Should the skin be left in place with a mild skin tear?

Management of Mild Skin Tears

For mild skin tears, the skin flap should be left in place to serve as a biological dressing, as this promotes optimal healing and reduces the risk of infection. 1

Understanding Skin Tears

Skin tears are traumatic wounds commonly found among individuals with fragile skin, particularly in older adults. They are largely preventable but frequently encountered in emergency and unscheduled care settings 2, 3. These tears occur when mechanical forces cause the epidermis to separate from the dermis or when both the epidermis and dermis separate from underlying structures.

Assessment and Management

Initial Wound Care

• Gently cleanse the area with sterile normal saline (avoid iodine- or antibiotic-containing solutions) 1
• Remove superficial debris but avoid deeper debridement which could enlarge the wound and impair skin closure 1
• Position the skin flap back in place to cover the wound bed
• Leave the skin flap intact as it serves as a biological dressing 4
• Avoid applying direct pressure that might compromise blood flow to the skin flap

Dressing Selection

• Apply a non-adherent dressing to protect the skin tear and maintain proper positioning of the skin flap
• Consider covering with a sterile occlusive dressing as wounds heal better with less infection when covered 1
• Avoid adhesive dressings directly on fragile skin as they can cause additional skin tears upon removal 5

Follow-up Care

• Monitor the wound for signs of infection (increased pain, redness, swelling, purulent drainage)
• Keep the affected area elevated if swollen to accelerate healing 1
• Follow up within 24 hours either by phone or during an office visit 1

Special Considerations

Infection Prevention

• If infection develops despite good wound care, consider antimicrobial treatment and possible hospitalization 1
• Watch for signs of infection including pain disproportionate to the injury, increasing erythema, or purulent drainage

Wound Closure

• Do not suture infected wounds 1
• For mild skin tears, primary closure with the skin flap is preferable to delayed closure

Prevention Strategies

• Identify patients at risk (those taking steroids, anticoagulants, or with comorbidities affecting balance) 2
• Implement skin protection measures for vulnerable individuals
• Educate patients, caregivers, and healthcare providers about prevention techniques
• Use proper techniques when applying and removing adhesives or dressings 5

When to Refer

• If the skin tear shows signs of infection despite appropriate care
• If the wound fails to heal within expected timeframes
• If the patient has comorbidities that may impair wound healing (diabetes, peripheral vascular disease)

By maintaining the skin flap in place and providing appropriate wound care, mild skin tears can heal effectively with minimal scarring and reduced risk of complications.