(CS-177) Best Practice to Manage Skin Tears

Introduction: The author practices in a private wound care clinic. Skin tears can become complex wounds that negatively affect patient outcomes. Best practices are crucial to manage skin tears to prevent complications while promoting healing. 10 patients are presented with class 3 skin tears managed with polymeric membrane dressings* (PMDs) after dissatisfaction with prior standard wound care approaches. Concerns with prior approaches: dressings stuck to wounds, causing trauma and discomfort during dressing changes; slow healing; costs associated with frequent sharp debridement; and multiple products required. PMDs reduced need for frequent debridement, reduced wound trauma during dressing changes, reduced supply costs and dramatically improved time to wound closure.

Methods: PMDs changed once/wk or twice/wk, depending on exudate. All wounds, prior to initial dressing application, were flushed with normal saline and hypochlorous acid (HA). HA is applied to gauze and wiped over the wound bed. There is no excess left, and the wound bed is “dry” before PMD application.

Results: PMDs did not stick to wounds, eliminating wound trauma and discomfort during dressing changes. Pain that was intermittent throughout the day and night was eliminated. PMDs encouraged autolysis so wounds required little or no debridement, reducing the supply cost of debridement which also reduced treatment time by up to 10 minutes/visit. Pt. 2, 5, 6 and 10 were initially managed by another provider in the clinic using other wound care approaches. When wounds were not progressing, the author
switched to PMDs; as a result, all 10 patients’ skin tears closed. PMDs improved time to wound closure. As an example, Pt 5 had a history of skin tears. A 12 sq cm wound managed with Bismuth Tribromophenate and combination wound care products closed in 17 days (0.7sq cm/day closure). In contrast, on same patient, using PMDs on an 89 sq cm wound closed in 24 days (3.7 sq cm/day closure).

Discussion: PMDs promote healing and comfort. PMDs are easy to use, while reducing the cost of care. No complications occurred. PMDs are the preferred dressing to manage skin tears.