Understanding skin tears and traumatic wounds

The most common mistake is the name people give it: just a scratch. On fragile skin, a scratch on the shin can become a long, stubborn problem, and waiting to see is how many of them begin. The second is the old advice to let a wound dry out in the open air. Clinicians today generally prefer a wound kept covered and protected, and the treating clinician will say what suits this one. The third is trusting whatever bandage is in the cabinet. A strong adhesive can strip skin when it comes off and leave a second wound beside the first. Finally, families sometimes read a skin tear as proof of rough handling. It can happen during careful, gentle care, though repeated tears deserve a closer look at how and when they occur.

What the treating clinician looks at

For any injury below the knee, the treating clinician examines the leg, not only the wound. Pulses at the foot and ankle, skin temperature and color, and hair and nail growth give clues about blood flowing in. Swelling, brownish staining around the ankle and bulging veins give clues about blood flowing back out. Both matter, because a shin wound on a swollen or poorly supplied leg behaves like a leg ulcer in the making. If the findings raise questions, the clinician may order circulation testing before deciding how swelling should be managed. The care plan then covers the leg as a whole: protecting the wound, controlling fluid, and guarding the shin against the next knock.

Local context: Florissant

People in Florissant 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.

Florissant is one of the largest cities in North County, with a historic Old Town at its heart and decades of subdivisions spreading out from it. Lindbergh Boulevard cuts across the city, and New Halls Ferry Road links it to its neighbors. A great many of its homes are single-story ranches, bought by young families years ago and still occupied by the same owners. That makes Florissant a natural place for aging at home, and it makes home-based wound care and primary care especially useful as those owners need more medical attention.

At home between visits

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

In a facility

Assisted living raises a practical question that nursing facilities do not: who is allowed to change the dressing? Staffing and licensing differ from one community to the next, and many rely on a visiting nurse, a home health agency or the family for wound care tasks. Gateway sorts this out at the start. We ask the community what its staff can do, share the treating clinician’s orders with whoever will carry them out, and arrange for supplies to be on hand in the resident’s apartment. The wellness nurse or director receives an update after each visit, and the family is told about changes to the plan.

What to report and when to call 911

Whoever changes or checks the dressing sees the wound most often. Pass these observations to the treating clinician without waiting for the next visit:

  • A dressing that sticks, or skin that lifts when it is removed
  • New tears, blisters or a rash where tape or dressing edges sat
  • A wound that measures larger or looks deeper than before
  • Drainage that has increased or changed color
  • A person who has started guarding the limb or refusing care

Call 911 for heavy bleeding, fainting or loss of consciousness, or sudden severe pain with a limb that cannot be moved.

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 Florissant →

How to get started in Florissant

Setting up skin tear and traumatic wound care for someone in Florissant usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Florissant residents usually go to Christian Hospital in North County, east along Interstate 270, or to SSM Health DePaul Hospital in Bridgeton to the southwest. Gateway is independent of both. For discharge planners, the process is short: fax the referral, wound orders and face sheet, and note whether the patient is going home or to a facility. For families, call and tell us the hospital and the going-home date. Gateway requests the records, checks availability in 63031, 63033 or 63034, and arranges follow-up with a treating clinician.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Florissant

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

Common questions

Does Gateway arrange skin tear care in nursing homes and assisted living in Florissant?

Yes. Facility nurses, administrators and families can all make the request. We confirm that a partner clinician can visit that facility, then coordinate with the nursing staff on timing, records and orders. The treating clinician sees the resident on site. When a visit can be arranged, the resident does not have to be driven to an outside appointment for a wound check.

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 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.

Florissant has three ZIP codes. Which ones can request care through Gateway?

All three. People in 63031, 63033 and 63034 can ask Gateway to arrange wound care or primary care at home or in a facility. These ZIP codes also take in some areas outside the city limits with a Florissant mailing address, and those are welcome too. Availability is confirmed for the exact address and the care setting, so please have the street address ready when you call.

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.