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

Much of the care plan for a skin tear comes down to what touches the wound and how it is held there. The treating clinician generally chooses a dressing with a gentle contact surface, one that can stay on for several days and release without lifting the flap or the skin around it. The clinician also decides how it is secured, often with a soft wrap or sleeve in place of tape, and who will change it. Past reactions to adhesives are worth mentioning at this point. Pain is part of the assessment too. A dressing change that hurts is looked into, because it can point to a dressing that sticks, to swelling or to infection.

Arranging this care in the Metro East

On the Illinois side of the river, an injury is usually first treated at an Illinois hospital or urgent care, and the insurance behind it may be an Illinois Medicaid plan or a Medicare Advantage plan with its own provider list. Before a wound visit is scheduled in the Metro East, Gateway confirms which partner clinician can see the person in Illinois and helps the family raise the right questions with the plan. A fresh skin tear should not be left waiting on paperwork, so call once the injury has been seen. We request the hospital records in the meantime.

The Metro East is the Illinois side of the St. Louis region: St. Clair, Madison and Monroe counties, running from Alton and Godfrey in the north to Columbia and Waterloo in the south. It takes in river towns on the floodplain, older cities such as Belleville and Granite City, growing suburbs like Edwardsville and O’Fallon, and farm communities to the east. A good deal of the region’s specialty care sits across the river in Missouri, and a bridge crossing is a real obstacle for someone who is frail or in pain. Care arranged close to home matters here.

Care 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

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.

Changes to report

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

Several common medicines change how skin injures and heals. Blood thinners make bleeding and bruising heavier. Long-term steroid medicines can thin the skin. Medicines that cause drowsiness or lower blood pressure make a fall more likely. None of this means a medicine should be stopped. These drugs are prescribed for serious reasons, and only the prescriber should adjust them. What primary care can offer is a full medication review with the wound in mind, along with a check of vaccination records. Gateway shares the wound clinician’s notes with the primary care clinician, so that review starts from what was seen at the bedside.

Primary care at home in the Metro East →

Arranging skin tear and traumatic wound care in the Metro East

People asking about skin tear and traumatic wound care in the Metro East 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.

Patients in the Metro East come home from many hospitals, including Memorial Hospital Belleville, Memorial Hospital Shiloh, HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois, Anderson Hospital in Maryville, Alton Memorial Hospital, OSF Saint Anthony’s Health Center in Alton, Gateway Regional Medical Center in Granite City and Touchette Regional Hospital in Cahokia Heights. Gateway Wound Care is not affiliated with them. Whichever hospital it was, a family member or discharge planner can ask us to arrange follow-up. We obtain the discharge orders and set up a visit with a partner clinician at the home or facility.

  • County: St. Clair, Madison and Monroe counties, Illinois
  • Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
  • Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the Metro East

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

Common questions

Does Gateway arrange skin tear care in nursing homes and assisted living in the Metro East?

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.

Do skin tears need stitches?

Often not. Very thin skin may not hold stitches well, so clinicians frequently rely on other ways to settle a flap back in place and protect it while it heals. The choice belongs to the clinician who examines the wound. A deep or gaping injury is a different matter and should be seen urgently, because it may need to be closed soon after it happens.

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.

Gateway is based in Missouri. Does it really arrange care in the Metro East?

Yes. Gateway’s region is Greater St. Louis in Missouri and the Metro East in Illinois. The administrative office is in Chesterfield, Missouri, but patients are not seen there. Care is arranged with partner clinicians where the patient lives, including in St. Clair, Madison and Monroe counties. Availability varies by town and care setting, so we confirm it for your address 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.