The current management of skin tears

Multi-disciplinary management of type 1 and 2 skin tears using a silver-based hydrofiber dressing

Skin tear is a common problem encountered in the emergency department. If it is not properly managed, it can lead to wound infection, skin necrosis and a need for further surgical intervention and skin grafting. Current management is to cleanse the wound, replace the thin skin tear followed by coverage with a dressing that is inducive for wound healing. Several dressings have been suggested for the coverage of these wounds. But, up to now, there has been no mention of the use of a silver-based hydrofiber dressing in the management of this condition. The objective of this study was to explore the use of a silver-based hydrofiber dressing for the management of paper-thin skin tears. We retrospectively reviewed all patients with Type 1 or 2 skin tears that had undergone management using a silver-based hydrofiber dressing between October 2019 and October 2020. Demographic data and medical history was obtained by retrospective chart review. Data that was collected included: age, sex, comorbid illnesses, defect location, defect size, complications, number of times the silver-based hydrofiber dressing was replaced and the number of days required to achieve complete wound healing. A total of 65 patients were included in the study. There were 42 males and 23 females. There were 28 patients whose age was greater then 85 years old, of which 14 patients were over 90 years old. The mean number of outpatient visits was 2. The mean defect size was 33 cm2 (range 1 cm × 1 cm to 18 × 10 cm). The mean number of days required for total wound healing was 13 days (range 7-21). We did not encounter any patients that required further surgical debridement or split-thickness skin grafting. The use of a silver-based hydrofiber dressing was well tolerated by the elderly population as it provided an easy, efficient, economical and effective form of management of skin tears. We suggest that a silver-based hydrofiber dressing can be used as a first-line treatment method for type 1 and 2 skin tears.

Pretibial lacerations

Patients with pretibial lacerations are commonly referred to plastic surgery services for operative intervention. However, the vast majority of cases can be managed conservatively. Through understanding the epidemiology and pathophysiology underlying these injuries to appropriately assessing and managing these patients, this review demonstrates how best to facilitate wound healing and undertake conservative management. A multidisciplinary approach to managing patients with pretibial lacerations is discussed so that clinicians can provide a better quality of life for patients through optimisation and preventing further decline.

Oral intake of lingonberry and amla fruit extract improves skin conditions in healthy female subjects: A randomized, double-blind, placebo-controlled clinical trial

In this study, we examined the effect of ingestion of lingonberry and amla fruit extract (LAE) on several human skin conditions. To conduct a randomized, double-blinded, placebo-controlled study, we randomly divided 99 healthy female subjects into three groups; the first group received a drink containing 25 mg of lingonberry extract and 30 mg of amla fruit extract; the second group received a drink containing double the volume of extracts received by the first group; and the third group received a placebo drink. Each participant drank 50 mL of their assigned drink once daily for 12 weeks. The primary endpoint was skin elasticity, and the secondary endpoints included skin thickness, stratum corneum water content, and degree of wrinkles around the eyes. After 12 weeks of LAE drink intake, skin elasticity showed significant, dose-dependent improvements (P < 0.01). Skin thickness, stratum corneum water content, and the degree of wrinkles also significantly improved (P < 0.001) in a dose-dependent manner. The improvements in skin elasticity and thickness, as well as in the stratum corneum water content and the degree of wrinkles, observed upon oral intake of LAE indicate that LAE may be considered a candidate anti-aging agent for preventing skin weakening.

Minimising pain and medical adhesive related skin injuries in vulnerable patients

The skin is the largest and one of the most important organs of the body and as such it is essential that skin integrity is maintained to preserve normal body functions as much as possible at all times. Health professionals must endeavour to minimise any pain and trauma likely to be encountered by their patients through the use of a variety of medical products and devices that are designed to adhere to the skin, especially as the use of dermatological and wound-management products in particular, that incorporate adhesives to help keep them secure and in place, has grown in line with the increasingly ageing population and changing demographics throughout the UK. This article reviews the literature related to the causes of medical-adhesive-related skin injuries (MARSIs) and the reported patient effects, in particular pain and skin trauma and highlight some ‘at-risk’ patient groups and potential actions to minimise risk. A sterile silicone medical adhesive remover—Appeel Sterile—is introduced and the clinical benefits highlighted through the discussion of clinical evidence and case studies undertaken on a range of patients with varied aetiologies.

Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit

Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.

The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care

AIMS AND OBJECTIVES

To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds.

METHODS

A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded.

RESULTS

Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence.

CONCLUSION

A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed.

RELEVANCE TO CLINICAL PRACTICE

Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

Pilot parallel randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people: 'STOPCUTS'

BACKGROUND

Skin tears are common in older adults and those taking steroids and warfarin. They are traumatic, often blunt injuries caused by oblique knocks to the extremities. The epidermis may separate from the dermis or both layers from underlying tissues leaving a skin flap or total loss of tissue, which is painful and prone to infection. 'Dermatuff™' knee-length socks containing Kevlar fibres (used in stab-proof vests and motorcyclists' clothing) aim to prevent skin tears. The acceptability of the socks and the feasibility of a randomised controlled trial (RCT) had not been explored.

METHODS

In this pilot parallel group RCT, 90 people at risk of skin-tear injury from Devon care homes and primary care were randomised to receive the socks or treatment as usual (TAU). The pilot aimed to estimate parameters to inform the design of a substantive trial and record professionals' views and participants' acceptability of the intervention and of study participation.

RESULTS

Participants were randomised from July 2013 and followed up until February 2015. Community participants were easier to recruit than care homes residents but were 10 years younger on average and more active. To recruit 90 participants, 395 had to be approached overall as 77% were excluded or declined. Seventy-nine participants (88%) completed the trial and 27/44 (61%) wore the socks for 16 weeks. There were 31 skin tear injuries affecting 18 (20%) of the 90 participants. The TAU group received more injuries, more repeated episodes, and larger tears with greater severity. Common daily diary reasons for not wearing the socks included perceived warmth in hot weather or not being available (holiday, in hospital, bed rest). Resource use data were obtainable and indicated that sock wearing gave a reduction in treatment costs whilst well-completed questionnaires showed improvements in secondary outcomes.

CONCLUSIONS

This pilot trial has successfully informed the design and conduct of a future definitive cost-effectiveness RCT. It would need to be conducted in primary care with 880 active at-risk, elderly patients (440 per arm). Skin tear incidence and quality of life (from EQ5D5L) over a 4-month period would be the primary and secondary outcomes respectively.

TRIAL REGISTRATION

ISRCTN, ISRCTN96565376.

The Art of Dressing Selection: A Consensus Statement on Skin Tears and Best Practice

PURPOSE

To provide information about product selection for the management of skin tears.

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES

After participating in this educational activity, the participant should be better able to:1. Explain skin tear (ST) risk factors and assessment guidelines.2. Identify best practice treatments for STs, including the appropriate dressings for each ST type.

ABSTRACT

To aid healthcare professionals in product selection specific for skin tears, the International Skin Tear Advisory Panel conducted a systematic literature review and 3-phase Delphi consensus with a panel of international reviewers to provide the best available evidence for product selection related to the treatment of skin tears.

Pilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people "STOPCUTS": study protocol

Background

Skin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common and occur mostly in older adults and those taking medications that compromise skin integrity. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment to heal. Traumatic injuries are the second most common type of wounds after pressure ulcers in care homes and are the commonest reason for older adults to require the attention of a community nurse. Common causes of skin tear injuries are bumping into furniture and other obstacles, using mobility aids, transfer to/from wheelchairs, getting in and out of bed and falls. No effective preventative measures currently exist but knee-length, protective socks are now available that contain impact-resistant Kevlar fibres (of the type used in stab-proof vests) and cushioning layers underneath.

Methods/design

In this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury will be randomised with equal allocation to receive the intervention or usual care. They will be recruited from care homes and from the community via general practices and a research volunteer database. Pilot outcomes include recruitment, eligibility, attrition, ascertainment of injuries and completion of outcome measures. Acceptability of the intervention and of study participation will be explored using semi-structured interviews. The proposed primary outcome for the future definitive trial is skin tear-free days. Secondary outcomes are skin tear severity, health status, specific skin-tears quality of life, capability and fear of falling, measured at baseline and the end of the study and in the event of a skin tear.

Discussion

The results of this study will be used to inform the development and design of a future randomised controlled trial to assess the effectiveness and cost-effectiveness of a unique and innovative approach to skin tear prevention.

