Skin Tear – Causes, Effects, Risks, and Treatments

scarSkin tear is a partial or complete separation of the outer skin layers from the inner tissue. In younger people, whose skin is more flexible, thicker, and less fragile, tearing is most often the result of an accident, particularly when shearing or friction forces are involved. With the elderly, whose skin tends to be thinner and more fragile, tearing can occur more easily, quite easily in some instances, and is therefore somewhat more commonplace. Infants, whose skin is still immature and somewhat thin, are also more susceptible to injuries of this type than is the case with adults. An infant’s skin is normally just over half the thickness as that of an adult. Some diseases, particularly diabetes, can cause the epidermal and dermal tissues to become weakened, making the skin more susceptible to tearing. Those with heart disease or other cardiac conditions or who are suffering from either malnutrition or a weakened immune system are also more at risk of experiencing skin tears.

Tears can occur anywhere on the surface of the body but, in most cases, occur on the face or on the extremities, where wounds typically are somewhat more likely to occur. Adhesives are a common cause of these tears, especially among those who have particularly sensitive skin. While a tear can be caused by a cut, it is in the majority of cases the result of a blunt trauma, which can damage and weaken the tissues that lie just beneath the epidermis.

Factors Involved in Increasing the Risk of Skin Tearing

elderly-patient-with-doctorChronological age in itself is not a cause of skin tearing, but as people age, their skin does undergo changes, most notably around the time they are in their 70s. The overall consequences of normal skin aging will of course vary from person to person. As you get older, your epidermis becomes thinner. It is not particularly thick to begin with. The epidermis in most people is approximately 0.1 mm thick. The epidermis is quite tough however, but it tends to become weaker as it is becoming thinner with advancing age. The epidermis does not have its own blood supply. It receives its nutrients and oxygen from the underlying dermis. It also tends to flatten out with age, as if it were being stretched. There is generally a pronounced loss of collagen and elastin in the dermal layers as a person grows older. This loss of elastin tends to make the integument less flexible or more rigid and therefore less able to withstand the forces of friction.

In addition, when people age, they will experience a certain amount of atrophy in the dermis, which, coupled with a general decrease in sweat and oil gland activity, makes the integument drier. The circulatory system plays a role as well. As a person grows older, arteriosclerotic changes cause the blood vessels near the surface to become significantly thinner. This, in turn, results in a decrease of blood supply to the dermal layers, especially at the extremities. The skin, in its entirety, therefore becomes increasingly fragile as all of these different factors come into play and tends to become more and more susceptible to the effects of shear forces, localized pressure, and blunt trauma as a person grows older.

The Three Categories of Skin Tears

categoriesAs is the case with some of the other types of injures, skin tears fall within three general classifications or categories:

  • Category I does not involve the loss of tissue. The epidermis has, however, become separated to some degree and this separation is referred to as either a linear wound or a flap-type wound. With a Category I tear, the separated epidermal layer can usually be placed back into its normal position, if it has not already done so on its own accord. This should only be done while the integument still retains its normal color, which indicates that necrosis has not set in.
  • Category II means there has been a scant to moderate tissue loss. Scant in this sense means 25% or less, while moderate to large means more than 25% of the epidermal flap, but not all of it has been lost. In a Category II tear, the edges of the integument cannot be returned to their normal position and allowed to heal, as some of the skin is missing.
  • When all of the torn tissue has been lost, it is classified as Category III. The injury then has to be treated as an open wound.

Treating the Different Categories of Wounds

bandageIt is safe to say that the smaller the amount of tissue that has been left, the more difficult treating the injury is likely to be. A Category I tear may not require anything more than a Band-Aid or a compress; anything that will cover the injury yet allow the integument to breathe is often all that is required. When the tear is of the Category II type, it is often necessary not only to position the exposed flap back into its normal place to the degree possible but also to secure it. This is often done using tissue glue, as the integument is often not strong enough to allow the wound to be stitched. An exception would be if the wound is deep and involves the subdermal tissue. A dressing will need to be applied to the wound and remain in place for several days while it is healing.

Treatment for a Category III tear will depend a great deal upon the size of the wound. If there is not enough of a flap of skin remaining to cover a good percentage of the wound, the healing time will be longer. One of the primary concerns for this type of wound is the possibility of a secondary infection taking hold. The epidermis is one of the body’s main barriers against microbial and chemical invasion. When infections do occur, they can usually be managed through the use of antimicrobials or an administration of antibiotics.

Caring For Higher Risk Patients

caring-for-elderlyMedical practitioners and caregivers who work in hospitals, assisted care facilities, and nursing homes are quite often trained in not only treating skin tears, but in protocols and procedures to follow that are designed to prevent them. These protocols vary from taking extreme care during transport and handling to making certain a patient’s fingernails are properly trimmed. Statistics show that the majority of tears occur among the elderly. In fact, something on the order of 40% of all injuries suffered by the elderly involves tearing of the skin, and a significant portion of those injuries are associated with pressure ulcers. Part of the reason for this, of course, is that since the skin is thinner and weaker, these tears occur much more easily. Those of advanced age who are living at home are in particular danger of not having tears treated quickly or adequately.

Treating A Torn Skin

skin-tear-treatmentIt is generally recommended that the first thing you need to do is to control any bleeding that may be present. Your wound then needs to be assessed to determine its category so you can determine the optimum treatment approach. Your wound needs to be cleaned, either with water or a warm saline solution, after which any skin flap that may still be present needs to either be carefully aligned or removed if it appears the tissue is dying.

You should then apply a dressing that will encourage moist healing. Any use of adhesive strips should best be avoided, or in any event the strips should not be allowed to come into contact with even healthy skin, which nevertheless could be fragile. A wrap, tubular bandage, or a stocking-like support should then be used to keep the dressing in place over the wound. Obviously, when it is time to change the dressing, you will need to remove and replace everything with great care, both to protect your skin and to avoid disrupting the healing process.