Does a large superficial skin tear require trimming of the extra skin?

Management of Large Superficial Skin Tears

For large superficial skin tears, the extra skin flap should not be trimmed off but rather preserved and repositioned to its original location whenever possible to promote optimal healing and reduce scarring.

Assessment and Classification

When evaluating a skin tear, consider:

• Size and depth of the tear
• Viability of the skin flap
• Location of the tear
• Patient factors (age, comorbidities, medications)

Evidence-Based Management Approach

Primary Management of Skin Flaps

1. Preserve the skin flap

   • According to the 2018 World Society of Emergency Surgery/Surgical Infection Society-Europe consensus, only devitalized/infarcted skin should be removed while normally perfused skin should be spared 1
   • When skin viability is questionable, preservation and reassessment at a second evaluation is indicated 1

2. Reposition the flap

   • Clean the wound gently with normal saline or wound cleanser
   • Carefully reposition the skin flap to its original anatomical position
   • Avoid applying tension to the skin flap

3. Secure the flap

   • Use wound closure strips or silicone-based dressings to hold the flap in place
   • Consider a disposable negative pressure wound therapy device as a bolster in appropriate cases 2

Wound Care After Repositioning

• Apply a non-adherent dressing that will not disrupt the flap when changed
• Avoid adhesive dressings directly on fragile skin
• Keep the wound environment moist but not macerated
• Minimize dressing changes to reduce the risk of disrupting the healing flap

Rationale for Preserving Skin Flaps

1. Biological benefits:

   • The skin flap serves as natural biological coverage
   • Contains viable cells that can contribute to healing
   • Provides a template for re-epithelialization
   • Reduces wound contraction and scarring

2. Clinical outcomes:

   • Faster healing times compared to trimming the flap
   • Reduced risk of infection
   • Better cosmetic results
   • Decreased pain during healing

Special Considerations

• For elderly patients: Skin tears are particularly common in this population due to fragile skin 3. Extra care should be taken when handling the skin flap.

• For infected wounds: If signs of infection develop, more frequent monitoring is needed, but the flap should still be preserved unless it becomes clearly necrotic.

• For poorly healing wounds: If the repositioned flap fails to adhere after 5-7 days, reassess and consider alternative treatments.

Prevention Strategies

Skin tear prevention is critical, especially in high-risk populations:

• Twice-daily moisturization of skin 3
• Proper patient handling techniques
• Padding of equipment and furniture
• Education of healthcare providers and caregivers 4

By following this approach of preserving and repositioning skin flaps rather than trimming them, clinicians can optimize healing outcomes and minimize complications in patients with large superficial skin tears.