Linda Nazarko Consultant Nurse Clayponds Hospital August 2015 Skin tears Linda Nazarko Consultant Nurse Clayponds Hospital August 2015

Healthy skin Protection Sensation Heat regulation Storage Absorption

Ageing skin Thinned epidermis Loss integrity, loss fat Thinned dermis Dryness Slow replacement Reduced immune function Increased risk sunburn and skin damage Senile purpura

How illness & ageing affect healing Anaemia – reduces oxygen, delays healing. Cardiac disease – reduces oxygen & nutrients. Hypertension – reduced blood flow Diabetes, peripheral neuropathy, arterial problems NSAIDs & steroids – impair healing

Caring for older skin Prevent dry skin Avoid overlong soaks Protect from damage Prevent soreness Treat dry skin

Who is at risk? Frail older people People who have had long term steroids Very thin people who lack subcutaneous fat People with dementia People with visual impairment

How do we treat? Determine category of skin tear – this affects treatment. Categories are: 1a, Linear type 1b, Flap type 2a, Less that 25% loss tissue 2b, More than 25% of flap lost during trauma 3, Entire loss of tissue caused by trauma or death of skin flap.

Category one tears Control bleeding: Use Kaltostat. This has haemostatic properties. Other alginates don’t. Moisten with saline, squeeze out excess Leave for 10 minutes If flooded replace When bleeding has stopped treat.

Rolled up skin Priority to unroll skin flap without damaging: Apply saline to flap. This rehydrates skin. Don’t use saline spray. This can damage skin. Use saline from sachet or pod. Drip onto skin Rehydration takes 3-5 minutes. Gently unroll skin with your gloved fingers Spread skin back over the wound

Treating the tear The wound is now covered with skin Apply steristrips Tension important. Too tight wound edges become necrotic. Too loose wound edges don’t heal Apply primary dressing

Dressing the tear Use Mepitel. Doesn’t stick, doesn’t damage on removal. If not available then use a tulle dressing folded into at least four pieces. Dangers are that wound will bleed and you’ll remove scab and damage wound edges Apply absorbent dressing and soft conforming bandage

Caring for the wound Check secondary dressing daily first three days. Replace if needed. Leave primary dressing and steristrips in place Then check alternate days and replace secondary dressing if needed Remove primary dressing and steristrips after seven days Apply protective dressing to protect healed tissue

Category two tears Effectively two different wounds. Use what is left of skin flap to cover wound. Don’t pull skin too tightly. Use techniques we’ve discussed for flap Cover the entire wound with mepitel (or substitute) Use foam dressing over the entire wound Check wound as discussed and replace secondary dressing as needed

Ongoing care category two tears On day seven you will have an area of healed skin and a granulating wound. A foam dressing can protect healed skin and encourage granulation. Tielle is suitable if wound is not too wet. If wetter use another type of foam dressing with a conforming bandage. Don’t use adhesive foams. You may damage fragile skin Don’t use a hydrogel. It will damage the healed skin by macerating it.

Category three tears All tissue is lost. This will heal by granulation. Control bleeding. If this is problem use moistened kaltostat as primary dressing. Use mepitel as primary dressing if possible. Then you won’t have to disturb granulating tissue. Use foam dressing as secondary dressing Check foam daily. Replace as needed. Change mepitel on day seven.

Prevention An ounce of prevention is worth a ton of cure. Identify problems. Work out solutions Pad frames, pad chair arms, apply protective dressings Look at the person’s clothes. Bigger sizes, different styles Staff behaviours, techniques

Thank you for listening Any questions?

Recommendations for dressings are based on personal experience and I have no financial relationship with the makers of recommended dressings