If you work with elderly patients, then you have probably seen “skin tears.” There is a nice basic article (see full reference below) on the topic that recently crossed my desk. I’d like to share some of the information with you. (photo credit)
I will consider the etiologic factors associated with the development of skin tears through these 2 subdivisions: pathomechanical & pathophysiological.The French term la melodie de la peau de papier ("the melody of the little piece of paper") is useful to describe both the mechanical (human machine interface) and the pathophysiological (human) mechanisms of skin tears.To make the point, try the following experiment. First, take a clean smooth piece of paper on a flat surface and run your hand and fingers over the top surface. There should be no drag or friction, and the surface tension should be minimal-a smooth ride, if you will.Now take that same paper, fold it, make a tear in it, and, finally, wrinkle and moisten it. Now repeat the experiment by the hand motion. There is a significant increase in the drag coefficient (Cd) (increasing the resistance and shear forces), decreased surface tension, and further damage to the paper surface. In this experiment, the paper was the surrogate for the skin, and I consider this a model for explaining the mechanisms of mechanical forces and how they contribute to skin tears.
- Advanced age (>85 years of age)
- Sex (female)
- Race (white)
- Immobility (chair or bed bound)
- Inadequate nutritional intake
- Long-term corticosteroid use
- History of previous skin tears; presence of ecchymoses
- Altered sensory status or cognitive impairment
- Stiffness and spasticity
- Using assistive devices; Visual impairment
- Applying and removing stockings
- History of vascular, cardiac, and/or pulmonary problems
Once again, the STAR consensus was to simplify the parameters of assessment anda category 1a or 1b skin tear is one ‘where the edges can be realigned to the normal anatomical position
(without undue stretching)’.A category 2a or 2b skin tear presents ‘where the edges cannot be realigned to the normal anatomical position (without undue stretching)’.
- Category 1a or b skin tears can be treated with adhesive strips anchor or Dermabond to the re-approximated edges
- Category 2a or b skin tears can be treated with soft silicone or low tact foam dressing.