Skin tears: a review of the evidence to support prevention and treatment.

Physiological changes that occur as part of the aging process put the elderly at risk for developing skin tears. Lack of consistent care in the management of skin tears in the authors' community sparked a literature search to determine best evidence for the management of skin tears. Medline and Cochrane Library databases were searched for studies and systematic reviews on skin tear prevention and treatment. The literature suggested that the greatest number of skin tears occurs among the elderly (65 years and older). Factors reported to be associated with the occurrence of skin tears in addition to age include immobility and a history of skin tears. In the absence of systematic risk factor research, clinicians continue to report that all variables that may be associated with these wounds must be considered when assessing the elderly. Several small studies suggest that most skin tears occur on the extremities and seasonal incidence variations also have been reported. Despite consistent sample-size limitations, the results of controlled clinical studies and case series consistently suggest that education and implementation of prevention protocols reduce the incidence of skin tears in extended care facilities by almost 50%. Studies to evaluate and compare the effectiveness and cost-effectiveness of skin tear treatments are limited but when appropriate care is provided most skin tears can be expected to heal after 7 to 21 days depending on the severity of the wound. A combination of skin protection, preventive measures, and treatments that facilitate moist wound healing appear to be most effective. Risk factor and epidemiological studies as well as research to validate the existing skin tear classification system and improve clinician ability to provide evidence-based risk assessments, preventive care, and treatment are needed.