What is the proper care for a skin tear?

Skin Tear Management

Clean the wound gently with warmed sterile water or saline, decompress any blisters by piercing at the base without removing the skin flap, apply the detached skin back over the wound as a biological dressing, and cover with a nonadherent dressing plus emollient to maintain moisture. 1

Initial Wound Assessment and Cleaning

• Gently irrigate the skin tear with warmed sterile water or saline to remove debris and reduce infection risk, using higher volumes (100-1000 mL) at adequate pressure for effective cleaning. 1
• Alternatively, use dilute chlorhexidine (1/5000) as an antimicrobial cleansing solution if contamination is suspected. 1
• Warmed cleaning solutions may reduce procedural pain compared to cold solutions. 1
• Handle the wound area carefully to minimize shearing forces and prevent extension of the tear. 1

Management of the Skin Flap

• Pierce any blisters at the base with a sterile needle (bevel up), selecting a site that allows gravity drainage. 2
• Apply gentle pressure with sterile gauze to facilitate drainage and absorb fluid. 2
• Do NOT remove the detached skin flap—leave it in place to act as a natural biological dressing that protects the underlying dermis and promotes healing. 1, 2
• Reposition the skin flap carefully over the wound bed after decompression. 1

Dressing Application

• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the entire wound to support barrier function, prevent drying, and reduce transcutaneous water loss. 1, 2
• Cover with a nonadherent dressing (such as Mepitel™ or Telfa™) to prevent trauma during dressing changes. 1
• Use a secondary foam or absorbent dressing (such as Exu-Dry™) to collect exudate if needed. 1
• Avoid adhesive dressings directly on fragile skin—if tape is necessary, use soft silicone tape and consider silicone medical adhesive removers (SMARs) for removal. 1

Infection Prevention and Monitoring

• Monitor closely for signs of infection including increased pain, erythema, purulent drainage, or systemic symptoms (fever, confusion). 1
• Take bacterial and viral swabs from areas showing clinical signs of infection, particularly sloughy or crusted regions. 1, 2
• Apply topical antimicrobials only to sloughy or infected areas for short periods—avoid routine prophylactic use. 1, 2
• Consider silver-containing products for infected wounds, but limit use if extensive areas are involved due to absorption risk. 1
• Change dressings using aseptic technique to minimize contamination. 2

Ongoing Wound Care

• Keep the wound moist with occlusive dressings and/or topical emollients—this significantly shortens healing time compared to dry wound management. 1
• Avoid rubbing or aggressive cleansing that could extend the tear. 1
• Document the location and extent of skin tears daily to monitor progression. 2
• Consider daily bathing with antiseptics for extensive erosive wounds. 2

Common Pitfalls to Avoid

• Never remove the skin flap entirely—this eliminates the natural biological barrier and delays healing. 1, 2
• Avoid adhesive products on fragile skin, including standard tape, adhesive dressings, and blood pressure cuffs directly on skin. 1
• Do not allow wounds to dry out—maintaining moisture is critical for optimal healing. 1
• Avoid over-aggressive irrigation pressure that could extend the tear, but ensure adequate volume for effective cleaning. 1

When to Seek Specialist Care

• Refer for specialist wound care if signs of infection develop, healing is delayed beyond expected timeframes, or the wound shows conversion to a more complex chronic wound. 1, 3
• Consider specialist consultation for extensive skin tears covering large body surface areas or those in high-risk patients with multiple comorbidities. 3, 4