About skin tears and traumatic wounds

Young skin is anchored. Its outer and inner layers lock together with small ridges, a little like two egg cartons stacked. Over the decades those ridges flatten, the skin makes less collagen and natural oil, the cushion of fat beneath thins out, and small blood vessels grow brittle. The result is skin that slides, splits and bruises under forces a younger person would never notice. Most of those forces come from ordinary life: a hand gripping an arm during a transfer, a bed rail, a walker frame, a watch band, a pet’s claws, a fingernail, or a strip of tape peeled away. Dryness and years of sun make matters worse, which is one reason tears cluster on the forearms and the backs of the hands.

What an assessment covers

Looking at the wound, the treating clinician sorts out several things before choosing a plan:

  • Whether a flap remains, how much of the wound it covers, and whether its color suggests it is alive
  • How deep the injury goes
  • Blood trapped beneath the skin
  • Dirt, gravel, splinters or other debris
  • The state of the skin around it: bruising, swelling, dryness, old scars

Skin tears are often grouped by how much of the flap is lost: none, part or all. That grouping guides how the wound is protected. The wound is measured and usually photographed, so that later visits compare against a record instead of memory.

Local context: Alton

Families in Alton sometimes assume wound follow-up means crossing the river to a St. Louis clinic, a hard trip for someone bruised and unsteady after a fall. It may not have to. Gateway arranges skin tear and traumatic wound care with partner clinicians who see patients on the Illinois side, at home or in a facility. Because Illinois Medicaid and Missouri plans follow different rules, we confirm the treating provider and ask about benefits before the first visit. Dressings and wraps ordered by the clinician are coordinated to the Illinois address in the same way.

Alton rises from the Mississippi River in steep hills and bluffs, on the Illinois side upriver from St. Louis. The Clark Bridge connects it to Missouri, and the Great River Road follows the bluffs toward Grafton. It is an old city with brick streets, tall houses and neighborhoods that sit above or below one another. Those hills are part of what people love about Alton, and they are hard on anyone with a leg wound, poor balance or limited strength. Gateway arranges wound care and primary care in the home or facility, so the hills stay outside the door.

At home between visits

Most of a skin tear’s healing happens on the days nobody visits. Before leaving, the treating clinician explains who will change the dressing, when, and what to do if it slips, gets wet or soaks through. Many families are asked to do less than they expect: leave the dressing alone, keep the area protected, and watch. It helps to jot down dates and anything that looks different, to show at the next visit. If something worries you in between, call 314-325-0126. Gateway passes the message to the wound care team, and the clinician decides whether the plan or the visit schedule should change.

For residents of nursing and senior living communities

A resident with dementia may have no idea how a wound appeared, and sometimes nobody else does either. The treating clinician works from what staff observed, where the injury sits and how the wound looks. The plan has to hold up against the resident’s own hands, since a dressing that feels strange may be picked at or pulled off within the hour. Clinicians often choose low-profile dressings covered by a sleeve or clothing, and time changes for a calm part of the day with a familiar caregiver present. Staff are asked to report resistance to care, guarding of a limb or a pained expression, because the resident may not be able to say what hurts.

What to report and when to call 911

Infection is the complication clinicians watch for most closely after a skin injury. Report these to the treating clinician or the facility nurse promptly:

  • Redness that is spreading outward from the wound
  • Skin around it that feels hot, hard or newly swollen
  • Thick, cloudy or foul-smelling drainage
  • Pain that is rising instead of easing
  • Fever, chills or feeling generally unwell

Call 911 if the person becomes confused, very drowsy, short of breath or faint, with or without a fever. Those can be signs that an infection is affecting the whole body and cannot wait for a scheduled visit.

How primary care fits in

A skin tear is often the visible part of a fall, and a fall usually has causes that can be found. A primary care clinician can check blood pressure lying and standing, review vision and hearing, look at feet and footwear, test strength and balance, and ask about dizziness and nighttime trips to the bathroom. Small findings add up. When Gateway arranges wound care and primary care together, the wound clinician’s account of how the injury happened reaches the clinician who can look into why. Any next steps, such as therapy or equipment, are coordinated alongside the wound visits instead of as a separate errand.

Primary care at home in Alton →

How to get started in Alton

If you have been managing a wound mostly on your own and are looking for skin tear and traumatic wound care in Alton, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Alton has two hospitals of its own, Alton Memorial Hospital and OSF Saint Anthony’s Health Center, and many local hospital stays happen at one or the other. Gateway is not affiliated with either. When someone comes home with a wound that needs follow-up or a changed list of medications, the family can call us to ask about visits. Hospital discharge planners and social workers can refer by phone or by fax at 314-786-7966. We gather the discharge records, coordinate with a partner clinician and keep the patient’s regular doctor informed.

Other conditions and nearby communities

Read the full guide to skin tears and traumatic wounds, or see everything Gateway arranges on the mobile wound care in Alton page.

Common questions

Is Gateway the right call for a fresh injury in Alton, or should we go to the emergency room?

Gateway is not an emergency service. A wound that is deep, gaping, bleeding heavily, caused by a bite or holding a foreign object needs urgent or emergency care first, and 911 if the situation is serious. We arrange what comes after: follow-up visits for a wound that has already been seen, or assessment of a skin tear or scrape that is not an emergency but is not healing well.

Is a large, swollen bruise after a fall a wound?

It can be. A hematoma is blood pooled under the skin, and a big one on fragile skin, especially over the shin, presses on the tissue above it. Even with no break in the skin on the first day, the area can blister or open later. Have a clinician look at any bruise that is raised, tense, very painful or growing.

How is a skin tear different from an ordinary cut?

A cut is made by something sharp and usually has clean edges that go straight down. A skin tear is made by rubbing, bumping or pulling, and it peels the top layer of skin sideways, often leaving a thin flap. Skin tears tend to be shallow but wide, and they happen on skin too delicate for some of the closures used on cuts. That is why they are assessed and dressed differently.

Gateway is based in Missouri. Does it really arrange care in Alton, Illinois?

Yes. Gateway coordinates wound care and primary care across the Metro East as well as Greater St. Louis, and Alton is part of that region. Care is delivered by partner clinicians, and availability is confirmed for each Illinois location and care setting. Call 314-325-0126 and tell us the address and where the patient is living.

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.