skin tear not healing

[twokidsmom,rn]

A non approximated skin tear. Caretaker applied adaptic and tegaderm. It now has white area in center.

[systoly]

What do you seek?

[twokidsmom,rn]

Should I use telfa instead of adaptic? Or will that dry it out too much?

[systoly]

Sorry, I don't know what to tell you. I don't know if it's just a skin tear or a stasis ulcer or what. Maybe you could have someone look at it.

[twokidsmom,rn]

It is a skin tear on his elbow and forearm. Not a stasis ulcer, he bumped into the doorway and tore his skin.

[KateRN1]

I'm no wound care expert, but I'll do my best.

First, assessment. How long has he had it? What comorbidities (diabetes, etc)? Anything else that might prevent healing? Does it appear infected? If so, has it been cultured? How often is dressing being changed? Too frequent changing can prevent wound healing.

If adaptic isn't working and it's a dry wound, try hydrogel, cover with telfa, wrap with rolled gauze and an ace wrap if he won't leave the gauze in place. Change 2 x/wk. Other suggestion would be a thin hydrocolloid that you can leave in place until it literally falls off. Or if it's not draining and wound bed just needs to be protected to allow it to heal on its own, try covering with a tegaderm.

If you have a WOCN available for consult, try sending pictures and see what recommendation you can get.

[CarolynSRN]

I have found that a very difficult area to heal and most people find it annoying to wear a dressing there. Most of my elderly patients heal best when I have left it open to air. There is a spray on bandage that has also worked for one of my patients.

If your patient will wear a bandage, adaptic and gauze wrap are good, use hydrogel if the wound is dry.

If ok with MD, try adding Vitamin D and Vitamin C to aid in healing.

[paddler]

if the wound is not infected try just tegaderm or a hydrocolloid and leave it on as long as possible, up to a week. Remove after 7 days and voila!

[MauraRN]

For skin tears in elderly I swear by vaseline gauze dressing cut to fit wound, covered with 2x2 or 4x4 with paper tape.

[julieanneb]

Should I use telfa instead of adaptic? Or will that dry it out too much?

Why do we feel the need 2 get so fancy with skin tears???????????????? Telfa will just keep it moist. A freaking bandaid! I finally realized that after 9 yrs of homecare. I am sure the pts. skin is prone to another skin tear with the bandaid but use skin remover when taking off the bandaid. Sumtimes the good old fashioned way is the best 4 a skin tear. In fact,I feel it is always the best. It gets air to it,so it will scab,the non-adherent part of the bandaid wont stick to the tear,and badaboom! I will heal in a few days!