how to treat road rash

I thought I'd post something on my blog on how to care for road rash. Road rash happens to all of us cyclists/ triathletes from time to time.

Do not take chances. Some clinical studies (Basler, et al, 2001) suggest that the traditional treatment for road rash used by cyclists for years may, in fact, cause additional harm to wounded tissues and slow the healing process. Practices such as excessive scrubbing of the wound and/or the use of hydrogen peroxide as a cleaning agent can compromise the cellular regeneration needed for wound restoration. Cells called fibroblasts act as a sort of scaffolding for tissue and secrete matter that forms tissue. You must maintain your fibroblasts to insure quickest wound healing. Excessive scrubbing of a wound, improper dressing or the use of harsh antiseptics can damage or destroy fibroblast cells. It is important to clean the wound, but do not scrub too hard. Only use hydrogen peroxide or other harsh antiseptics when nothing else is readily available at the accident scene. Assessment of the wound also means examining it for additional injuries that may be concealed by road rash. These injuries can include deep cuts caused by rocks, glass or bicycle components that require suturing or contusions and even fractures or soft tissue damage. If you even suspect these conditions, immediately go to urgent care. Another important consideration in wound assessment is the status of your tetanus immunization. If your tetanus shots are not up to date, get one while in the urgent care facility.
The second step in treating road rash is cleaning. When you slide across pavement foreign matter becomes lodged in the open wound. This matter includes fragments of your disintegrated clothing, dirt and road debris such as small rocks. A significant amount of bacteria can also be introduced into the wound area. These injuries can be more dangerous than third degree burns. Picture a third degree burn with a handful of dust and road dirt ground into it. With road rash, infection is a certainty unless the wound is treated quickly and proactively.

Care must be taken when cleaning to not make the wound deeper. If the wound involves a significant area, is hard to reach, has a significant amount of exposed white tissue inside it or bleeds significantly, go to the urgent care facility. It may be too difficult and painful to clean thoroughly on your own.

Your primary goal in cleaning the wound is removal of foreign matter. Your secondary goal is to gently remove any dead tissue from the wound. This second step may need to be done by a medical professional if there is a significant amount of dead tissue inside or surrounding the wound. Dead tissue is the small ridges of skin torn up inside and around the wound that will not heal. Sometimes it is difficult to differentiate dead tissue from tissue that will heal; if in doubt have a trained medical professional examine the wound.

First, irrigate the wound. While cleaning you should wear latex gloves to avoid further contamination. If you have an assistant cleaning the wound, be certain they wear sterile gloves such as latex exam gloves to prevent the exchange of blood or other bodily fluids. This is a common concern when two riders have crashed together and both have injuries. Make disposable medical latex exam gloves a part of your road rash kit. The best way to irrigate a wound is with a syringe filled with nontoxic surfactant such as contact lens solution or other weak (0.9% sodium chloride) saline solution. The best wound irrigation solutions are the brand name Carraklenz, Ultraklenz and Microklenz from Carrington Pharmaceuticals- all available on line. Tap water can be used as a substitute if you are in an area where water can be trusted for purity. Once the wound has been irrigated some of the foreign matter may simply be rinsed out of the wound site. Since road rash frequently occurs on joints there may also be some localized inflammation. Using cold water helps prevent additional inflammation. Cooler water, to quite cold, can also temporarily numb the wound area to better facilitate cleaning. Especially on elbows, if you run the wound under cold water for a few moments to irrigate, reduce inflammation and numb the area you will be able to clean the wound more effectively with less discomfort.

Use care when cleaning. You must strike a balance between removing debris and minor amounts of dead tissue and further injuring the area. Use of a solution specific to wound cleaning is important. Avoid fragrance soaps or soaps with additives. Apply the cleaning solution to the wound in a gentle stream and use a sterile gauze surgical sponge or very soft, sterile brush to gently wipe debris away. Do not scrub too deeply- you only make the wound worse, create pain and could press foreign matter into the wound. You must clean the wound site but not injure it further.

Once the wound has been irrigated and cleaned of foreign debris use a new, sterile gauze surgical sponge to gently blot the area dry.

