Understanding skin tears and traumatic wounds

A skin tear is an injury wound, not a disease. It forms when rubbing, a knock or a tug slides the outer layer of skin away from the layer beneath. Sometimes the top layer lifts as a flap that can be laid back down. Sometimes part or all of it is lost, leaving a raw, shallow, tender area that may bleed more than its size suggests. Traumatic wound is the larger family that skin tears belong to. It takes in lacerations (cuts), abrasions (scrapes), punctures, and hematomas, where blood collects under the skin after a blow. What these wounds share is a clear starting moment. What differs from person to person is how well the body underneath can repair them.

What the treating clinician looks at

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: Ferguson

People in Ferguson often move between settings without leaving the area: home, a hospital stay after a fall, a spell of rehabilitation, then home again or into assisted living down the road. An injury wound travels with them, and dressing plans tend to get lost at each handoff. Because Gateway arranges care in private homes and in the senior living communities and skilled nursing facilities close by, the same wound orders, records and supply list can follow the person. The treating clinician picks up from the last note instead of starting over.

Ferguson is a North County city of older, tree-shaded neighborhoods set between Interstate 270 to the north and Interstate 70 to the south. Florissant Road runs through its small downtown, and West Florissant Avenue carries traffic along the east side. Most streets are lined with modest houses, many owned by the same families for a generation or more. When someone in one of those homes develops a wound that will not close, or comes back from the hospital weaker than before, care delivered at home or in a nearby facility keeps treatment from depending on a ride.

When care happens at home

Family caregivers do the daily handling that fragile skin either withstands or does not. A home visit is a good time to ask the treating clinician to watch a transfer, look over the wheelchair or walker, and point out what to change. Common suggestions include:

  • Padding on bed rails, table edges and wheelchair leg rests
  • Long sleeves, long pants, or soft sleeves made to protect shins and forearms
  • Supporting a limb from below with open palms, not gripping it
  • Short fingernails and no rings or watches during care
  • A plain moisturizer on arms and legs every day
  • Clear, well-lit paths, above all at night

Care in skilled nursing and assisted living

In a skilled nursing facility, a skin tear is usually found by an aide or nurse during morning care or after a transfer. The facility documents it, notifies the attending physician and the family, and can refer to Gateway for a wound care visit. The treating clinician assesses the resident at the bedside and writes orders that facility nurses carry out between visits. Findings go back to the attending physician, the director of nursing and the wound nurse, so the chart tells one consistent story. Because many tears happen during bathing, dressing and repositioning, the clinician can also advise on handling and protective measures for that resident.

Signs to tell the clinician about

When the wound came from a fall, the skin may not be the most serious injury, and some problems show up hours or days later. Let the treating clinician know about:

  • New pain in a hip, wrist, shoulder, ribs or back
  • Limping, or reluctance to stand or use an arm
  • Dizziness on standing, more unsteadiness or another fall
  • A wound that looks no better from one week to the next

Call 911 if the person hit their head and then develops a severe headache, vomiting, confusion, unusual sleepiness or trouble speaking, or if an arm or leg looks misshapen or cannot bear weight.

How primary care fits in

Skin is built from what a person eats and drinks. Older adults who have lost their appetite, lost weight or drink little often have dry, slow-healing skin, and a wound raises the body’s need for protein and fluid. Diabetes adds another layer, since high blood sugar slows repair and makes infection more likely. A primary care clinician can check weight trends, order lab work where appropriate, review blood sugar and suggest a dietitian if that fits. These are slow fixes, so they help most when started early. Arranging primary care alongside wound visits means the body’s side of healing gets attention while the dressing does its part.

Primary care at home in Ferguson →

Getting care arranged in Ferguson

People asking about skin tear and traumatic wound care in Ferguson usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

Christian Hospital in North County and SSM Health DePaul Hospital in Bridgeton are where people from Ferguson are most often admitted. Neither is affiliated with Gateway. The step from hospital to home is where wound care tends to get lost: new dressings, new medications, and no one assigned to look at the wound next week. A discharge planner can prevent that by faxing a referral before the patient leaves. Families can call us with the same information. Gateway obtains the records and arranges follow-up with a treating clinician at the Ferguson address.

  • County: St. Louis County, Missouri
  • ZIP codes: 63135
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, North County, North St. Louis, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Ferguson

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

Common questions

Is Gateway the right call for a fresh injury in Ferguson, 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.

How often will the wound be looked at?

The treating clinician sets the schedule after the first assessment. It depends on the wound’s size and location, how much it drains, the dressing chosen and who is available to help between visits. Skin tears generally do better when they are not uncovered more than necessary, so fewer checks is not a sign of less care. If the wound changes, the schedule can change too.

What should I have ready when I call about an injury wound?

A name and phone number are enough to start, and the web form asks for nothing more. For the conversation that follows, it helps to know when and how the injury happened, where on the body it is, what care it has had so far and where the person lives. A medication list, insurance card and any discharge papers from urgent care or the hospital are useful too.

My grandmother in Ferguson has no ride to appointments. How can Gateway help?

Gateway can arrange for a partner clinician to visit her at home in Ferguson, so no ride is needed for wound care or primary care visits. If the treating clinician orders something that requires travel, such as imaging or a specialist appointment, we can coordinate transportation arrangements and the appointment together. Call 314-325-0126, tell us her address and phone number, and we will check what is available.

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.