kin tears are a common occurrence for nonacutely ill residents of long-term care facilities. These painful, traumatic injuries can include minimal to complete tissue loss. The physiological changes that occur in the skin with aging include a decrease in subcutaneous tissue, dehydration, and atrophy of the skin. These conditions predispose the elderly to an increased risk of developing skin tears. The attachment between the epidermis and the dermis becomes thin and fragile - minor trauma can result in a separation of these layers, creating a skin tear. An estimated 1.5 million skin tears occur each year in nursing homes in the United States.1 These acute traumatic injuries can incur additional unanticipated treatment costs. Most skin tears occur in the upper extremities.Figure 1
|  | | Full thickness skin-tear (1cm x 1.5 cm). |
One of the keys to successful wound care is choosing the dressing that has the most appropriate fit for managing the needs of the wound and periwound skin. Characteristics of the ideal skin tear dressing include the ability to:
* maintain a moist wound environment
* manage a wide range of wound drainage
* protect the wound and periwound skin from trauma upon dressing removal
* conform to the wound
* be cut without impacting the integrity of the dressing
* provide pain-free dressing application and removal
* render a cost effective method for managing the wound.Figure 2
|  | | Applying soft silicone dressing on the wound and surrounding skin. |
An effective dressing for managing skin tears is Mepitel(R) (Molnlycke Health Care, Newtown, Pa.). This porous, nonadherent, soft silicone contact layer dressing can be used for a variety of wounds, including painful wounds, graft sites, granulating wounds, second-degree burns, and skin tears. It will adhere gently but firmly to intact skin so it remains in place for several days. When removed, the dressing does not damage the fragile surrounding skin because it does not adhere to the moist wound bed, allowing for virtually pain-free dressing changes. In addition, it protects newly forming tissue in the wound bed from damage during wear.
Because of the dressing's open structure, topical ointments can penetrate the wound and drainage can pass through to an outer absorbent cover dressing of choice. The base dressing, therefore, can be left in place over the wound for several days while the cover dressing can be changed as needed.
Case StudyFigure 3
|  | | Nonadherent cover dressing over the soft silicone dressing. |
Ms. K is an 81-year-old woman who sustained a skin tear in December 1997. She has a complex medical history that includes Alzheimer's Disease, seizure disorder, peripheral vascular disease, depression, chronic obstructive pulmonary disease, and impulse control disorder with aggression, and she is blind due to dense cataract formation. She was at high risk for developing a skin tear due to her thin, atrophic skin, impaired perception, limited mobility, and mental confusion including disorientation and aggression.
Her full-thickness skin tear measured 1 cm x 1.5 cm with a viable wound base (see Figure 1). The surrounding periwound skin was intact although ecchymotic. The skin tear wound was cleansed with normal saline. The soft silicone dressing was applied to the wound and the surrounding skin (see Figure 2). A low adherent dressing was applied as a cover dressing and secured with a gauze wrap (see Figure 3). The fragile surrounding skin was protected from further injury/trauma.
In most cases, the soft silicone dressing can remain in place for 7 to 10 days. The cover dressing is usually changed daily for the first few days post injury and then on an as-needed basis. In Ms. K's case, the skin tear was completely healed in 15 days (see Figure 4).Figure 4
|  | | Healing skin tear. |
Maintaining a moist wound environment that will facilitate the process of epithelialization and granulation is an important part of healing. When a dressing adheres to a wound bed, the newly forming tissues can be damaged upon dressing removal. Active bleeding and pain are indications that tissue has been damaged. Using a soft silicone dressing helps alleviate the pain and potential damage of dressing changes, improving the chances for both healing and less stressful wound management for patients, especially those with skin at risk. - OWM |
