Acute management of skin tears with mesh grafting: a prospective study and cost-benefit analysis

Abstract

**Background**: Skin tears cause a significant burden to the patient and healthcare system. Acute management has traditionally comprised of operative debridement and formal skin grafting, which is costly, invasive and often followed by admission for five to seven days. In a 2014 pilot study by Vandervord and colleagues, a protocol for re-laying the skin tear as a meshed skin graft (mesh protocol) was proposed, which has not been validated to date. Our study aims to compare a prospective cohort to the original pilot study to determine validity in clinical practice and provide an updated cost-benefit analysis.**Method**: All patients who presented with acutely sustained skin tears at Northern Beaches Hospital, NSW, Australia, were prospectively entered into the mesh protocol as described by Vandervord and colleagues. An updated cost-benefit analysis was performed using a national hospital cost data collection report produced by the Independent Hospital Pricing Authority (IHPA).**Results**: We enrolled 53 patients onto the protocol who had sustained a total of 64 discrete skin tears, with 11 patients sustaining more than one skin tear. The average age of patients was 86, and the most common location of the skin tear was pretibial, followed by forearm/hand. Only one patient required a return to theatre for debridement and formal skin grafting, and three patients required long-term dressings for partial mesh graft loss. The cost to the healthcare system is consistent with the pilot study, with a significant difference between discharge from the emergency department post-procedure and formal grafting and admission for five to seven days.**Conclusion**: Use of the mesh protocol creates wound coverage and prevents the need for formal skin grafting, and reduces costs associated with formal operations and hospital admissions.