Preventing skin tears among older adults in general practice

In this article, Sarah Jane Palmer discusses the importance of the prevention of skin tears and the role practice nurses can play Skin tears can present a complex and chronic problem for an older patient with fragile skin, and can be very disabling, reducing quality of life dramatically in some cases. The right care is essential from all members of the wider team caring for older patients, in order to identify risk factors for skin tears, as well as formulating a care plan of prevention that relates to these risk factors. Good skin care is essential, as well as patient education, and identifying ongoing issues with the patient's health that present a factor to consider when caring for them, such as mobility issues. Self-care should be encouraged where possible, and the correct use and choice of emollients that are pH balanced is crucial. By preventing skin tears we not only give the patient a far better quality of life, but we also reduce the need for very limited NHS resources.

Caracterização da produção científica acerca das lesões por fricção: revisão integrativa

Objetivo: identificar na literatura as produções científicas sobre lesões do tipo Skin Tears. Metodologia: revisão integrativa, cuja busca ocorreu entre abril e junho de 2020, nas bases de dados LILACS, PubMed, SCOPUS, SciELO, Web of Science e Cochrane para responder à questão norteadora: “Quais as características da produção científica sobre lesões do tipo Skin Tears?”. Foram incluídos artigos de pesquisa originais que atendiam ao objetivo da pesquisa. Excluíram-se estudos da literatura cinzenta (relatos de caso, reflexão, recomendações), artigos de revisão e estudos que focavam outras temáticas. Resultados: as buscas nas bases de dados pesquisadas capturaram 371 referências. Após as exclusões, selecionaram-se 13 estudos para serem lidos na íntegra, onde destes, 07 artigos foram selecionados para compor esta revisão, agrupados empiricamente, conforme suas similaridades, em três categorias: “Prevalência e fatores de risco para as Skin Tears”, “Importância da prevenção, e manejo das Skin Tears” e “Fragilidades de protocolos institucionais que padronizem o cuidado das Skin Tears”. Conclusão: a abordagem teórica sobre as lesões por fricção é primordial para prestar uma assistência efetiva, visando minimizar o desconforto e as complicações em pacientes acometidos por estas. Entretanto, constatou-se escassez de estudos que possibilitem fundamentar uma discussão de qualidade, dado que é imprescindível a promoção de uma assistência integral que garanta melhor qualidade de vida.

Creation of skin grafts from traumatic avulsed skin

As the proportion of geriatric patients increases, so too does the incidence of geriatric trauma. Trauma centres must develop protocols to reduce the risk of complications from injuries in this specialised patient population. From a soft tissue standpoint, open wounds tend to heal slower in these patients and have a significant impact on their quality of life. In this case report, we describe our protocol for managing traumatic skin tears using a combination of traumatic skin grafts and minced expansion grafts with photographic documentation of the healing from significant wounds in an elderly patient involved in a high-energy blunt traumatic injury.

A Recent Advance in the Closure of Skin Wounds on Fragile Skin

The delicate nature of the skin in elderly patients poses a difficult challenge to healthcare providers. Emergency departments are frequently presented with traumatic skin tears and soft tissue avulsions in this group of patients. Procedures aimed at closure of these types of wounds often result in worsening of the tears. The DermaClip® skin closure device, which can eliminate the need for anesthesia, addresses these disadvantages and allows for atraumatic, cosmetically satisfactory closure in a rapid and efficient manner, saving time, and costs.

Casper’s sign in the elderly

Casper’s sign refers to the absence of external signs of trauma despite severe and often lethal internal injuries. It occurs because the elasticity and resilience of the skin results in it deforming and moving rather than sustaining injuries from being tethered and relatively immobile. Given the known increase in skin and soft-tissue fragility in the elderly with a greater vulnerability for bruising and skin tears, a study was undertaken to determine whether Casper’s sign may be present or not in older populations. A review of autopsy files at Forensic Science SA over a 20-year period from January 2000 to December 2019 was performed in individuals ≥80 years of age where death involved blunt chest trauma, blunt abdominal trauma or multiple blunt-force injuries. Four cases were identified. All of the decedents were males aged 82–89 years ( Mage=86 years) with deaths associated with a fall ( n=1) and vehicle impacts ( n=3). Despite significant and often lethal internal chest/abdominal injuries, none of the cases had external injuries to their torsos. Thus, as Casper’s sign may be present at all ages, the absence of external injury in the elderly may be no reflection of the force of the impact or the degree of resultant skeletal and/or internal organ disruption. This may be pertinent in cases of elder abuse.

Unusual Skin tear caused by eye taping using acrylic-based adhesive tape in a adult patient with recurrent craniopharyngioma

Skin tears due to medical adhesives are a ubiquitous but under documented complication that occurs in in almost all clinical settings and frequently in patients with certain risk factors. Due to lack of information regarding proper usage, suitable selection and the right technique for application of adhesive products can influence patient safety besides hampering the quality of life. Medical adhesives-related skin injuries (MARSI) is the latest term used, defined ‘an occurrence in which erythema and/or other manifestations of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion or tear) persists 30 min or more after removal of the adhesive’ [1]. We describe a report of skin tear due to acrylic based adhesive in a young male who underwent craniotomy and tumor excision. A 21 year-old male with a diagnosis of a recurrent craniopharyngioma was posted for a Pterional craniotomy and excision of the tumour. The patient had secondary hypothyroidism and secondary hypocortisolism on thyroid and steroid replacement respectively. He was shifted to the OT and after attaching all the standard ASA monitors, he was induced after adequate preoxygenation, with Fentanyl, Propofol and Vecuronium and intubated with a 8.5mm sized ET tube. A central venous catheter was inserted post induction in the right subclavian vein and was fixed with an adhesive tape. Before positioning the patient, scalp block with 15 ml of 0.5 % bupivacaine was administered. The eyelids were then taped with acrylic-based adhesive tape. The duration of the surgery was approximately 11 hours. In view of the prolonged nature of the surgery, the decision was made to not extubate the patient in the OT and to shift him to the Intensive Care Unit for further management and elective ventilation. Before the patient was shifted out of the OT, the adhesive tapes over his eyes were removed. While the left eye and periorbital region were found completely normal, the right periorbital region was mildl