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ACEP Now: Vol 34 – No 01– January 2015

ACEP Now features one article each issue related to an ACEP eCME CME activity.

Log on to the ACEP eCME CME site to complete the activity for this article and earn free AMA PRA Category 1 Credit.

Skin Tears! Who Cares?

Why care about skin tears? The standard for skin tear repair has always been “more is less.” The more you try primary closure with sutures, the more tissue destruction you cause, resulting in frustration and, often, a worse cosmetic result. So many, if not most, of us have just given up, taking the easy way out—“less is more”—embracing the ethical luxury of telling these patients that we have little to offer other than wound cleansing, a bio-occlusive dressing, and discharge. A quick in-and-out for you, but a poor cosmetic result and wound care hassle for them.

This old standard may have changed! Primary closure for skin tears is possible. It was never in question that primary closure of skin tears would be optimal. However, it just couldn’t be accomplished in thin-skinned patients because the sutures, no matter how small, always seemed to pull through the skin as soon as tension was applied. You can’t thicken the skin; conversation over—but not so fast. Davis et al published a paper reporting a novel technique: the use of Steri-Strips but not in the traditional sense.¹ They applied Steri-Strips across the skin tear as anchoring devices and then sutured through them (see Figure 1).

After reading this article several months ago, I gave it a try. However, I modified the technique slightly due to a stellate, nonlinear wound and some tissue defect. I cut pieces of Steri-Strips for anchoring at key locations and sutured through them; my Steri-Strips did not span across the wound. My modification provided a bit more flexibility regarding the most advantageous wound edges to approximate (see Figure 2).

Oxygen Must Be Good

Oxygen is air! It is critical to survival. So how could it possibly be bad? Well, water is essential to life as well; however, too much can result in hyponatremia or even drowning (on a larger scale). A recent article by Stub reported “new” information calling the use of oxygen into question in ST segment elevation myocardial infarction (STEMI) patients who have normal oxygen saturations.²

Figure 1. Davis et al applied Steri-Strips across the skin tear as anchoring devices and then sutured through them.