Skin tears are a separation, but not a loss, of the epidermis from the dermis as a result of shearing or friction.

General Instructions

1.       Change outer dressing daily.

2.       Inspect in 48 hours and then daily. Cleanse with spray surfactant or normal saline. Apply dry, sterile dressing until healed.

3.       Skin prep outer edges of wound with protective barrier.

4.       If signs of infection are present, apply topical antibiotic every day following cleansing.

5.       Avoid use of tape and adhesive dressings.

6.       Cover with non-adhering dressing and secure. Avoid Telfa.

7.       Avoid use of semi-occlusive, occlusive, and thin-film dressings.

Category I

Includes linear and flap-type tears that can be approximated so that one millimeter or less of the underlying tissue is exposed.

1.       After cleansing, approximate edges with a sterile Calgiswab or rayon swab until open area is closed. (May use normal saline or spray surfactant to assist with movement of skin.)

2.       Place steri-strips across approximated edges from intact skin over injury to intact skin. (Apply as intended by manufacturer. Do not remove and place individually. Do not cross the strips over each other. Apply across longest continuous line.)

3.       Leave steri-strips in place until wound is healed.

4.       Cover with dry, sterile dressing.

5.       If signs of infection are present, apply antibiotic daily following cleansing.

Category II

Involves a 25% loss of epidermis exposing dermis or underlying tissue.

1.       After cleansing, apply moist gauze and wrap until bleeding has stopped.

2.       Approximate remaining epidermal edges using a sterile Calgiswab or rayon swab.

3.       Place steri-strips over wound. (Apply as intended by manufacturer. Do not remove and place individually. Do not cross strips over each other.)

4.       Use hydrogel if tissue exposure increases risk of dressing adhering to exposed underlying tissue.

Category III

Involves an absent epidermal flap and/or exposure of underlying structures. Skin loss of greater than 25% should be treated under this category.

1.       After cleansing, apply moist gauze and wrap until bleeding has stopped.

2.       If the injury has occurred on a flat surface that allows the dressing to remain free of wrinkles and/or bubbles, apply a polyurethane foam with securing cover. Change every 5-7 days.

3.       If the injury is not on a flat surface and/or exposes underlying structure, apply calcium alginate and secure with thin film or transparent hydrocolloid. Change every 2-3 days. Once the wound has granulated and epithelial tissue is present on all edges, cover with polyurethane foam and securing cover. Change every 5-7 days.

4.       It may be necessary to wrap the extremity with gauze to maintain a secure dressing.

5.       Avoid disturbing the wound daily unless exudate lifts dressing, in which case an absorptive dressing should be considered.