SCIENCE, PRACTICE AND EDUCATION used to describe the severity of a skin tear. 1 In this system, Category I refers to a linear tear with no tis- sue loss, or a flap-type tear where the epidermal flap covers the dermis. A more recently validated system is the International Skin Tear Advisory Panel (ISTAP) classification system, which defines Types 1, 2 and 3 skin tears. A Type 1 tear has no skin loss, with a linear flap tear that can be repositioned to cover the wound bed.4 A Type 2 tear is characterised by partial flap loss that cannot be repositioned to cover the wound bed. Finally, a Type 3 tear entails total flap loss exposing the entire wound bed.4 Elderly patients are commonly affected by skin tears, due to compromised nutrition, previous skin tears or the challenge of using a wheelchair or bed con- finement. 5 Especially vulnerable are the residents of long-term care (LTC) facilities, where more than 1.5 million skin tears occur each year, with skin tear prevalence among residents at LTC facilities in the US estimated between 16% and 33%. 5 6 The prevalence of Payne-Martin category-typed skin tears were reported at a 114-bed Canadian LTC facility. It was found that 25 out of 113 (22%) residents had skin tears. 7 Of those reported, 51% were rated with no skin loss (ISTAP Type 1 equivalent), 16% had partial flap loss (ISTAP Type 2 equivalent) and 33% had total flap loss (ISTAP Type 3 equivalent). The most common skin tear locations were the arms (48%), lower legs (40%) and hands (12%). 7 In a recent prospective study of 380 individuals >65 years of age, it was confirmed that the prevalence of skin tears was 20.8% in the LTC population, with an incidence rate of 18.9% in four weeks. 8 Many states in the US require LTC facilities to track and report their incidence of skin tears. 9 Some skin tears are preventable through the use of skin sleeves, padded side rails, gentle skin cleansers, moisturising lotions, disposable diapers and staff education. 9,10 Through implementation of these practices at LTC facilities, the incidence of skin tears can be reduced by 50%. 10 Treatment of skin tears Distinguishing between the types of skin tears is essential for choosing appropriate skin care and avoiding unnecessary pain and discomfort to the patient. 2,11 Several commercially available skin prod- ucts have been used for the treatment of skin tears, including non-adherent mesh dressings, foam dress- ings, hydrogels, cyanoacrylates, alginates, hydro fibres and silver dressings. 12,13 In the past, skin tears were routinely treated using adhesive skin closure strips, but these are no longer a preferred treatment. 3,14 Skin tear closure methods In a multi-centre randomised controlled trial, 814 pa- tients with 934 wounds were enrolled; these included 383 lacerations, 235 skin lesions and 316 minimal and general surgeries. 15 The study was designed to compare wound closure using 2-octyl-cyanoacrylate (OCA) to standard wound closure (SWC) methods. Overall, wound closure was significantly faster using OCA (2.9 vs 5.2 minutes, p < 0.001); however, the cosmetic appearance was similar at three months. 15 A study of elderly patients (mean age of 83) in an LTC facility were treated with cyanoacrylate topical bandages for severe skin tears, including Category 2 (partial flap loss) and 3 skin tears (total flap loss) that were less than eight hours old. 5 Out of 20 pa- tients treated, 90% had complete healing with only one application and within one week of treatment. Only one patient reported experiencing pain during treatment. 5 A meta-analysis of 26 randomised controlled trials compared the OCA to SWC methods. A total of 2,105 patients with 2,637 wounds were evaluated and compared. 16 Sixteen out of the 26 studies directly compared skin sutures to tissue glue. Of the 16 stud- ies, 14 confirmed that the time for skin closure using tissue glue was considerably faster, compared to skin sutures. Eight of 12 studies reported that patients were more satisfied with the use of tissue glue. In a clinical evaluation of a liquid dressing for minor nonbleeding abrasions and Class 1 and 2 skin tears in the emergency department, 40 adult patients (20–90 years of age) with 39 skin abrasions and 11 skin tears located on the face (n=16), hands (n=14), legs (n=11) and arms (n=9) were treated with 2-octyl cyanoacr- ylate Marathon™ (Medline Industries, LP). 17 All pa- tients were monitored every 1–2 days until complete wound healing was obtained. The median time to complete healing was 10 days (range 7.4–14.0). The complete wound mean healing time was 12.4 days (range 10.8–14.1, occurring in 90% of patients and 92% of wounds treated). Only one wound required additional treatment. The results of a survey of the members of an ISTAP review panel showed that 85.7% agreed, or some- what agreed, that cyanoacrylates ‘skin glues’ are ap- propriate for the treatment of Type 1 and 2 skin tears. Cyanoacrylates have also been used successfully for JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION 100
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