Approval was granted by the NRES - Cornwall and Plymouth Research Ethics Committee (13/SW/013). Dissemination will include publication of quantitative and qualitative findings, and experience of public involvement in peer-reviewed journals.

Trial registration

Current Controlled Trials: ISRCTN96565376

Skin tear treatment and prevention by nurses: an integrative literature review

The objective of the present study was to identify scientific evidence in the literature regarding management and prevention of skin tears by nurses over the last ten years. This is an integrative review of articles found in the LILACS, SciELO, BDENF, MEDLINE, Scopus, ScienceDirect and PubMed databases, identified with the Portuguese, English and Spanish descriptors for "skin," "friction," or with the keyword "skin tears". After inclusion and exclusion criteria were applied, fifteen texts were selected. Scientific evidence demonstrated that the best management results are obtained by covering the tear with the skin flap itself, using octylcyanoacrylate or silicone-based products. Prevention consists of promoting a safe environment, through multidisciplinary work and health education. We conclude that it is the nursing staff's responsibility to avoid infection, trauma of any intensity, pain and bleeding.

Skin tears: care and management of the older adult at home

Skin tears experienced by older adults require special skills to promote healing. Home healthcare providers are in key positions to manage skin tears and prevent further skin trauma. Several guidelines, risk assessments, classifications, and products exist to manage high-risk patients. Frequent evaluation of the effectiveness of the treatment and prevention strategies in an overall skin care protocol for home care patients is critical to reduce skin tear incidence and promote prompt healing when skin tears are present.

Epidemiology of "fragile skin": results from a survey of different skin types

BACKGROUND

Epidemiologic information regarding the prevalence of "fragile skin" in different adult populations is currently limited. The objective of the current survey was to assess the occurrence of perceived "fragile skin" across different skin types in the general adult population.

METHODS

Individuals aged 15-65 years from five representative geographic regions (France, Spain, Sweden, Japan, and the US) were interviewed and grouped into the following skin types: Caucasian North skin (n=1,218), Caucasian South skin (n=1,695), Asian skin (n=1,500), and Black skin (n=500). The main survey question was "In your opinion, do you have fragile skin?" Concepts relating to the nature and appearance of an individual's skin were also evaluated.

RESULTS

A total of 4,913 individuals were interviewed. Subjects in the Caucasian North, Caucasian South, Asian, and Black skin type groups responded positively to the question "In your opinion, do you have fragile skin?" in the following proportions: 24.44%, 29.71%, 52.67%, and 42.20%, respectively. With the exception of individuals in the Black skin group, "fragile skin" was prevalent in significantly more women than men (P<0.0001). Compared with other age categories, the prevalence of "fragile skin" was significantly higher in individuals aged 15-34 years (P<0.0001), regardless of skin type. In general, individuals reporting "fragile skin" were 2-3-fold more likely to respond positively to a series of questions relating to the nature and appearance of their skin. The prevalence of "fragile skin" was also higher in individuals who experienced dermatosis (skin lesions of any type) in the previous 12 months.

CONCLUSION

Whilst these findings need to be confirmed through objective evaluation, the current survey demonstrated that "fragile skin" is perceived to occur in a substantial proportion of individuals from any given country, particularly in the age range of 15-34 years, regardless of skin type.

Prevalência de lesões por fricção em pacientes hospitalizados com câncer

Esse estudo objetivou identificar a prevalência de lesões por fricção (LF) em pacientes hospitalizados com câncer e avaliar os fatores demográficos e clínicos associados ao seu desenvolvimento. Estudo epidemiológico, de corte transversal, realizado no Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira. Todos os pacientes adultos, internados entre 10 e 18 de abril de 2010, foram avaliados por meio de entrevista e exame físico. Utilizou-se o teste Qui-Quadrado para comparação das variáveis demográficas e clínicas entre pacientes com e sem LF. Foram avaliados 157 pacientes: cinco apresentaram nove LF, acarretando prevalência de 3,3%. Quanto às variáveis demográficas, houve diferença estatisticamente significativa somente para o número de filhos (p=0,027). Clinicamente, pacientes com LF apresentaram menores escores na escala de Karnofsky (p=0,031) e na Escala de Braden (p=0,026), além de comportamento pouco colaborativo (p=0,042). Esse estudo contribui para um melhor conhecimento acerca das LF em pacientes com câncer.