in the important work you do as a family caregiver.
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