What skin tears and traumatic wounds are
Skin tear and traumatic wound care in St. Louis often begins with a small accident: an arm caught on a doorframe, a shin against a wheelchair footrest, a bandage pulled off too fast. A skin tear happens when a bump, rubbing or pulling force separates the layers of the skin. The top layer may peel back as a flap or come away completely.
Skin tears are most common on the forearms, hands and shins of older adults, whose skin has become thinner and drier. Traumatic wound is a wider term for any wound caused by an injury. It includes cuts, scrapes, puncture wounds and a hematoma, which is blood that pools under the skin after a blow or a fall.
If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.
Why a small injury can be slow to heal
On fragile skin, several things work against healing:
- Thin skin with little padding underneath, especially over the shin
- Leg swelling or weak circulation in the lower leg
- Blood thinners or long-term steroid use, which make bruising and tearing more likely
- A skin flap that has lost its blood supply
- Pooled blood under the skin pressing on the tissue above it
- Dressings or tape that stick and tear the skin again when removed
- Diabetes, dehydration or not eating enough
A lower-leg wound that lingers can become a long-term ulcer, so ask for help early.
What the treating clinician considers
The treating clinician’s assessment usually covers:
- How and when the injury happened, and whether a fall was involved
- Whether a skin flap is present and whether it looks healthy
- How deep the wound is and whether blood is trapped under the skin
- Dirt or debris in the wound, and when the last tetanus shot was given
- Circulation and swelling in the leg, for wounds below the knee
- Signs of infection
- The condition of nearby skin and any past reactions to tape
On fragile skin, the clinician generally looks for a dressing that protects the area, can stay in place for several days and lifts off without pulling. Gateway coordinates the orders and supplies for dressing selection and changes.
Skin tear care at home and in facilities
At home, Gateway arranges visits from partner clinicians, so a person with limited mobility does not have to travel for each check. Families can also lower the chance of the next injury, as our guide to skin tears in older adults explains:
- Pad sharp furniture corners, bed rails and wheelchair parts
- Keep walkways clear and well lit
- Choose long sleeves, long pants or shin protection
- Moisturize dry skin
- Support a limb from underneath during transfers instead of gripping or pulling
In facilities, many skin tears happen during bathing, dressing and transfers. The treating clinician works with nursing staff on handling, dressing changes and a prevention plan. This is especially important for residents receiving wound care in memory care, who may not remember the injury and may pick at a dressing.
How primary care factors in
A skin tear from a fall raises a larger question: why did the fall happen? A primary care clinician can look at mobility and fall risk, including dizziness, vision, footwear and medicines that cause drowsiness.
Primary care also covers a medication review, tetanus vaccination, nutrition, hydration and leg swelling. Blood thinners and steroids are prescribed for important reasons. Do not stop them because of bruising or a skin tear. Ask the prescriber.
Changes to report and when to call 911
Tell the treating clinician or the facility nurse about:
- A wound that is getting larger, or a flap that turns dark
- Redness, warmth, swelling or pain that is increasing
- Pus, a bad smell or fever
- A swollen, tight, painful bruise that keeps growing
- A wound that is not clearly improving from week to week
A deep or gaping cut, a bite or a wound with something stuck in it needs urgent or emergency care, not a scheduled visit.
Call 911 for bleeding that does not stop with firm, steady pressure, a fall with a blow to the head, loss of consciousness, new confusion, or severe pain with an arm or leg that cannot be moved or bear weight.
How Gateway helps arrange care
Patients, family members and caregivers can call 314-325-0126 directly, without a referral, or request care online. The form takes a name and phone number only.
We gather records, coordinate clinician orders and supplies, and schedule the visit with a partner clinician. Availability is confirmed by location and care setting. Facility nurses and physician offices in Greater St. Louis and the Metro East can refer a resident or patient.
Common questions
Does a skin tear need to be seen by a clinician?
Some small tears heal with basic first aid and protection. Have a clinician look when the tear is on the lower leg, the flap is large or missing, the person has diabetes, poor circulation or takes blood thinners, or the wound is not improving.
Why does my parent’s skin tear so easily?
With age, skin gets thinner, drier and less elastic, and its layers hold together less firmly. Sun exposure, steroid medicines, dehydration and poor nutrition add to this. Easy tearing alone does not mean someone is being handled roughly, but repeated tears are a reason to review handling, clothing, furniture and skin care.
Should the loose flap of skin be cut off?
No, do not cut or pull it off yourself. A flap that still has a blood supply can sometimes act as a natural cover while the wound heals underneath. The treating clinician decides whether it can be kept or needs to be trimmed.
What should I ask a facility after my loved one gets a skin tear?
Ask how and when it happened, whether a fall was involved, who assessed the wound and what the dressing plan is. Ask how often it will be checked, what is being done to prevent another injury and how you will be told about changes.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.