Management of Large Skin Tears
For a large skin tear, apply white soft paraffin (petrolatum) or a petrolatum-based ointment to the wound after gentle cleansing, then cover with a nonadherent dressing such as Mepitel or Telfa, followed by a secondary foam dressing to absorb exudate. 1, 2
Initial Wound Care
Cleansing the wound:
- Gently irrigate the skin tear with warmed sterile water, saline, or dilute chlorhexidine (1:5000) to remove debris and reduce bacterial load 1
- Avoid aggressive scrubbing that could extend the tear or damage fragile surrounding skin 3
Handling the torn skin flap:
- Leave the detached skin flap in place whenever possible—it acts as a natural biological dressing that protects the underlying dermis 1
- If blisters are present, decompress them by piercing and expressing fluid, but preserve the overlying skin 1
Topical Ointment Selection
Primary recommendation - Petrolatum-based products:
- Apply white soft paraffin (plain petrolatum) or a 50:50 mixture of white soft paraffin with liquid paraffin over the entire wound area 1, 2
- Petrolatum-based ointments provide equivalent or superior wound healing compared to antibiotic ointments, without the risk of allergic contact dermatitis or antibiotic resistance 4, 5
- Consider aerosolized formulations to minimize shearing forces during application 1
Alternative options if petrolatum unavailable:
- Petrolatum-based antibiotic ointments (polymyxin or bacitracin) are acceptable alternatives, though antibiotics add minimal benefit for clean wounds 1, 4
- Natural ointments containing aloe vera and honey may promote healing and reduce erythema 6
Products to avoid:
- Do NOT use silver sulfadiazine on skin tears—it prolongs healing time and increases infection rates 7
- Avoid preparations containing urea, salicylic acid, or other active ingredients that risk systemic absorption through denuded skin 1
- Avoid products with fragrances or preservatives that may cause irritation 1
Dressing Application
Primary dressing layer:
- Apply a nonadherent dressing directly to the wound (Mepitel or Telfa are specifically recommended) 1
- These dressings prevent trauma during dressing changes while maintaining a moist wound environment 1
Secondary dressing layer:
- Use a foam or absorbent burn dressing (such as Exu-Dry) over the nonadherent layer to collect wound exudate 1
- Hydrocolloid or foam dressings that are adherent yet easily removable are gentle alternatives for smaller tears 1
Ongoing Management
Dressing change frequency:
- Change dressings when saturated with exudate or if signs of infection develop 1
- For large tears, daily assessment is essential to monitor healing progress and detect early infection 7
Monitoring for complications:
- Watch for increased pain, purulent drainage, expanding erythema, or systemic signs of infection (fever, confusion) 1
- If infection is suspected, obtain wound cultures before starting systemic antibiotics 1, 7
Pain management:
- Over-the-counter analgesics such as acetaminophen or ibuprofen are appropriate for pain control 1
Critical Pitfalls to Avoid
- Never apply topical antibiotics to large surface areas as monotherapy—this increases resistance risk and provides no healing advantage over petrolatum 4
- Avoid removing the skin flap unless it is clearly necrotic or infected—intact flaps significantly improve healing 1
- Do not use adhesive dressings directly on fragile skin surrounding the tear, as removal can cause additional trauma 3
- Avoid excessive moisture from occlusive dressings that may macerate surrounding skin—balance moisture retention with exudate absorption 1
When to Seek Specialist Care
Refer for specialist wound care or surgical evaluation if: 3
- The tear involves the face, hands, feet, or genitalia
- There are signs of deep tissue involvement or exposed structures
- The wound shows no healing progress after 2 weeks
- Signs of infection develop despite appropriate local care
- The patient has significant comorbidities (immunosuppression, vascular disease) that impair healing