March 2017 - Volume 30 - Issue 3

  • Richard "Sal" Salcido, MD
  • 1527-7941
  • 1538-8654
  • 12 issues per year
  • 1.337
Current Issue Highlights


Payment Strategies

Practice Points

Product News

Industry News

Association News

Original Investigations

Clinical Management Extra

Welcome to Wound Clinical Solutions Investigation (CSI). See if you can make the diagnosis.

Q.  A 76-year-old retired school teacher developed a skin tear on the dorsal surface of her left hand. What is the best approach to manage skin tears?


 Skin tears 2017.jpg

A. According to the International Skin Tear Advisory Panel (ISTAP), a skin tear often results from trauma on the extremities, such as the arms, hands, pretibial areas and feet. Significant friction or shear forces the epidermis to be detached from the underlying dermal layer exposing deeper structure. As with other injuries, patients develop exquisite pain and fear further injury. This affects their quality of life and mobility. More than 1 in 4 patients within the healthcare system has evidence of skin tears at any given time. The ISTAP created a classification system to describe skin tears based on the amount of tissue loss. Skin tears can be described as type 1 with an intact skin flap and no tissue loss; type 2 involves partial tissue loss; and type 3 with complete tissue loss.


The ISTAP system is simple to easy and has been translated and validated in various languages, including Dutch, French, and Portuguese to date. The purpose is to create a universal language to describe skin tears that can match different treatment approaches. In the photos here, the patient suffered from a type 1 skin tear. She was at risk because of her age, dry skin, falls risk, and chronic use of a steroid, making her skin paper thin. The key to managing this type of skin tear is to ensure the skin flap is rolled back into its original position to approximate the edges and cover the exposed tissue; sterile strips and sutures should be avoided. Alternatively, acrylate type agents can be applied or sprayed on the edges of the skin tear to keep the flap in place. Dressing selection is based on the volume of drainage from the skin tear. In general, atraumatic nonadherent dressings are preferred to cover and leave in place for 7 days. Whatever dressing material that is chosen to cover the skin tear, it is advisable to draw an arrow to indicate the direction from which the dressing should be removed. If the dressing is removed in the opposite direction, the skin flap will likely be ripped off completely, causing more extensive damage. To prevent recurrence, daily moisturization is crucial.


For further information, readers are encouraged to review the following article published in this journal: LeBlanc K, Baranoski S, Christensen D, et al. The Art of Dressing Selection: A Consensus Statement on Skin Tears and Best Practice. Adv Skin Wound Care 2016;29:32-46.








Decreasing Multidrug-Resistant Bacteria Levels

Burn injuries are associated with high mortality associated with infections, especially those who suffer extensive burns that cover 40% or more of the body. Pseudomonas aeruginosa is one of the most lethal pathogens, found in approximately 33% of all burn cases and in 59% of extensive burns. Researchers from the Southwestern Medical Center in San Antonio showed that topical application of an engineered adhesion inhibitor molecule, Multivalent Adhesion Molecule 7, substantially decreased the multidrug-resistant Pseudomonas aeruginosa levels in wounds in the first 24 hours after administration. The molecules also prevented the spread of the infection to adjacent tissue for 3 days and aided wound healing by maintaining normal inflammatory responses. The new approach targets the microbes' ability to bind, or stick, to cells in an early and crucial step in causing infection.

FDA Approves PolyPlex Wound Dressing

Global Health Solutions has secured 510(k) clearance from the FDA for its PolyPlex wound dressing.  PolyPlex is a petrolatum-based topical gel that features the company's PermaFusion delivery system to provide protection against bacteria, fungi, and yeasts without irritation to fragile and healing tissue.  It is indicated for acute and chronic wound management. Petrolatum base may promote moist wound healing with minimal risk of causing maceration wounds like hydrogels.  PermaFusion delivery system is also used in the firm's other wound dressing product, CurX antimicrobial gel.

Evaluating Pain Management with Topical Analgesics

Clarity, an international scientific research company based in Austin, Texas, has released the results of a study titled, "Optimizing Patient Experience and Response to Topical Analgesics".  The study was intended to evaluate patient perceptions of pain treatment with the use of FDA-approved topical/transdermal formulations alone or in combination with neuropathic supplements.  The latest analysis of more than 1000 patients ranging in age from 18 to 64 indicates the efficacy of topical analgesic in reducing 45% of opioid usage and a significant reduction of nonopioid drugs to treat chronic pain. Most patients found the topical analgesics convenient and easy to use with minimal reported side effects.

SkinGun Technology Receives Patent Extension

RenovaCare has developed an autologous (self-donated) stem cell therapy for the regeneration of human organs and the US Patent and Trademark Office has granted an additional 30-month extension for the patent, providing protection beyond the year 2035.  The SkinGun technology is designed to isolate and spray a liquid suspension of a patient's stem cells onto burns and wounds for rapid self-healing. Independent studies have demonstrated that human skin stem cells sprayed with the SkinGun maintained 97.3% viability. The device and related systems are under development and have not received FDA approval.