Can you give some guidance on skin tears?

Skin acts as a protective barrier. It provides lipid barriers, maintains the acid mantle, and protects against fluid loss microorganism invasions. Protection is the best way to prevent skin tears.

Skin tears are a persistent problem for long-term care facilities. A skin tear is defined as a wound caused by shear, friction or blunt force injury resulting in the separation of skin layers. There are more than 1.5 million skin tears reported annually by institutions, with prevalence rates ranging from 14% to 24%. People over age 75 are prone to skin injuries due to a decrease in the composition of collagen and elastin, reduction in sebum production, thinning of muscle stores, flattening of rete ridges, and functional status decline such as a reduced immobility. 

Identification of residents “at risk” for skin tears upon admission to the facility and the implementation of a skin tear prevention program will help reduce the incidents of skin tears. The risk of skin tears should be assessed based on the individual’s condition and noted in the medical record. If a skin tear occurs, it should be classified based on the International Skin Tear Advisory Panel ‘s Skin Tear Classification System:

Type 1 — No skin loss

Type 2 — Partial flap loss (cannot be repositioned to cover the wound)

Type 3 — Skin loss

Care of a skin tear should include local wound care, debridement if necessary, treatment for any existing infection, and the avoidance of staples, sutures, and adhesives. Approximate the skin flap unless the skin is necrotic. 

Acrylic dressings, foams, contact layers, calcium alginates for moist wounds or hydrogels if wounds are dry and need hydration, are all acceptable dressings for skin tears. Avoid hydrocolloids, transparent adhesive dressings, and skin steri-strips.