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.

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.

Arranging this care in Webster Groves

People in Webster Groves 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.

Tall trees, deep front porches and houses that have stood for a century give Webster Groves its look. The city lies along Interstate 44 in St. Louis County, with Lockwood Avenue running through its center and Kirkwood, Shrewsbury and Crestwood nearby. Many residents have been here for decades and have no plans to leave. Those same older homes can be hard on someone with a leg wound or a recent surgery, since many have steps at every door. Arranging care at home, or in a nearby facility, spares the patient that climb.

Care at home

Most of a skin tear’s healing happens on the days nobody visits. Before leaving, the treating clinician explains who will change the dressing, when, and what to do if it slips, gets wet or soaks through. Many families are asked to do less than they expect: leave the dressing alone, keep the area protected, and watch. It helps to jot down dates and anything that looks different, to show at the next visit. If something worries you in between, call 314-325-0126. Gateway passes the message to the wound care team, and the clinician decides whether the plan or the visit schedule should change.

For residents of nursing and senior living communities

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.

Changes to report

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

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 Webster Groves →

How to get started in Webster Groves

To arrange skin tear and traumatic wound care in Webster Groves, 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.

After a hospital stay, Webster Groves residents often come home from SSM Health St. Mary’s Hospital in Richmond Heights, St. Luke’s Des Peres Hospital or Mercy Hospital South. None of these hospitals is affiliated with Gateway. If the discharge plan includes wound care, or the patient needs primary care follow-up and cannot easily get out, the family or the hospital’s discharge planner can contact us. We collect the discharge summary and orders, coordinate with a partner clinician and arrange follow-up visits where the patient is recovering.

  • County: St. Louis County, Missouri
  • ZIP codes: 63119
  • Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital; Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood, Affton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Webster Groves

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

Common questions

Will insurance pay for traumatic wound care at home in Webster Groves?

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.

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.

Why is there an arrow drawn on the dressing?

Clinicians often mark a skin tear dressing with an arrow and a date. The arrow shows which way the skin flap lies, so whoever removes the dressing peels in that direction and does not lift the flap back up. The date shows when it was applied and helps everyone keep to the change schedule. If you see a marked dressing, leave it in place unless you have been told otherwise.

My Webster Groves house has steps at every entrance. Is a home visit still possible?

Yes, and that is often the reason families call. The clinician comes to the patient, so the steps only matter for the visitor. Let us know which door to use and whether the patient is on an upper floor. If the stairs are making daily life unsafe, mention it, because the treating clinician can take that into account in the plan.

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.