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Words on Wounds

A forum to discuss the latest news and ideas in skin and wound care.

Thursday, April 23, 2020

How do we know a skin tear is healed?

skin tear 1.jpg

George is a long-term care resident who developed a skin tear on his lower leg (Figure 1, above). A silicone dressing was used to cover the open area and left in place for 7 days (Figure 2, below). 

skin tear 2.jpg

What dressing the best option for the treatment of skin tears?

Wound healing is a dynamic process that requires a delicate balance of various host and local wound factors. One of the challenges in wound management is to maintain moisture balance to create an environment that is conducive to healing. Although a desiccated wound surface can slow down cellular migration, impairing wound healing, excessive moisture can damage wound edges and periwound skin. Recognizing the importance of moist wound healing, a plethora of dressings have been developed and are available in the marketplace for clinician use.  Scientific evidence for the treatment of skin tears is lacking but this clinician prefers to use atraumatic silicone dressings to prevent further periwound skin damage.

How should providers measure skin tears?

Wound measurements comprise the longest wound length and width dimensions that are perpendicular to each other to estimate wound surface areas. For type 1 or 2 skin tears, the measurement should include the flap (which is the damaged skin), not just the open/exposed dermal tissue.

Upon reassessment, how do we know the skin tear is healed?

  • Completely healed type 1 skin tears: when a dry, slightly firm healing ridge or new epithelium has formed along the edge when the flap meets the skin. The healing ridge is described as an area of swelling and hardness under the re-approximated skin edges indicating deposition of new collagen in the wound.
  • Completely healed type 2 or 3 skin tears: when the wound edges are bridged by new epithelium, including the establishment of a healing ridge. 
The following Table may also help: Skin Tear Predicted Healing Times and Signs and Symptoms of Healing
Outcome MeasureDays 1-4Days 5-9Days 10-14 (proliferative healing)Day 15  (remodeling)
Type 1 Skin Tears
Periwound olorRed edges approximatedRed, progressing to bright pink (all  skin tones)Bright pink (all skin tones)Pale pink, progressing to white or silver in light-skinned patients; pale pink, progressing to darker than normal skin color or may blanch to white in dark- skinned patients
Surrounding tissue inflammationSwelling, redness or skin discoloration, warmth, painNone presentNone presentNone present
Drainage typeSerosanguinous None presentNone presentNone present
Drainage amountModerate to minimalNone presentNone presentNone present
EpithelializationPresent by day 14Present along entire wound PresentNone present
Healing ridgeNone presentPresent along entire wound by day 9Present along entire woundPresent
Type 2 and 3 Skin Tears
Periwound colorRed edges not approximatedPeriwound skin red, progressing to bright pink (all  skin tones)Bright pink (all skin tones)Pale pink, progressing to white or silver in light-skinned patients; pale pink, progressing to darker than normal skin color or may blanch to white in dark- skinned patients
Surrounding tissue inflammationSwelling, redness or skin discoloration, warmth, painNone presentNone presentNone present
Drainage typeSerosanguinous SerosanguinousSerosanguinousNone present
Drainage amountModerate to minimalModerate to minimalMinimalNone present
EpithelializationNoneNone PresentNone present
Healing ridgeNone presentNone presentPresent along entire woundPresent

Table © 2020 Kim LeBlanc & Kevin Woo.