Skin tears were defined by Payne and Martin as ‘‘a traumatic injury occurring on the extremities of older adults as a result of shearing or friction forces, which separate the epidermis from the dermis.’’7 This was later revised in 1993 as, ‘‘a traumatic injury occurring principally on the extremities of older adults as a result of shearing or friction forces which separate the epidermis from the dermis (partial-thickness wound) or which separate both the epidermis and the dermis from the underlying structures (full-thickness wound).’’6 This revised definition was later adapted as part of the Skin Tear Audit Research (STAR) skin tear classification system8. But regardless of the definition, skin tears occur commonly in the extremes of age, in the critically ill or medically compromised, and in those requiring assistance with daily activities. At present, the dressings commonly used for the management of skin tears include hydrogel, alginate, lipido-colloid based mesh and foam dressings, soft silicone, foam, calcium alginate dressings, absorbent clear acrylic dressings, and skin glue4,5. But there has been no description of the use of a hydrofiber dressing or a silver-based hydrofiber dressing for the management of this commonly seen problem.
This retrospective, noncomparative study showed that the use of a silver-based hydrofiber dressing in the management of class I and II skin tears in the Emergency Department setting, functions well, and is well accepted by the elderly and the general population. The application was easy and painless. The daily care of the dressing and the wound was stress-free and extremely well tolerated by the family members looking after the patient or even by the patient themselves. Out of all the patients, there were only 3 that had failed due to infection. The patients in this study were all extremely elderly, with an average age of 83 years old. There were 28 patients that were older than 85 years old and 14 patients that were over 90 years old. In the extremes of ages, you need to make wound care easy and fuss free. One has to take into account that in the elderly patient, there can be the presence of degenerative osteoarthritis or rheumatoid arthritis of the hands, leading to deterioration of fine motor skills. They are more susceptible to failing eyesight, as well as failing memory. Often, they might be living alone or in some circumstances it is one elderly family member looking after the other (elderly wife looking after elderly husband or vice versa). If the care of the wound becomes complicated, it will not be well tolerated by this group of patients. In this method, all the patients had to do at home was to change to gauze covering the silver-based hydrofiber dressing and to not get the dressing wet.
Silver has been used widely in wound management for many years to help control local infection. Historically, silver can be dispensed as metallic (silver foil), solution (eg, silver nitrate), or cream (eg, silver sulfadiazine). Ionic silver (Ag+) has received renewed interest as a prophylactic antimicrobial agent in wound dressings due to its broad spectrum antibacterial range. There are various mechanisms that can be used to explain the antimicrobial effect of ionic silver. Silver interferes with the cytochromes of microbacteria and additionally also interferes with components of the microbial electron transport system, binds DNA, and inhibits DNA replication. There is at present little evidence of emerging microbial resistance to silver.9–13
Aquacel® Hydrofiber dressing (ConvaTec, London, UK) is a moisture- retention dressing. It consists of a soft non-woven sodium carboxymethylcellulose fibers. This becomes gel-like when it comes in contact with wound fluid. This gel promotes a moist wound-healing environment while at the same time it retains wound exudates by vertical absorption. Fibrin that collects between the hydrofiber and the wound surface acts as an adhesive, fixing the dressing in place, allowing the adherence of the dressing to the wound.14− 20
It is based on these 2 properties that we used a silver-based hydrofiber for fixation of the paper-thin skin tears. Hydrofiber dressing has been applied to many types of wound care with favorable results and cost-effectiveness.14–20 Silver-based hydrofiber has been used to treat partial thickness burns both in the adults and in the pediatric population. It has been used in chronic wounds, non-ischemic diabetic foot ulcers, split thickness skin graft donor sites and in acute traumatic wounds21–27. This is the first description of using it in the management of skin tears.
A further benefit of this method, was that it avoided the need for sutures or staples. Even though sutures and staples are not advised in these types of wounds, some patients still mistakenly undergo primary repair. By using this dressing, it avoids the risk for needle stick injuries, and decreases the treatment time required for the management of these types of injuries. This is very important in the Emergency Department where time is always in short supply. This method was also welcomed by the patients themselves, as they do not need to experience the pain associated with the injection of local anesthetics and suturing. The method was so simple, that after complete healing of the wound, some of the patients asked to purchase extra silver-based hydrofiber dressings to keep at home in case further injuries like these happens in future.