What is the best treatment for skin tears?

Best Treatment for Skin Tears

The best treatment for skin tears is to gently cleanse the wound with warmed sterile water or saline, maintain the skin flap in place as a biological dressing, and apply a non-adherent dressing to protect the wound while it heals. 1

Understanding Skin Tears

Skin tears are traumatic wounds caused by mechanical forces that result in separation of skin layers. They are particularly common in older adults with fragile skin and typically heal within 7-21 days if managed properly 2. However, improper management can lead to chronic, non-healing wounds that compromise quality of life 2.

Treatment Protocol

Initial Management

• Gently cleanse the wound using warmed sterile water, saline, or a mild antimicrobial such as chlorhexidine (1/5000) to remove debris and reduce bacterial load 1
• If a skin flap is present, reposition it to cover the wound bed, acting as a biological dressing 1
• Decompress any blisters by piercing and expressing or aspirating fluid while maintaining the blister roof as a protective covering 1

Dressing Application

• Apply a greasy emollient (such as 50% white soft paraffin with 50% liquid paraffin) over the wound area to maintain moisture and prevent adherence 1
• Cover with a non-adherent primary dressing (such as Mepitel™ or Telfa™) to prevent disruption of the healing tissue 1
• Apply a secondary foam dressing to collect exudate and provide protection 1
• Secure dressings with wrap bandages rather than adhesive tape to prevent further skin damage 3

Ongoing Care

• Monitor for signs of infection (increased pain, erythema, exudate, odor) 1
• Change dressings as needed based on exudate levels, typically every 5-7 days if no complications arise 1
• Take wound swabs for bacterial and candidal culture if signs of infection develop 1
• Administer systemic antibiotics only if clinical signs of infection are present 1

Prevention Strategies

Since skin tears are largely preventable, implementing prevention strategies is crucial:

• Maintain skin hydration with regular application of emollients 3
• Protect vulnerable skin with padded clothing, long sleeves, and skin protectants 3
• Ensure safe patient handling techniques and padded equipment 3
• Create a safe environment by removing hazards and improving lighting 3
• Use proper adhesive removal techniques when removing medical devices or dressings 3

Advanced Treatment Options

For complex or non-healing skin tears:

• Consider negative pressure wound therapy as a bolster over conventional wound closure strips, which has shown promise in maintaining 100% viability of opposed skin tear tissue 4
• For infected wounds, apply topical antimicrobial agents only to sloughy areas (choice guided by local microbiological advice) 1
• Silver-containing products/dressings may be considered for infected wounds, though use should be limited if treating extensive areas 1

Common Pitfalls to Avoid

• Avoid aggressive cleansing that could further damage fragile tissue 1
• Do not use adhesive dressings directly on the wound or surrounding fragile skin 3
• Avoid topical antiseptic or antimicrobial dressings for routine wound healing 1
• Do not use honey or bee-related products for wound healing 1
• Avoid collagen or alginate dressings for routine treatment 1

By following these evidence-based approaches to skin tear management, healthcare providers can promote optimal healing while minimizing complications and preventing future skin tears.