About 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.

How the care plan is built

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: St. Louis City

Many injuries in the City of St. Louis are first seen at one of the large medical centers nearby, where a cut is closed or a skin tear dressed and the person goes home with a sheet of instructions. The harder part comes afterward, in a third-floor walk-up or an older building with no elevator, when going back for wound checks means risking another fall on the stairs. Gateway arranges follow-up where the person lives. We request the emergency department records, confirm a partner clinician for that address, and coordinate dressings so the plan started at the hospital continues at home.

The City of St. Louis is its own jurisdiction, separate from St. Louis County, and stretches from the Mississippi riverfront west to Forest Park and the county line. Inside it are dozens of distinct neighborhoods, from Downtown and Soulard to the Central West End, The Hill and the north side. The city is dense, old and largely built of brick, and many households do not have a car. For someone managing a wound or several chronic conditions, getting to appointments by bus or by borrowed ride is a recurring struggle that care at home can ease.

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.

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

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.

Primary care and overall health

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 the City of St. Louis →

Arranging skin tear and traumatic wound care in the City of St. Louis

To arrange skin tear and traumatic wound care in the City of St. Louis, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Barnes-Jewish Hospital, beside Forest Park, and SSM Health Saint Louis University Hospital, on Grand Boulevard, are the two major hospitals in the City of St. Louis. Gateway is not affiliated with either. Both discharge patients to every part of the city, and some go home with wounds that need regular attention. Case managers and social workers can refer by phone at 314-325-0126 or by fax at 314-786-7966. Families can call directly. Once we have the discharge summary and orders, we look for a partner clinician for the patient’s neighborhood and report back.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
  • Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the City of St. Louis

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

Common questions

Is Gateway the right call for a fresh injury in the City of St. Louis, 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.

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.

Will the skin be normal again once a tear has healed?

It will be closed, but usually not as strong as before. Healed skin over a tear is often thinner and may stay pale, pink or purplish for a long time. The same spot can tear again more easily, so protection still matters after the dressing comes off. Ask the treating clinician how to care for the area, and report any reopening early.

My father in the City of St. Louis has both Medicare and Medicaid. Can we still ask about home visits?

Yes. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans, alone or in combination. Whether a visit is a covered benefit depends on the treating provider, the plan and the care your father needs, so Gateway cannot tell you ahead of time that something is a covered benefit. Have both cards with you when you call 314-325-0126, and we will explain what the treating practice needs to check.

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.