A new method for closing skin tears in elderly patients
A combination of Steri-Strips and sutures may help close skin tears in fragile skin.
One of the unfortunate things that can occur in the emergency department is when an elderly patient comes in with a skin tear. Attempting to suture the wound will often leave the patient with worsening tears because their fragile skin cannot withstand the sutures. Many times, we are only able to apply a pressure dressing with the added support of GELFOAMTM (Pharmacia & Upjohn Company LLC, Kalamazoo, Mich.) to aid in hemostasis. Sometimes, I will try a loose running stitch with absorbable sutures to try and tack down the skin. Other times, I will use a combination of Steri-StripsTM (3M, St. Paul, Minn.) and glue to close the wounds. Unfortunately, elderly patients are often on anticoagulants or aspirin therapy, which make the hemostasis of the wound even more difficult.
Recently, we had a patient whose skin tear was not responding to pressure and GELFOAM. The attending mentioned that we should try a method I was not familiar with. It involved closing the wound with Steri-Strips and then running sutures through the Steri-Strips for added support. I decided that I needed to explore this technique further.
During my research, I came across a lot of literature regarding this topic, but none of these articles gave the technique an actual name. One article called it the “Suture/Steri-Strip combination,” which I suppose eliminates guesswork about what the method involves. Regardless of the name, the benefits of this technique are simple: The Steri-Strip acts as a barrier and prevents the suture from tearing through the skin. In turn, the sutures provide added support in wound closure and offer more strength than the Steri-Strips alone.1
This method sounds simple, but it only works under certain circumstances since every skin tear presents itself differently. For example, if the wound is actively bleeding, applying the Steri-Strips can be rather difficult because they will not adhere to the skin. Therefore, the wound either has to be one that is not prone to bleeding or one that has already stopped bleeding. Wounds that require a lot of strength to close may also cause difficulties; the Steri-Strips may be under too much stress to hold the wound closed to suture.
For some wounds, it may be best to lay down all of the Steri-Strips first and then suture, while in other cases it can be best to use one Steri-Strip/suture combination at a time. While doing my research I came across a concept I have yet to try but imagine would work quite well, and that involves running Steri-Strips parallel to the wound to act as the base for the suture.2 I can't wait to use this technique to see how it works.
One of the cons of using sutures is that the patient needs to have them removed if the sutures are non-absorbable. Using sturdy, absorbable sutures can circumvent this issue.
I am always glad when I learn about new techniques in medicine, and I am especially glad when they involve techniques for wound closure. When it comes to skin tears, I find myself getting creative and having to treat each skin tear on an individual basis. I will definitely add this method to my arsenal of tricks.
How do you approach skin tears? Do you have any other creative tricks?
Jillian Knowles, MMS, PA-C, works as an emergency medicine physician assistant in the Philadelphia area.
- Davis M, Nakhdjevani A, Lidder S. Suture/Steri-Strip Combination for the Management of Lacerations in Thin-Skinned Individuals. The Journal of Emergency Medicine. 2011;40(3):322-323. doi:10.1016/j.jemermed.2010.05.077.
- Tricks of the Trade: Steristrip-suture combo for thin skin lacerations. Little White Coats. 2011. Available at: http://littlewhitecoats.blogspot.com/2011/03/trick-of-trade-steristrip-suture-combo.html. Accessed November 3, 2015.