Caring beyond the skin tear

Best‑practice interventions for wound healing and balance 

SPONSORED EDITORIAL 

Wendy White, Founder, TALKING WOUNDS® and WOUNDed® 

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Skin tears are a common, skin-related injury sustained by older persons living in the community. Primary health care nurses are often the first point of contact for identification, assessment and management. Recognising the risk and implementing early, best-practice interventions are critical. 

Skin tears are considered ‘high risk’ for chronic wound development and are influenced by person, wound and care factors known to delay or negatively impact wound healing. Early intervention can mean the difference between restored skin integrity within 14–21 days or progression to a hard-to-heal wound associated with pain, negative lived experiences, infection risk and increased healthcare burden. Restoring ‘Wound Balance’ can help when a skin tear doesn’t heal as expected. 

Identifying opportunities for early intervention 

‘What happened here, Mary? What have you done to yourself since I saw you last?’  

This may be a familiar question in primary health care. You are a registered nurse working in general practice and Mary has come to see you for her blood pressure check. You notice a crusted wound on Mary's lateral lower leg. Mary, a 78-year-old widow who lives at home alone, describes brushing against a cardboard box, or a car door, or a coffee table – or simply scratching an itch.  

These everyday events reflect a consistent pattern: minor mechanical force applied to fragile ageing skin can result in a skin tear. Falls and other blunt force trauma are also common causes and often occur on hands, arms and lower limbs (see Figure 1). 

Such forces can occur not only in the home but in clinical settings, including primary health care, for example during: 

• adhesive dressing or tape removal (medical grade) 

• compression hosiery application or removal (donning or doffing) 

• manual handling and transfers (from chair to examination table) 

• accidental fingernail or jewellery contact (healthcare professional or carer). 

Repeat these scenarios across settings and one conclusion is clear – this can be a widespread, under-recognised and under-reported problem. 

Figure 1: A Type 1 skin tear involves no skin loss. 

 

Understanding ageing skin and risk of skin tears 

Australia’s ageing population continues to grow, with one in six people aged ≥65 years and one in eight aged ≥85 years.^¹,² Skin integrity declines with age, increasing susceptibility to injury. 

Dermatoporosis describes an advanced state of chronic cutaneous fragility.³ Clinical features include skin atrophy (thinning), senile purpura (irregular discoloration), pseudoscars (small white scar-like areas; see Figure 2) along with skin tear injuries, superficial and deep dissecting haematomas. These changes increase the older person’s vulnerability to injury, with skin tears the most common acute wound in this ageing population. 

Figure 2: Dermatoporosis is an advanced state of chronic cutaneous fragility often associated with ageing skin. 

 

What is a skin tear? 

The International Skin Tear Advisory Panel (ISTAP) has redefined a ‘skin tear’ as ‘a traumatic wound caused by mechanical forces, including removal of adhesives and patient handling, the depth of which may vary (not extending through the subcutaneous layer)’⁴ (see Figure 3). 

While prevention is important,4–8 the impact of early, evidence-informed management when a skin tear is sustained should not be underestimated. Clinical decisions made at the time of injury can directly influence outcomes and risk of complications, highlighting the importance of individualised assessment. 

According to ISTAP, skin tears can be further described as ‘uncomplicated’ (i.e., expected to heal within ~4 weeks) or ‘complicated’ (i.e., does not heal within 4 weeks and may become a chronic wound).⁴ Factors contributing to skin tear complexity include: 

• poor health (chronic disease) or compromised nutritional status 

• multiple comorbidities/polypharmacology   

• lower limb vascular disease and/or chronic oedema  

• compromised immune status and infection risk  

• suboptimal holistic assessment or management interventions.  

Early identification of these risks allows clinicians to intervene sooner and improve healing trajectories. Best-practice recommendations and Wound Balance can support primary health care nurses to maintain or restore balance earlier rather than later. 

Figure 3: Dermatoporosis is an advanced state of chronic cutaneous fragility often associated with ageing skin. A Type 2 skin tear involves partial flap loss. 

 

Best-practice steps for skin tear management 

ISTAP provides comprehensive, evidence-informed guidance, including skin tear resources and checklists for risk identification and reduction, decision algorithms, classification and data-collection tools.4 Variations in clinician awareness, knowledge and practice reinforce the need for ongoing education and system guidance to support improved recognition and optimise management strategies.^₅,^₆ 

The Skin Tear Decision Algorithm can help provide a guide to best-practice first aid, assessment and treatment.⁴  

Initial management 

For the initial management of a skin tear, follow these steps:  

1. Stop the bleeding and use calcium alginate for first aid. 

2. Cleanse gently. 

3. If skin flap is present but necrotic, consider careful debridement.⁴ 

4. Re-approximate viable skin flap. Gently ease the flap back into place using a gloved finger and dampened cotton tip applicator. 

5. Classify and document the skin tear as Type 1 (no skin loss), Type 2 (partial flap loss) or Type 3 (total flap loss). 

6. Identify goals of care and treatment options. 

7.  

Ongoing management 

When managing an uncomplicated versus a complicated skin tear, the goals of care require individual assessment and planning. Silicone foam dressings are atraumatic and have demonstrated to support superior wound healing when compared with non-silicone products.⁹ ISTAP does not recommend iodine-based dressings, transparent film/hydrocolloids with strong adhesive, adhesive skin closure strips or gauze. Suturing a skin tear is also not recommended.⁴  

For uncomplicated skin tears: 

• Maintain a moist wound environment.  

• Protect peri-wound skin. 

• Minimise trauma during dressing changes. 

• Monitor healing. 

• Expect improvement within 14–21 days. 

For complicated skin tears, manage as per an uncomplicated wound, plus: 

• Consider infection, inflammation and exudate management. 

