Skin Tear Repair
Answer: E
This is an example of a skin tear, common in patients with thin, fragile skin, such as the elderly and those on long-term corticosteroids.
Skin tears are classified into categories I, II, and III. Category I tears have no tissue loss; after wound cleansing, the edges may be approximated with surgical tape (‘steri-strips’), and covered with a non-adherent dressing.
Category II tears have some (partial) tissue loss, and category III tears have complete tissue loss. These advanced tears can be treated by supporting secondary intention healing with petroleum-saturated gauze, hydrogels, foams, hydrocolloids, or any other wound dressing that promotes a clean, moist environment. Frequent dressing changes and wound checks are recommended in these types of wounds. Elastic tubing is a good support for any skin-tear application (see picture):
Suturing (B,C) skin tears should be avoided if possible, especially when superficial. The skin’s fragility does not support the use of sutures, which rely on collagen integrity (the suture will typically tear through the thin skin).
Cyanoacrylate tissue adhesive (‘dermabond’) (D) is an option. However, this is best used when the wound edges are nearly approximated. Surgical tape has the advantage in that there is more wound support; in addition, surgical tape allows for drainage of the wound. This should be considered in wounds that may be ‘dirtier’ than others.
Due to your efforts, the patient comes in three weeks later for an unrelated complaint, and proudly shows you the results of your careful approach to her wound care:
From ABEM LLSA 2010 reading list:
Singer AJ, Dagum AB. Current Management of Acute Cutaneous Wounds. N Engl J Med. Sept 2008;359(10):1037-1046.
This is an example of a skin tear, common in patients with thin, fragile skin, such as the elderly and those on long-term corticosteroids.
Skin tears are classified into categories I, II, and III. Category I tears have no tissue loss; after wound cleansing, the edges may be approximated with surgical tape (‘steri-strips’), and covered with a non-adherent dressing.
Category II tears have some (partial) tissue loss, and category III tears have complete tissue loss. These advanced tears can be treated by supporting secondary intention healing with petroleum-saturated gauze, hydrogels, foams, hydrocolloids, or any other wound dressing that promotes a clean, moist environment. Frequent dressing changes and wound checks are recommended in these types of wounds. Elastic tubing is a good support for any skin-tear application (see picture):
Suturing (B,C) skin tears should be avoided if possible, especially when superficial. The skin’s fragility does not support the use of sutures, which rely on collagen integrity (the suture will typically tear through the thin skin).
Cyanoacrylate tissue adhesive (‘dermabond’) (D) is an option. However, this is best used when the wound edges are nearly approximated. Surgical tape has the advantage in that there is more wound support; in addition, surgical tape allows for drainage of the wound. This should be considered in wounds that may be ‘dirtier’ than others.
Due to your efforts, the patient comes in three weeks later for an unrelated complaint, and proudly shows you the results of your careful approach to her wound care:
From ABEM LLSA 2010 reading list:
Singer AJ, Dagum AB. Current Management of Acute Cutaneous Wounds. N Engl J Med. Sept 2008;359(10):1037-1046.