Wound Care Made Incredibly Easy

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External threats to skin integrity

tear may end up with a chronic wound. The constant weeping from the edema does not allow the wound to close (without adequate compres sion) and the subcutaneous tissue may be compromised due to the chronic injury from poor edema control. Chapter 7 includes methods to control such edema and allow the skin tear to heal.

This bump and small skin tear occurred on the way to a shower. Because of the chronic lymphedema (unhealthy subcu taneous tissue), this injury took 7 months to heal and required Unna wraps for com pression, changed weekly. Remember to keep legs covered until after transferring into a shower chair!

Risk factors and prevention

Get wise to wounds

A 6-month prospective cohort study in two Japanese long-term care hospitals reported a 13% incidence of skin tears (Minematsu et al., 2021). They noted predictive factors such as dry skin and actinic purpura (mild bruises that occur without known trauma to fragile capillaries usually due to aging). In another study, an Australian hospital reported a prevalence of skin tears of 8.9%, most often happening in patients over age 70 and most often due to falls or collisions with equipment (Miles et al., 2022). A 4-week study of a long-term care population in Ontario, Canada, showed a prevalence of 20.8% and incidence of 18.9% (LeBlanc et al., 2020). A report from six U.S. long-term care facilities showed a 9% prevalence rate with an average age of 83 among those sustaining wounds (Hawk & Shannon, 2018). The majority had mobility limitations, supporting mobility as a risk factor, and a third of the skin tears were due to falls. What can be done to reduce the occurrence of skin tears? Certainly, preventing falls is essential, but simple nurs ing interventions such as encouraging good nutrition and hydration and twice-daily moisturizer for at-risk skin are also helpful. A review of literature showed that a comprehensive skin tear bundle, or a standardized way to prevent and treat skin tears, can decrease incidence and prevent complications (Al Khaleefa et al., 2022).

Classification of skin tears

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In order to standardize treatments for skin tears, it is helpful to speak the same language about the severity of the injury. The International Skin Tear Advisory Panel (ISTAP) Classification System is one tool for categorizing skin tears.