A Clinical Minute: Managing Skin Tears With MEDIHONEY
In the hospital or long-term care setting, clinicians will see skin tears in all shapes, sizes, and etiologies. As with pressure ulcers, the aim is to prevent them. But when they occur, skin tears are painful for the patient, challenging to treat, and can open the door to other problems such as infection and delayed wound healing. Having a skin tear dressing protocol and dressing application training in place for staff is essential to getting everyone on the same page.
We recently updated our skin tear dressing algorithm to include just 2 products to promote a moist wound healing environment: a silicone dressing and a honey-based dressing line, MEDIHONEY®. The silicone dressing provides gentle adhesion while MEDIHONEY® helps promote removal of debris from the wound and enhances conditions for healing.
MEDIHONEY® contains active Leptospermum honey and works through 2 key mechanisms of action: 1) it acts as an osmotic engine to immediately draw fluid from deeper tissues to the wound surface. This stimulates the wound environment, bathing the wound and cleaning away any devitalized tissue1-3; and 2) its low pH (3.5–4.5) helps modulate the pH of the wound, contributing to an acidic environment conducive to wound healing.4-6 Together, these 2 mechanisms create an optimal, moist wound healing environment appropriate for skin tears that promotes granulation tissue formation and reepithelialization.
MEDIHONEY® is available in various formats: calcium alginate, hydrogel colloidal sheet dressing, gel, paste, and honey colloid. This offers the clinician choices to provide the most appropriate product for a particular skin tear.
This article discusses the skin tear healing rates found in a 60-patient evaluation when using a skin tear algorithm tool. The purpose of the evaluation was to assess the ease of use of the tool, obtain data to further investigate why skin tears were occurring (ie, prevalence of device, fall, or tape-related skin tears), and make recommendations for preventing skin tears. Healing rates were witnessed post dressing application and documented in the patient’s chart.
Evaluation
Within a 30-day period, our facility treated 60 patients with skin tears related to a variety of factors, including devices, tape, trauma, and falls. The wounds were categorized using the Skin Tear Audit Research7 (STAR) skin tear classification system (see Table 1). The STAR classification tool was newly instituted in our facility and was chosen over other classification tools because it was simple to understand, helps categorize skin tears, and could be documented easily by all staff. Skin tear severity categories include: 1a (edges can be realigned to normal position; skin/flap not pale, dusky, or darkened), 1b (edges can be aligned; skin/flap pale, dusky, or darkened), 2a (edges cannot be realigned; skin/flap not pale, dusky, or darkened), 2b (edges cannot be realigned; skin/flap pale, dusky, or darkened), or 3 (flap completely absent). We also implemented our treatment algorithm in conjunction with this STAR tool to provide facility-wide skin tear guidelines.
MEDIHONEY® Paste or Hydrogel Colloidal Sheet (HCS) dressing was used on all 60 skin tears. MEDIHONEY® Paste was used under a silicone dressing or sometimes spread on top of a porous silicone contact layer, enabling reapplication of the paste without disturbing the wound area. The gentle, nonadherent HCS dressing can be used on its own and should be applied directly to the wound area. Staff were instructed to change the dressings as needed or at 70% saturation.
All 60 skin tears progressed or healed completely before patient discharge. The staff reported that after applying MEDIHONEY®, patients noted a decrease in pain. Dressing changes were nontraumatic, and often the MEDIHONEY® dressings could be left in place for days, reducing frequency of dressing changes. Damage to surrounding skin was minimized if not totally eliminated by the staff following the algorithm and dressing protocol.
A typical case involved a 72-year-old woman who underwent shoulder surgery and experienced a Category 2b skin tear from her surgical cuff (see Figure 1a,b). She was treated with MEDIHONEY® HCS. Within 2 days, positive wound progression was noted with no trauma or pain experienced when changing the dressing.
The development of a streamlined algorithm accompanied by staff education on proper application and removal of the dressing were 2 critical components of our success. In addition, having MEDIHONEY® paste and dressing options enabled us to dress skin tears of all shapes and sizes. These positive clinical outcomes demonstrate how MEDIHONEY® can enhance the moist wound healing environment to advance the skin tear toward healing.
For more cases on outcomes of the use of MEDIHONEY® in skin tears, visit the MEDIHONEY® Power Webinar series at www.dermasciences.com/medihoney-webinars for a 30-minute case review by Connie Johnson, MSN, RN, WCC, LLE, OMS, DAPWCA.
A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications.
This article was not subject to the Ostomy Wound Management peer-review process.
References
1. Dunwoody G, Acton C. The use of medical grade honey in clinical practice. Br J Nurs. 2008;17(20):S38–S44.
2. Dunford C. The use of honey-derived dressings to promote effective wound management. Prof Nurs. 2005;20(8):35–38.
3. Chaiken N. Pressure ulceration and the use of active Leptospermum honey for debridement and healing. Ostomy Wound Manage. 2010;56(5):12–14.
4. Gethin G, Cowman S. Changes in pH of chronic wounds when honey dressing is used. In: Wounds UK Conference Proceedings. Aberdeen, UK: November 13–15, 2006.
5. Milne SD, Connolly P. The influence of different dressings on the pH of the wound environment. J Wound Care. 2014;23(2):53–57.
6. Leveen H, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop B, et al. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Ann Surg. 1973;178(6):745–753.
7. Skin Tear Audit Research Tool. Available at: www.silverchain.org.au/assets/GROUP/research/STAR-Skin-Tear-tool-04022010.pdf. Accessed May 19, 2015.
