Wound Care Management

Skin Tear

skin tearCauses:
  • occurs when friction and shearing forces cause tissue layers to slide across each other breaking blood vessels.

  • examples of actions that can result in fragile tissue being abraided:
    • sliding patients in bed
    • aggravated patients moving in bed
    • removal of adhesive dressings

Goals of treatment:

  • to protect skin from further damage
  • heal the wound

Things to keep in mind:

  • patient's skin condition
  • potential for further skin tears
  • nurses must be mindful of transparent film on fragile and dehydrated skin. If you need to use transparent film, remember to remove using the "lateral pull" method.
  • minimize use of tape and adhesive products
  • avoid more friction and shear
  • maximize nutrition and hydration

Suggested treatment*:

  • Mepitel would be the suggested dressing* for this wound
  • Place Mepitel directly on the wound bed and cover with dry gauze (abd pad if necessary for comfort)and kling or burn net
  • Change gauze when saturated and change Mepitel every 5-7 days
  • Mepitel is an inert, silicone based dressing that can stay in place for 7 days (the cover dressing can be changed if soiled)
  • This is an ideal alternative to Sofratulle

* All suggested treatments and dressings in this web site were evidence based choices by the authors and by no means represent the only dressing option available.

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