Skin tearing occurs when the outer layer of the skin is partially or completely separated from the bottom layer. This can happen to the slightest abrasion, scratching or shearing in wallet handles, bracelets, shopping bags, door stoppers, or bushes in the yard. Parking bumpers are one of the most common criminals with skin tears. People got out of the car, walked into a restaurant with their friends, and tripped over those concrete bumpers. They may even be painted bright yellow, but since cement bumpers are usually only four inches high, they are not in the field of view.
If the skin tears, the first action is to apply pressure to stop the bleeding. Then it is essential to wash the wound with a lot of ordinary tap water. You do not need hydrogen peroxide, alcohol or bleach. These liquids are very harmful or corrosive to the skin. Just lather with liquid soap and rinse thoroughly.
If the flap is torn off, you can use bacitracin or Aquaphor and a non-stick dressing. People are often allergic to Neosporin, so I don't recommend using it. If the skin tear is large and there is a flap, your healthcare provider can sometimes put the flap back in place at least partially. The flap shrinks when it tears, so it always looks smaller. Sometimes flaps are feasible-this means that there are enough capillaries in the flaps to adhere to the surface of the skin. This can provide a graft for the skin to protect it. When the injury occurs for the first time, it is impossible to judge whether the flap is feasible. As a provider, I always assume it is and will treat it accordingly until I figure it out in the next week or two.
Usually, once the wound is thoroughly washed, I will use a non-stick dressing. Ordinary is similar to Telfa. Some more advanced people will add petroleum jelly (such as petroleum jelly gauze or Adaptic). Keeping bacitracin on the wound can prevent the dressing from sticking. Another product sometimes used is a prescription cream or ointment called mupirocin. This covers a wide variety of bacteria and general ointments.
Because the skin around the wound is very fragile and thin, it is best to avoid any type of tape or adhesive. To attach the dressing, we use wrapping gauze (such as Kerlix). We also use elastic nets of various sizes to fit the limbs. At home, the easiest to use is to cut off the long socks. This will perfectly keep the dressing in place. It can be cleaned and reused.
If the tape or bandage attached to the skin is attached to the skin, it is very important that the tape cannot be removed directly. Without damaging or abrading the skin, the easiest way to remove the bandage is to soak it in water and apply any type of lotion or cream so that the adhesive will fall off. Never untie the bandage! If the dressing sticks to it, take a shower and let water loosen it. After showering, wash with mild soap (such as Cetaphil), pat dry and reapply the dressing.
If at any time you are concerned about fluid, redness, swelling, or failure to heal a wound, be sure to consult your healthcare provider or wound care professional.
Kathleen Mahan, ARNP, MSN, WCC, is a senior registered nurse (239-482-1010) for physicians' primary care in the Office of Family and Internal Medicine, 7381 College Parkway, Southwest Florida.