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

2. Healthy skin
Protection
Sensation
Heat regulation
Storage
Absorption

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

4. 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

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

6. 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

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. 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

17. Thank you for listening
Any questions?

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