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