Initial management of skin tears

Initial management of a skin tear depends on the degree of tissue trauma. Ensure that any separated tissue is replaced anatomically, if possible.

Clean and dress the skin tear carefully to avoid causing further damage. Other management strategies include:

• providing analgesia
• controlling bleeding (which can be profuse initially) using pressure; an alginate dressing can be used to stop bleeding, but should not be used as the primary dressing (see Dressings for skin tears)
• cleansing the wound with potable water or sterile saline (sodium chloride 0.9%). If the wound is extensively contaminated, consider using a noncytotoxic antiseptic (see Cleansing and debridement)
• expelling subflap haematoma—if viable flap tissue remains, gently roll a gloved finger, moistened cotton bud or the smooth edge of plastic forceps on top of the flap
• debriding a nonviable flap
• gently replacing the tissue flap over the wound, avoiding tension on the flap
• applying an appropriate dressing (see Dressings for skin tears)
• reviewing the need for tetanus vaccination (see Tetanus-prone wounds)
• supporting the limb using a tubular support bandage, if not contraindicated; see Compression therapy.

Limbs with skin tears should be supported with appropriate compression, applied carefully to minimise shear. Local oedema occurs with all wounds, and can impair healing. Appropriate limb support can prevent a skin tear developing into a chronic wound.