Using your sterile, surgical gloves open a wound dressing package larger than the size of the wound. Do not touch the surface of the dressing that comes in contact with the wound. Perhaps the most effective dressings for road rash are the type used for burn patients, such as gel impregnated hydro-dressings tend to work best for road rash. 2nd Skin is among the most readily available. These dressings are breathable and maintain a clean, moist wound environment. Other moist, permeable dressings include the Tegaderm and Bioclusive brands. 2nd Skin has been the best we’ve used. This can be purchased from on-line medical supply stores. You will need to change your dressing at least once a day, but likely more than that when you consider showers and other activities that can contaminate the dressing or cause it begin to come off. Changing your dressing is critical to the prevention of infection and to speed healing time.

For the first dressing of road rash, you may want to use a topical wound treatment such as Neosporin + Pain Relief. This will assist in preventing infection, help to stop the introduction and proliferation of bacteria and exert a mild anesthetic affect. A liberal application will help prevent your first dressing from sticking to the wound. You can substitute a sterile gauze pad for the first dressing but subsequent dressing changes are better done with a non-stick, Moist Burn Pad such as 2nd Skin. The initial burn dressing may only remain in place until you get to the urgent care facility, hospital or better area for more complete wound care.
Using your sterile exam gloves, do not touch the area of the dressing with the topical wound treatment. Gently apply the dressing to the wound area, covering it completely with at least a quarter inch overlap of the dressing surrounding the wound.

To hold the dressing in place on legs and arms nothing is better than Tubular Elastic Dressing Retainer. Surgilast is flexible, soft and breathable. It does not use any adhesive that sticks to your skin. Surgilast is a stretch fishnet covering that holds wound dressings in place. If you use Surgilast dressing retainer you will never suffer from the pain of removing tape or adhesive bandages. This is especially important for road rash on your legs if you do not shave your legs. Surgilast also works perfectly for holding dressings on knees and elbows since it moves with the joint.

For road rash on buttocks, back, chest and face you will have to use some type of tape or adhesive dressing. Be careful with the adhesive on these- it can cause its own brand of skin problems and be painful when removed. The use of hypo-allergenic adhesive bandages and tape over gauze dressings that hold the hydrogel dressing in place is the best arrangement. The problem with these mild, breathable adhesive bandages and tape is that they just don’t stick very well.

Once you have initially cleaned the wound, dressed it and visited urgent care you need to monitor the wound for signs of infection. An increase in pain, swelling, red rings or streaks around the wound all signal an onset of infection. No question: Go to the doctor quickly. Even moderate sized road rash can cause deep infections quickly that may result in serious problems. Almost every cyclist knows other riders who have had serious medical problems from infected road rash. If you even suspect infection, immediately seek professional medical assistance. Do not delay even 24 hours.

Frequent inspections for infection are an additional reason to change dressings. A practical reason is to take a shower. For showering with road rash it is best advised to simply keep the current dressing in place, wrap the area with Saran wrap and shower as quickly as possible. Keep the wound dressing from being soaked. Once out of the shower towel off and remove the Saran wrap. Gently remove the dressings and blot dry with gauze surgical sponges. Re-dress the wound using a burn specific topical ointment that promotes cellular regeneration such as Carrasyn V hydrogel wound dressing. This is amazing stuff. Using Carrasyn (formerly Carrington Gel) a road rash can heal completely to new skin in under 10 days. Carrasyn V also reduces scarring.

It is fine to exercise with mild road rash but be certain your dressings are kept clean. Do not swim with road rash. You may contract (or spread) an infection.

Road rash takes a significant amount of supplies to treat and maintain. Since it is a certainty that you will eventually get some road rash it is smart to have a basic road rash treatment kit handy. You will quickly learn it takes an enormous amount of supplies. You will use two moist burn dressings per day per wound site and liberal applications of Carrasyn. Additionally, you need to change tape and bandages each time you change dressings and keep the Surgilast wound retention fabric clean and fresh. Also in your kit should be a good pair of bandage scissors, tweezers for removing bits of debris from wounds, latex gloves for initial wound cleaning and dressing, syringes for irrigation and irrigation/wound cleansing solution, Saran wrap for showering and gauze sponges as well as various sizes and shapes of adhesive bandages and wound dressing tape.

We use a wound treatment kit based on military kits that we assembled on our own. The kit is lightweight, compact and travels around the world with us especially to countries where sterile wound management may be difficult.

As with any medical condition you are always best served to get trained, professional medical diagnosis and treatment. This article is no substitute for qualified medical diagnosis and treatment. Do not take chances with road rash. Prevention is the best cure, but if it is too late for prevention, it is still early enough to get help.