Skin tears, while beginning as acute wounds, can encounter complications and become chronic wounds. Individuals suffering from skin tears state they have increased pain and decreased quality of life. Populations at the highest risk for skin tears include those at extremes of age, as well as the critically or chronically ill. These individuals are at a higher risk for developing secondary wound infections and have co-morbidities.
Healthcare professionals must become cognisant of which individuals are at risk for developing skin tears, how to prevent these wounds and how to treat them once they occur. As most skin tears result from equipment or a fall, many should be preventable. Unfortunately, there is a dearth of literature on the appropriate prevention, assessment and management of skin tears, leaving it a continuing challenge for healthcare providers.
Panel to raise awareness of skin tears
The International Skin Tear Advisory Panel (ISTAP) was formed to raise international awareness of the prediction, assessment, prevention, and management of skin tears. In January 2016, ISTAP became an official interest group of the Canadian Association for Enterostomal Therapy (CAET). ISTAP now includes 19 global expert members from 11 countries and has participated in the publication of 14 articles. The ISTAP classification system has been translated into English, Danish and French-Canadian, while publications are pending in Spanish and Swedish. Translations into Czech, Mandarin and Italian are in progress.
The panel identified several key knowledge gaps and areas of common misperception among clinicians. To address these issues and provide vital support to healthcare professionals around the world, ISTAP, in collaboration with Wounds International, convened a group of international experts in November 2017 to discuss key topics around skin tears. The topics under discussion included:
- definitive guidance on terminology for skin tears, or the ISTAP definition
- differences across age groups, patient populations and care settings
- skin tear prediction risk factors
- skin tear prevention disciplines
- skin tear assessment and classification (ISTAP, STAR, Payne Martin)
- skin tear management across different care settings
- skin tear complications.
Categories of skin tears
The ISTAP classification system groups skin tears into three main categories. Type 1 has no skin loss, and is characterised by a linear or flap tear that can be repositioned to cover the wound bed. Type 2 is ‘partial flap loss’, in which the skin is partially missing and cannot be repositioned to cover the wound bed. The third category is Type 3 or ‘total flap loss’, in which the entire wound bed is exposed.
Expertise across disciplines
ISTAP serves as a think tank for improved patient outcomes when it comes to the issue of skin tears. Its purpose is to positively impact lives and unite professionals working collaboratively across a broad range of disciplines.
The panel consisted of ISTAP members and key global opinion leaders such as:
- Kevin Woo (Canada)
- Dimitri Beechman (Belgium)
- Kimbelry LeBlanc (Canada)
- Diane Langemo (US)
- Samantha Holloway (UK)
- Karen Campbell (Canada)
- Patricia Idensohn (South Africa)
- Anne Marie Dunk (Australia)
- Karen Ousey (UK)
- Catherine Harley (Canada)
- Hubert Vuagnat (Switzerland)
- Marco Romanelli (Italy)
- Heidi Hevia (Chile).
The output from these discussions formed the basis of a global best-practice document that will be published by Wounds International in the second quarter of 2018. The meeting and consensus document have been made possible through generous support from 3M, Acelity, Medline and Mölnlycke Health Care.
ISTAP is thrilled to bring the dream of developing international best-practice recommendations for the prevention and management of skin tears to reality. It invites medical professionals and industry to join together in May 2018 in Krakow, Poland at the EWMA conference for the launch of these groundbreaking recommendations, supported by Mölnlycke.
