Derm

Skin Tear

search

Skin Tear, Thin Skin Flap

  • Epidemiology
  1. Common among elderly
  • Risk Factors
  1. Elderly
  2. Chronic Systemic Corticosteroid use
  3. Malnourishment
  • Pathophysiology
  1. Decreased subcutaneous tissues (esp. overlying joints and bony prominences)
  2. Increased tension at skin surface allows for tearing of thin skin
  3. Presentation is often delayed
  • Management
  • General
  1. Cleanse wound well and reapproximate flap
    1. Consider pretreatment with Lidocaine-Epinephrine-Tetracaine (LET Anesthesia)
    2. Irrigate the wound well to decrease risk of infection
    3. Consider soaking the region of the tear to loosen dried skin and blood
  2. Bandage
    1. Cover site with non-stick pad or Vaseline Gauze
    2. Wrap with gauze roll (avoid skin tape)
    3. Change dressing every 3-5 days
  3. Other measures
    1. Control edema
    2. Avoid Transparent Film Dressing (risk of pulling up flap and skin at time of dressing removal)
  4. Follow-Up
    1. Wound recheck in 48 hours
  • Management
  • Steri-Strip closure technique
  1. Glue steri-strips with benzoin, parallel to wound edges
    1. Suture through the steri strips into skin
    2. Allows for greater strength at wound edge and prevents Suture from tearing through
    3. Pacifico (2009) J Plast Reconstr Aesthet Surg 62(12): e637-8 [PubMed]
  2. Glue steri-strips perpendicular to wound edge, across the Laceration (standard use)
    1. Suture through the steri-strips and traverse the wound as would be done normally
    2. Davis (2011) J Emerg Med 40(3): 322-3 [PubMed]
  3. Precautions
    1. Patient must keep the area clean and dry, and not apply Antibiotic ointment to prevent the steri-strips from sloughing
  • References
  1. Gallentine (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)
  2. Fisher and Swaminathan (2024) Skin Tears, EM:Rap, published 4/8/2024