Understanding 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 the treating clinician looks at

Assessment starts with the story of the injury. The treating clinician asks what the skin struck or what pulled on it, how long ago, how much it bled and what was done first. A fall changes the conversation, because other injuries have to be ruled out. The clinician also asks about diabetes and circulation problems, and about the date of the last tetanus vaccine, particularly when soil, rust or a dirty surface was involved. Those answers shape the plan as much as the wound’s appearance does. A clean tear in a well-nourished person and a contaminated scrape in someone with several health conditions call for different levels of watchfulness.

Skin tear and traumatic wound care in South County

People in South County 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.

South County is shorthand for the southern part of St. Louis County, a band of communities roughly south of Interstate 44 that reaches from the River des Peres at the city line down to the Meramec River. It includes Affton, Lemay, Mehlville, Oakville, Concord, Sappington, Green Park, Crestwood and Sunset Hills. Gravois Road, Tesson Ferry Road, Lemay Ferry Road, Telegraph Road and Lindbergh Boulevard are the roads everyone uses. People here tend to stay for life, and many are retirees. Bringing wound care and primary care to them fits the way South County lives.

When care happens at home

Home visits suit this kind of wound for a simple reason: the person who has just fallen or torn their skin is often the person least able to travel. After you contact Gateway, we learn where the person lives and what happened, gather any urgent care or emergency room paperwork, confirm that a partner clinician is available for that address, and schedule the visit. The clinician assesses the wound at home, with the chair, the bed and the bathroom that may have played a part in plain view. Orders and supplies are coordinated from there, and we stay in touch with the family about what comes next.

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

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.

Why primary care matters here

Below the knee, a traumatic wound is rarely only about the skin. Fluid from heart, kidney or vein problems collects in the lower legs, stretches the skin and seeps through any break in it. Narrowed arteries deliver too little blood to rebuild tissue. Both are long-term conditions that belong to primary care and, where needed, to heart or vascular specialists. The wound clinician may be the first to notice them. With both kinds of care arranged through Gateway, that observation can become a referral, a test or a treatment change handled by the right clinician, and the wound plan is updated when the answers come back.

Primary care at home in South County →

How to get started in South County

Setting up skin tear and traumatic wound care for someone in South County 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.

Mercy Hospital South is the hospital most South County residents know best. SSM Health St. Clare Hospital in Fenton and St. Luke’s Des Peres Hospital are used by many people on the western and northwestern sides. None of them is affiliated with Gateway. For discharge planners, a referral by phone or fax with the summary, wound orders and a family contact is enough to start. For families, one call to 314-325-0126 before or after discharge works. We then look for a partner clinician for the patient’s home or facility and confirm what happens next.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in South County

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

Common questions

Will insurance pay for traumatic wound care at home in South County?

It depends on the plan, the treating provider and the care that is needed, so we cannot tell you in advance that a service is a covered benefit. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Keep the insurance card handy when we talk, and we will help you work out which questions to put to the plan and the provider before care begins.

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.

Can the person shower with a skin tear dressing on?

Ask the treating clinician, because the answer depends on the dressing and where the wound is. Some dressings tolerate a brief shower and others must stay dry. In general, avoid soaking the area in a bath and pat the surrounding skin dry instead of rubbing. If the dressing loosens or water gets under it, follow the instructions you were given or call.

What areas does Gateway mean by South County?

We use South County the way most St. Louisans do: the southern part of St. Louis County, including Affton, Lemay, Mehlville, Oakville, Concord, Sappington, Green Park, Crestwood and Sunset Hills. That covers ZIP codes 63123, 63125, 63126, 63127, 63128 and 63129. Fenton and Arnold are nearby and are covered as well. Availability is confirmed for each address and care setting.

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.