What is the recommended treatment for a small skin tear?

Small Skin Tear Treatment

For small skin tears, the recommended treatment is to gently cleanse the wound with clean water or saline, leave the skin flap in place as a biological dressing, and apply a non-adherent dressing such as Mepitel or Telfa with a greasy emollient. 1

Initial Management

1. Cleansing the Wound:

   • Perform hand hygiene before touching the wound 1
   • Gently cleanse the wound with clean water, saline, or an antimicrobial solution 1
   • Take care not to disrupt any intact skin flap during cleaning 1

2. Blister/Skin Flap Management:

   • Do not remove the skin flap - leave it in place as a biological dressing 1
   • If there is a blister, pierce it at the base with a sterile needle to allow drainage 1
   • Select a site where fluid will drain by gravity to prevent refilling 1
   • Gently apply pressure with sterile gauze to facilitate drainage 1

Dressing Application

1. Primary Dressing:

   • Apply a non-adherent dressing directly to the wound (e.g., Mepitel or Telfa) 1
   • Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over denuded areas 1

2. Secondary Dressing:

   • Apply a secondary foam dressing to collect exudate (e.g., Exu-Dry) 1
   • Secure with non-adhesive wraps or bandages - avoid adhesive tapes directly on fragile skin 2

3. Dressing Changes:

   • Change dressings every 2-3 days unless excessive exudate requires more frequent changes 1
   • Use silicone medical adhesive removers (SMARs) when removing any adhered products to prevent further skin damage 2

Infection Prevention

• Monitor for signs of infection such as increasing pain, erythema extending >5cm beyond wound margins, temperature >38.5°C, or heart rate >110 beats/minute 1
• Systemic antibiotics are only indicated if there are signs of disseminated infection or systemic symptoms 1
• For minor cuts and scrapes, a small amount of topical antibiotic (like bacitracin) may be applied 1-3 times daily to help prevent infection 3

Special Considerations for Older Adults

• Skin tears are common in older adults due to age-related skin changes including declining dermal thickness and loss of elasticity 4
• Prevention strategies are crucial for those at risk, including:
  • Using soft clothing to cover affected areas 1
  • Avoiding skin irritants such as perfumes, deodorants, or alcohol-based lotions 1
  • Applying moisturizing lotions to keep skin hydrated 5
  • Using protective padding on bed rails or furniture edges for those at high risk 5

Follow-up Care

• Document the size and location of the wound to monitor healing progress 1
• Most skin tears should heal within 7-21 days with proper care 6
• If the wound shows signs of infection or isn't healing as expected, seek further medical evaluation

Common Pitfalls to Avoid

• Removing the skin flap (this should be left in place as a biological dressing) 1
• Using adhesive tapes or dressings directly on fragile skin 2
• Aggressive cleansing that could disrupt the wound bed 1
• Ignoring signs of infection that would require additional treatment 1
• Neglecting preventative measures in those with fragile skin who are at risk for additional tears 5