• Use higher absorbency or advanced dressings.  

• Reassess if healing is delayed (>4 weeks).  

For lower limb skin tears: 

• Undertake vascular assessment, including ankle–brachial pressure index. 

• Introduce compression where appropriate.  

• Consider early referral if lower limb vascular assessment and compression prescription local expertise is not available. 

 

What is Wound Balance? 

The Wound Balance concept is a practical framework integrating the key elements of ‘Patient,’ ‘Wound’ and ‘Care’ to guide clinical decision-making in chronic wound management.^10–11 Applying the Wound Balance concept can help guide management if a skin tear is slow to heal and becomes a chronic wound. 

Here are some suggestions for putting the key elements of Wound Balance into practice.   

PATIENT (person-centred care): Balance the art 

Understand the person, their goals, their wellbeing and their ability to engage. 

In Navigating Wound Balance, Swanson, White et al. identify the ‘importance of [healthcare professionals’] commitment to person-centred, empathetic communication and the development of trusting, therapeutic relationships and compassionate care.’¹⁰ 

WOUND (and skin): Balance the science 

Create the right environment to support healing. Use validated wound-assessment tools, such as TIMERS12 (for local wound and skin assessment, including Tissue, Infection/Inflammation, Moisture, Edge, Repair and Social factors) to guide appropriate product, dressing or device selection to match the goals of care and the person’s preference (scan this QR code to learn more about the Wound Balance Pathway).¹⁰ 

CARE (clinical practice): Balance the practice 

Deliver consistent, timely and evidence-informed wound care. 

In Navigating Wound Balance, by Swanson, White et al., the expert panel recommends integration of recent international consensus documents and national Australian standards.¹⁰ This includes the Australian Standards for Wound Prevention and Management, 4th edition (2023).¹³ 

Improving health outcomes for older patients 

Skin tears represent more than a superficial injury – they are a visible indicator of underlying skin vulnerability and a test of clinical decision-making in real time. While prevention remains important, it is the quality of early assessment and management that often determines healing outcomes.  

Primary health care nurses are uniquely positioned to influence this trajectory through informed practice, critical thinking and patient-centred care. This is where Wound Balance can help.  

In Mary’s case, applying best‑practice wound care and the principles of Wound Balance could promote improved healing and quality of life. Early, appropriate intervention would help reduce the risk of her skin tear progressing to a long‑term chronic wound. 

As populations continue to age, advancing knowledge and confidence in skin tear management is not optional – it is essential to delivering safe, effective and dignified care.  

Skin tear care: Key takeaways  Skin tears are common acute wounds in older populations.   They are at risk of developing into chronic wounds.  Best‑practice management (i.e., ISTAP) and early intervention improve healing outcomes and reduce the risk of complications.  Silicone dressings are recommended in skin tear management.

For further information and resources, go to www.skintears.org (ISTAP)

Wendy White is an Independent Nurse Consultant and Educator and founder of TALKING WOUNDS® and WOUNDed®. She specialises in skin integrity and hard-to-heal wounds, supporting clinicians through education, coaching and evidence-informed practice to improve outcomes for individuals at risk of or living with complex wounds.  Wendy White has received an honorarium for this sponsored editorial.

 

References 

1. Australian Institute of Health and Welfare (AIHW), Older Australians, AIHW website, 2 July 2024, accessed 17 April 2026.  

2. Australian Bureau of Statistics (ABS), Population projections Australia 2017 to 2066: Population aged over 85 to double in the next 25 years, ABS website, 22 November 2018, accessed 17 April 2026. 

3. A Kaya, HB Vuagnat and G Kaya, ‘Dermatoporosis: Clinical features, molecular mechanisms and novel therapeutic targets—A literature review’, J Wound Manag, 2022, 23(3), doi: 10.35279/jowm2022.23.03.08.  

4. K LeBlanc, K Campbell, D Beeckman et al., Best practice recommendations for the prevention and management of skin tears in aged skin, 2nd edn, Wounds International, London, 2025.  

5. H Van Tiggelen and D Beeckman, ‘Skin tears anno 2022: an update on definition, epidemiology, classification, aetiology, prevention and treatment’, J Wound Manag, 2022, 23(2):38–47, doi:10.35279/jowm2022.23.02.09.  

6. H Van Tiggelen, D Beeckman, et al. ‘Development and psychometric testing of the OASES instrument for skin tear knowledge’, Int Wound J, 2021, 18(4):466–475.  

7. J Deprez, A Fourie and D Beeckman, ‘Measures that patients living in the community can take for the prevention and treatment of skin tears: a review,’ J Wound Manag, 2020, 23(2), doi:10.35279/jowm2022.23.02.04.  

8. K LeBlanc, K Campbell, D Beeckman et al., Best practice recommendations for the prevention and management of skin tears in aged skin, Wounds International, London, 2018.  

9. K LeBlanc and K Woo, ‘A pragmatic randomised controlled clinical study to evaluate the use of silicone dressings for the treatment of skin tears’, Int Wound J, 2022, 19: 125–134, doi:10.1111/iwj.13604.  

10. T Swanson , W White, AM Dunk et al. Navigating Wound Balance: practical approaches for the Australian landscape, Wounds International, London, 2023.  

11. World Union of Wound Healing Societies, Implementing Wound Balance: outcomes and future recommendations, Wounds International, London, 2025.  

12. L Atkin, Z Bućko, E Conde Montero E et al., ‘Implementing TIMERS: the race against hard-to-heal wounds’, J Wound Care, 2019, 28(3 Suppl 3):S1–S49, doi:10.12968/jowc.2019.28.sup3a.s1. 

13. E Haesler and K Carville, Australian standards for wound prevention and management, Australian Health Research Alliance, Wounds Australia and WA Health Translation Network, 2023.