RWV is supported by funding from the Australian and Victorian governments. The CHSP is funded by the

Australian Government Department of Health.

Oct-18

Skin Tears UpdateAgeing and Skin Health

Residential Aged Care Seminar

Monika SamolykClinical Nurse Consultant

Hume East region

Topics Covered

• Introduction to the latest evidence on skin tear prevention, assessment and management

• Putting it all together with case studies

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Definition (International Skin Tear Advisory Panel : ISTAP)

“A skin tear is a wound caused by shear, friction and/or blunt force resulting in the separation of skin layers. A skin tear can be partial thickness (separation of the epidermis from the dermis) or full thickness (separation of both the epidermis and the dermis from the underlying structures”

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Alternative terms

• Partial thickness wounds

• Abrasions

• Loss of epidermis

• Skin stripping

• Skin flaps

• Full-thickness wounds

• Linear lacerations

• Trauma

• Skin injury

• Shear

• Open wound

• Tears

• Slits

• Peels

• Splits

• Tape stripping

• Opening

• Scratch

• ………………………………..

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What is a chronic wound• A wound that does not heal along an expected

course

• Skin Tears can quickly become chronic and COMPLEX

• They can be exquisitely and agonisingly painful, distressing and life-threatening

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Prevalence of Skin Tears in the Older Person

• Reported to be similar to pressure injury prevalence rates or at least the second most prevalent wound.

Strazzieri-Pulido et al, 2015; Carville et al, 2007.

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Validated Skin Tear Classifications

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STAR Skin Tear Classification System

Silver Chain Nursing Association and Midwifery.

Curtin University of Technology. (2010)

ISTAP Skin Tear Classification System

International Skin Tear Advisory Panel. (2013)

International Skin Tear Advisory Panel (ISTAP) System©

Contents of the ISTAP Toolkit

• Skin Tear Risk Assessment Pathway

• Quick Reference Guide: ISTAP Risk Reduction Program and Rationale

• Skin Tear Decision Algorithm

• Pathway to Assessment / Treatment of Skin Tears

• ISTAP Skin Tear Classification System

• Skin Tear Prevalence Study Data Collection Sheet

• Medications that can affect the skin

• Drugs associated with risk of falls

• Skin tear product selection guide

http://www.skintears.org/Oct-18 8

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Quick Reference Guide: ISTAP Risk Reduction Program©

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Skin Tear Decision Algorithm ©

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ISTAP Skin Tear Classification System ©

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Pathway to Assessment / Treatment of Skin Tears ©

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Why does this person have a Skin Tear?

• When a Skin Tear is reported, the cause is not always known or documented

• WHY?

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Medications that can affect the skin ©

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Drugs associated with HIGH risk of falls ©

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Drugs associated with MODERATE risk of falls

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Assessment: Is this wound healable?

• Degree of blood supply to limb and flap?

• Degree of tissue loss?

• Can the edges be approximated?

• Clean or dirty wound?

• Bleeding?

• Infected?

• CHRONIC OEDEMA (SWELLING) IS THE ENEMY!!

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AVOID

• Film dressings

• Hydrocolloids

• Skin closure strips

• SUTURES / STAPLES

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Case Studies

Healing as expected Type 1

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Slow Healing Type 1

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A mixed bag!

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Multiple skin tears on 1, 2 and 3 weeks duration (including left arm)

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Bilateral Legs

Right Leg Left Leg

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Left Knee

Before Sharp Debridement After Sharp Debridement

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Left Wrist

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Skin Tear post suturing

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In Summary

• An international common language and approach now exists to enable consistency of care in skin tear prevention, assessment and management in the older person.

• The International Skin Tear Advisory Panel (ISTAP) provides a comprehensive suite of validated tools for the interdisciplinary team to guide the risk assessment, prevention, assessment and treatment of skin tears, even in the most complex situations.

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References

• Carville, K., Leslie, G., Osseiran-Moisson, R.., Newall, N., & Lewin, G. (2014). The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears, International Wound Journal, 11, pp 446 – 453.

• Carville, K., Lewin, G,. Newall, N,. Haslehurst, P,. Michael, R,. Santamaria, N., & Roberts, P. (2007). STAR: a consensus for skin tear classification, Primary Intention, 15 (1), pp 18-21, 24-28.

• LeBlanc, K., & Baranoski, S. (2011). Skin Tears: State of the Science: Consensus statements for the prevention, prediction, assessment, and treatment of skin tears. Advances in Skin and Wound Care, 24(9). pp 2 -15.

• LeBlanc, K., & Baronski, S. (2014). International Skin Tear Advisory Panel: Putting it all together, a tool kit to aid in the prevention, assessment using a simplified classification system and treatment of skin tears© WCET Journal, 34 (1), pp 12 -27.

• LeBLeBlanc, K., Baronski, S., Christensen, D., Langemo, D., Edwards, K., Holloway, S., Gloeckner, M., Williams. A., Campbell, K., Alam, T., & Woo, K. (2016). The Art of Dressing Selection: A consensus statement on skin tears and best practice, Advances in Skin and Wound Care, 29(1), pp 32 – 46.

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References• LeBlanc, K., Baranoski, S., Holloway, S., Langemo, D., & Regan, M. (2014). A descriptive cross-

sectional international study to explore current practices in the assessment, prevention and treatment of skin tears. International Wound Journal, 11, pp 424–430

• LeBlanc, K., Kozell, K., Martins, L., & Forest-Lalande, L., Langlois, M., & Hill, M, (2016). Is Twice-Daily Skin Moisturizing More Effective Than Routine Care in the Prevention of Skin Tears in the Elderly Population? Journal of Wound, Ostomy and Continence Nurses Society. pp17 – 22

• Manning, J., & Chrisakis, H. (2011). Case study: The journey towards healing: recalcitrant skin tear injuries, Wound Practice and Research , 19 (1), pp32-35

• Rayner,R., Carville, K., Leslie, G., & Roberts, P. (2015). A review of patient and skin characteristics associated with skin tears, Journal of Wound Care, 24(9), pp 407 – 414

• Skiveren, J., Bermark, S., LeBlanc, K., & Baranoski, S. (2015). Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System, Journal of Wound Care, 24 (8), pp388-392

• Strazzieri-Pulido, K., Peres, G., Campanili, T., & Santos, V. (2015), Skin tear prevalence and associated factors: a systematic review, Revista da Escola de Enfermagem da USP, REEUSP, (49) 4, Last accessed: 23rd September, 2018.Oct-18 33