M2 V01 Skin tear management

In this scenario, we’ll be showing you the principles of how to assess, manage and treat a skin tear, which is something that commonly occurs in residential aged care. In this simulation - this is a plastic mannequin and we’ve got some semi-transparent film acting as the skin flap. So in a normal skin tear as you can see, the skin flap is actually wrinkled back and has come completely stuck back on itself. Usually the first step that you would do in a skin tear management would be to prevent or to control the bleeding, so you might apply something like a firm pad, apply that with pressure to the wound for approximately 5 to 10 minutes to stop the bleeding process. Before removing the cotton pad what you might choose to do is to moisten it with some water so that you don’t restart the bleeding once you remove it. So remove that and then you can start to manage your skin tear.

So the first thing you want to do, because the skin flap is usually very sticky because of blood clots which have built up underneath, is you might get a saline ampoule or a syringe filled with some saline or clean tap water and gently irrigate underneath the skin flap. That will moisten the skin flap and then you can gently use some non woven gauze to cleanse around the skin flap.

Next, what you want to do is to try and realign that skin flap so as to actually move that skin flap back into position so that we can cover this deficit with the skin flap. What you would do is gently use a Q tip and roll underneath the skin flap. Roll on top of the skin flap so that you can gently roll that back into place without any undue stretching or trauma. So what we’re doing is rolling the moistened Q tip over top of the skin flap so that you’re gently easing that skin flap into position. Now once you’ve got the skin flap into position using your moistened Q tip, what that Q tip is actually doing is forcing out any fluid from underneath the skin flap to ensure that it adheres properly to the wound bed.

The next step that you want to do is make sure that you pat dry all of that surrounding skin so that your dressings will adhere more easily. Once you’ve realigned your skin flap, that’s when we use something like a skin tear assessment and classification system to determine the degree of tissue loss and the severity of the skin tear. For example, you may choose to use something like this skin tear assessment and classification system (STAR system). In this classification system there are three categories of skin tears with two sub categories in category 1 and 2.

For the purposes of this demonstration the skin flap that we have would be most closely aligned to a Category 1a skin tear, where the skin flap has been able to be realigned into normal anatomical position without any undue stretching and the skin or the flap colour is not pale, dusky or darkened, so it looks like normal skin.

So, this would be considered to be a category 1a skin tear because that skin flap has been able to be completely re-approximated and the skin flap is not pale or dusky or darkened.

There are a number of different dressing types that you could potentially use to treat a skin tear. One of the most commonly accepted types of dressings to use is a soft silicone dressing with a foam pad in the middle of it.

This is a soft silicone dressing with a foam pad in the middle. There are a variety of different brand names available, this is just one brand that we’re using but the same principles exist all around. So it’s a foam pad in the middle as an island and then an adhesive border around the edge, and I’m not sure whether you can see this on the video but the adhesive border actually has beads of silicone all across the entire surface of the dressing. And what that does is it helps to prevent trauma upon removal, the whole surface of that dressing is tacky which means that that skin flap wouldn’t actually require the use of.

So the back of this dressing, for example, is covered in little silicone beads across the entire surface and the surface of the dressing is tacky. Using a dressing like this means that you wouldn’t actually have to use something like a wound enclosure strip like a steri strip for instance, because the surface of the dressing being tacky means that you will be able to keep the skin flat in position without the need to use steri strips. What’s recommended is before you actually apply the dressing, that you put an arrow on the dressing with a permanent marker to indicate the direction for removal of the dressing.

So, using a felt tip pen, what we would do is draw an arrow on the dressing to indicate the direction for removal. We would also advise that you apply a date on the dressing to indicate the date of application so that someone knows that this dressing in 5 to 7 days, or whenever there is 70% strike through of this dressing, would actually indicate the need for changing. So depending on what your institutional policy might be, we actually recommend that you write the date today which is the 7th of May 2010. Once we’ve put that on, what we want to do is to indicate that when we remove this dressing, we take it off in this direction so that the skin flap isn’t pulled up once the dressing is removed.

So the skin flap has been realigned.

This is the edge of the skin flap here, we take the backing sheet off, taking the backing sheet off and one other tip that is sometimes helpful is to moisten the tips of your gloved fingers to prevent you from sticking to the dressing.

So, what we’re ensuring is that there’s at least a 1 ½ to 2 cm border around the wound and the dressing itself and then we simply apply the dressing without stretching or pulling it trying to keep as many wrinkles as possible out. Just gently holding it in place and using the warmth of your hand to help adhesion of that dressing and then your skin tear dressing is in place.

Now, this dressing can stay in place for up to 5 to 7 days or until there’s 70% strike through or exudate visible on that pad. So 70% of this pad would be filled with a brown or discolouration which may indicate that the dressing’s reached capacity and should be removed.

To remove this dressing more easily what’s recommended is that you gently lift the edge of the dressing and then use some saline or water again and then float the dressing off to prevent trauma upon removal. So that’s the basic principles.

One other thing you could do to help ensure that this dressing stays in place for longer and to help prevent further skin tear or trauma occurring to the lower limb is to use a limb protector from the toe up to the knee to help prevent any further trauma.

Promoting Healthy Skin - Video Transcript