Claire’s Story
Provided by Dr Corinne Scicluna PhD, SN. Senior Lecturer, Coordinator – Skin and Wound Care Course, Council Member – European Wound Management Association, President -Malta Association of Skin and wound Care (MASC). Faculty of Health Sciences, Department of Nursing, Mater Dei Hospital, Malta
Consent to use the details of this case and images was provided by the patient
Introduction to the Case
Patient History:
- 80-year-old female with fragile skin
- Widowed with 4 children
- Owns and manages several rental properties
- Normally fit and healthy, very active, enjoys swimming in the sea
- Mechanism of injury: fell off a step ladder at home
This case describes a lady called Claire who has experienced recurrent skin tears associated with age‑related skin fragility and repeated trips and falls.
In 2023, the patient sustained a fall from a ladder resulting in a fractured knee and a complex skin tear. While the fracture healed, the wound deteriorated despite repeated standard dressing changes and multiple courses of oral antibiotics. Early wound management involved routine dressings and frequent removal, leading to skin trauma, pain, and delayed healing.
After several weeks of non-healing, referral was made to a tissue viability nurse. Specialist assessment identified the need for debridement and appropriate advanced dressings. A structured treatment plan was implemented, including appropriate dressings. The wound subsequently progressed to healing.
Following this initial episode, the patient experienced further traumatic wounds to the lower limb, particularly the shins, attributed to severely fragile, paper-thin skin. These injuries were characterised by significant bleeding, skin flap loss, and prolonged healing times (approximately six weeks per episode) even when managed optimally.
Repeated injury led to substantial psychosocial impact, including fear of falling, hypervigilance, and loss of confidence. The patient implemented extensive preventative strategies (daily emollient therapy, environmental modifications, protective shin guards, carrying emergency dressings) and became highly reliant on rapid specialist advice to prevent deterioration when new wounds occurred.
Attended Emergency Department (June 25, 2025)
Claire’s thoughts on repeated injuries and living with fragile skin
- “Even a slight knock, and the blood just pours out.”
- “It’s not just a little cut—it’s six weeks of dressings and worry.”
- “Psychologically, it’s very traumatic.”
(June 25, 2025)
(June 27, 2025)
The patient referred herself to the Tissue Viability Nurse as her wound was painful and was not improving.
Three weeks following injury
(16 July, 2025)
The impact on Claire’s daily life
- “I couldn’t go to the beach. I couldn’t shower properly. It affected everything.”
- “Now I moisturise my legs before my face.”
- “In winter I wear shin guards—like a footballer.”
Claire’s reflections on when standard treatment does not work:
- “I thought you get a wound and it just heals on its own. I’ve learned that it doesn’t.”
- “I had three courses of antibiotics, and it never got better. It lasted longer than the fractured knee.”
Claire has experienced multiple episodes of skin tears
see ISTAP Best Practice Recommendations for more information.
ISTAP recommends classification of skin tears at presentation to guide management and prognosis.
Claire experienced delays in wound healing. The wound is sloughy and necrotic.
Claire’s experience of care:
- “They were just changing normal dressings. It just wasn’t getting better.”
For more information on Debridement please see the following resources:
Wound debridement – EWMA
Wound debridement pathway – EWMA
Claire’s thoughts on the importance of specialist care
- “If you want wounds to heal properly, you need specialised care.”
- “Otherwise they might heal eventually—but for me, that meant weeks and weeks of suffering.”
Patient Perspective: Living With Skin Frailty
For Claire, skin tears are no longer perceived as minor injuries. Each incident represents weeks of treatment, loss of independence, and anxiety. While prevention strategies and specialist support have improved outcomes, the ongoing risk remains a constant presence in daily life.
This case reminds clinicians that effective skin tear management is not only about wound healing, but about preserving confidence, independence, and quality of life in people living with skin frailty.
| Reflection Points – Has this case changed how you view skin tears in older adults? – What one change could you implement immediately in your practice based on this case? Consider making some notes on these reflective points and discuss the case with your colleagues. |
The case demonstrates:
- Delayed healing and prolonged morbidity when traumatic wounds in frail skin are managed appropriately
- The clinical and psychological burden of recurrent lower‑limb wounds in older adults
- The value of tissue viability expertise in assessment, dressing selection, debridement decision‑making, and patient education
- The importance of secondary prevention strategies and early intervention to reduce complications
- How the patient has learnt to self-care to ensure she receives the correct treatment immediately.