Skin tears
A ‘skin tear’ can be defined as a traumatic wound and frequently seen among elderly people (65+, > 80 years) primarily at limbs ( arms and legs), hands. The aging process of the skin is the most important cause.
A skin tear appears when a fragile skin is hurt against a hard or sharp object. Also shearing forces and friction can be an important risk factor. Skin tears can be described as a loosening of the epidermal layer from the dermal layer or a loosening of the epidermal layer, together with the dermal layer from the underlying structures.
Very often, the cause is very banal ( small, minor accidents which happens all the time at home, transfer from bed to wheelchair, bed to seat.
Risk factors are: being > 80 year, being a women, immobility, usage of corticosteroids over a longer period. Generally speaking, every nursing home patient is a patient at risk. Overall, skin tears are not life threatening; they are however often very painful. The care and treatment can be very expensive and often wound infection can be diagnosed. Most often, the skin tear wound classification of Payne and Martin is used to classify the gravity of the lesion ( without loss of tissue / partial loss of skin tissue / total loss of skin tissue). In literature, it is very difficult to find proper findings about prognosis, evolution toward a chronic wound, relapse. The average time needed to heal a skin tear can be estimated at 10 to 21 days. In most of the cases, patients have multiple skin tears; average: 2,5 to 2,6 skin tears/patient.
Classification Skin tears
Skin tear category III Skin tear category II
Developed in the late 1980s, the Payne-Martin Classification for Skin Tears addresses assessment, prevention, and treatment of skin tears. Although relatively new and not well known, this classification tool can help you assess, document, and track patient outcomes.
The classification system is divided into three categories:
Category I-skin tears without tissue loss:
- A linear type Category Ia skin tear; ’ full thickness wound’ ;the epidermis and dermis have been pulled apart, as if an incision had been made.
- A flap type Category Ib skin tear; ‘partial thickness wound’; the epidermal flap completely covers the dermis to within 1 mm of the wound margin.
Category II-skin tears with partial tissue loss; ‘ partial thickness Wound’:
- With a scant tissue loss type Category IIa skin tear, 25% or less of the epidermal flap is lost.
- With a scant tissue loss type Category IIb skin tear, more than 25% of the epidermal flap is lost. The Category IIb skin tear is referred to as a moderate to large tissue loss type skin tear.
Category III-skin tears with complete tissue loss; ‘ partial thickness Wound’:
- The epidermal flap is absent in this type of skin tear.