Skin Tears

Building upon the literature and the work of others, the International Skin Tear Advisory Panel (ISTAP), established the following skin tear definition:

A skin tear is a traumatic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer).

Skin tears are acute wounds, which have a high probability of becoming complex chronic wounds, if not properly managed. Individuals suffering from skin tears complain of increased pain and decreased Quality of Life. In addition, because the populations at the highest risk for skin tears often include those at extremes of age and the critically or chronically ill, these individuals are at a higher risk for developing secondary wound infections and to have co-morbidities which can contribute to skin tears moving from acute to chronic complex wounds.

The new simplified ISTAP skin tear classification© is:

Type 1: No skin loss; Linear or flap tear that can be repositioned to cover the wound bed
Type 2: Partial skin loss; Partial flap loss that cannot be repositioned to cover the wound be
Type 3: Total flap loss; Total flap loss exposing entire wound bed

ISTAP also states: “A flap in skin tears is defined as a portion of the skin (epidermis/dermis) that is unintentionally separated from its original place due to shear, friction and/or blunt force. This concept is not to be confused with tissue that is intentionally detached from its place of origin for therapeutic use eg. Surgical skin grafting”

Etiology

The common causes of skin tears are shear, friction, or blunt trauma. Skin tears can occur on any part of the body, but are particularly common in populations with fragile skin, such as the elderly, chronic or critically ill, neonates and pediatrics.

Risk Factors

1. Dry, fragile skin
2. History of previous skin tears
3. Medications that affect the thickness of the skin (e.g. steroids, immune-suppressives, anti-inflammatories, anticoagulants)
4. Impaired mobility or vision
5. Cognitive or sensory impairment
6. Comorbid conditions such as chronic heart disease, diabetes, renal failure or cerebrovascular accident (stroke)
7. Dehydration
8. Poor nutrition
9. Intrinsic age-related risk factors: dermal and subcutaneous tissue loss, thinning of the epidermis, decrease in skin moisture, elasticity, and tensile strength.

Complications

Left untreated, skin tears can lead to complications such as pain, delayed wound healing, localized infection, cellulitis or generalized sepsis.

Treatments & Interventions for Skin Tears

The following precautions can help minimize the risk of developing skin tears in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Create a safe environment for the individual that will minimize the potential of bumping or knocking into furniture.
• When possible, pad and protect the extremities.
• Maintain skin integrity through a consistent skin care regimen and proper nutritional and fluid intake.
• Wear protective footwear and clothing to reduce the risk of injury.
• Ensure safe patient handling techniques are being used to limit risk of injury.
• Avoid the use of adhesive products on frail skin.

In treating a skin tear, the main goals are to preserve the skin flap if possible, protect the surrounding tissue, reapproximate the edges without undue stretching, and then protect the site to reduce the risk of infection and further injury. In selecting a dressing to use on a skin tear, look for a dressing and medical adhesives that will allow for atraumatic removal, extended wear time, and moist wound healing. If the dressing is opaque, use an arrow to indicate the direction in which the dressing should be removed so as not to disturb the flap. Monitor the wound for signs of infection, such as pain, increased exudate, swelling, heat, erythema, and odor.

References

LeBlanc K, Baranoski S. International Skin Tear Advisory Panel: A tool kit to aid in the prevention, assessment and treatment of skin tears using a simplified classification system. Advances in Skin & Wound Care. 2013;26(10): 459-478.

LeBlanc K, Baranoski S. Skin Tears: State of the Science: Consensus Statements for the Prevention, Prediction, Assessment, and Treatment of Skin Tears©. Advances in Skin & Wound Care. 2011;24(9)(Suppl 1):2-15.

LeBlanc K, Baranoski S. Validation of a new classification system for skin tears. Advances in Skin & Wound Care. 2013; 26(6).

LeBlanc K, Baranoski S, Holloway S, Langemo D. A descriptive cross-sectional international study to explore current practices, in the assessment, prevention, and treatment of skin tears. International Wound Journal 2014.

Stephen-Haynes J, Carville K. Skin tears Made Easy. Wounds International. 2011;2(4).

Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, et al. Standardising the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel (ISTAP) Classification System in 44 countries. British Journal of Dermatology. 2019 Oct 12. doi: 10.1111/bjd.18604. [Epub ahead of print])