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Department: WOUND & SKIN CARE

Demystifying skin tears, part 1

LeBlanc, Kimberly A. BSCN, MHSCN, RN, CETN-C, IIWCC; Christensen, Dawn BSCN, MHSCN, RN, CETN-C, IIWCC

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doi: 10.1097/01.NURSE.0000390684.33761.83
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SKIN TEARS are a challenging type of laceration commonly seen in older adults but frequently mismanaged. In the United States, 1.5 million skin tears occur each year in older adults who are hospitalized or living in long-term-care facilities.1 This article focuses on understanding skin tears and which patients are at risk. Part 2 will focus on managing and preventing skin tears.

Shearing and friction

Skin tears are traumatic wounds, most often occurring on the extremities, in which shearing or friction causes the epidermis to separate from the dermis, or the epidermis and the dermis to separate from underlying structures.2 Older adults are at higher risk for skin tears for various age-related reasons (more on these shortly).3 Compared to more extensive and costly pressure ulcers, skin tears are often considered minor, inconsequential wounds. In reality, these wounds are painful and can lead to complications such as infection if not treated appropriately.4

Nearly 80% of skin tears occur on the arms and hands, but they can occur anywhere on the body; on the buttocks and back, they can be mistaken for Stage II pressure ulcers.1 The Payne-Martin Classification for Skin Tears is widely used in research and in the literature to define and classify these wounds (see Classifying skin tears).3,5

Age-related changes

Skin changes associated with aging increase the risk of skin tears and interfere with normal wound healing.1,2Intrinsic risk factors include dermal and subcutaneous tissue loss, epidermal thinning, and serum composition changes, which mean that older adults have decreased skin surface moisture, reduced skin elasticity, and reduced skin tensile strength.1 The risk of skin tears is further increased by dehydration, poor nutrition, cognitive impairment, altered mobility, and decreased sensation.3,6

Figure. C
Figure. C:
lassifying skin tears7

Extrinsic risk factors include the risk of mechanical trauma and the need for assistance with bathing, dressing, toileting, and transferring. Patients dependent on others for total care are at the greatest risk for skin tears.

Because soaps reduce the skin's natural lubrication, frequent bathing coupled with the natural decrease in lubrication associated with aging can increase an older adult's risk for skin tears.4,5

In a future article, we'll explore how you can manage and prevent skin tears.

REFERENCES

1. LeBlanc K, Baranoski S. Prevention and management of skin tears. Adv Skin Wound Care. 2009;22(7):325–332.
2. Patient Safety Advisory. Skin tears: the clinical challenge. Pennsylvania Patient Advisory Authority. 2006;3(3):5–10.
3. LeBlanc K, Christensen D, Orstead HL, Keast D. Best practice recommendations for the prevention and treatment of skin tears. Wound Care Canada. 2008;6(1):14–30.
4. Bank D, Nix D. Preventing skin tears in nursing and rehabilitation centers: an interdisciplinary effort. Ostomy Wound Manage. 2006;52(9):38–40, 44, 46.
5. Fleck C. Preventing and treating skin tears. Adv Skin Wound Care. 2007;20(6):315–320.
6. Brillhart B. Pressure sore and skin tear prevention and treatment during a ten month program. Rehabil Nurs. 2005;30(3):85–91.
7. Payne RL, Martin MC. Defining and classifying skin tears: need for a common language. Ostomy Wound Manage. 1993;39(5):16–20, 22–24, 26.

    RESOURCE

    Ayello EA, Sibbald RG. Preventing pressure ulcers and skin tears. In: Capezuti E, Zwicker D, Mezey M, Fulmer T., eds. Evidence-based Geriatric Nursing Protocols for Best Practice. 3rd ed. New York, NY: Springer; 2008.
      © 2010 Lippincott Williams & Wilkins, Inc.