Road Rashby Bernie Burton, MD
Reprinted with permission of the Rivendell Reader and the UltraMarathon Cycling Association. For more information on endurance cycling, go to www.ultracycling.com
If you ride a bike, you have probably gone down — at least several times. No matter how hard we try, if we ride enough, the ground will meet up with us eventually.
Unfortunately road rash frequently ends up as quite noticeable scars if the road rash is deep. Go to a race and look at the elbows, knees, forearms, legs and chins of the racers if you want to see a varied collection of scars.
The purpose of the article is to review the modern way to treat road rash, to minimize pain, control bleeding, and optimize healing, as well as what to avoid, how to reduce scarring if it occurs and how to detect it early if it should occur.
You have hit the ground — let's assume you were not knocked unconscious; all of your body parts move well, there are no obvious breaks, and you are not spurting blood. With no visit to the ER eminent, what do you do now? That depends on what you have with you for first aid. Dr. Arnie Baker, in his book Bicycling Medicine, has recommended first aid kits for your car and a more sophisticated kit for a group or medical personnel. With the limited amount of space and weight allowed, I would recommend that the one thing you should carry is what you should have with you anyway to prevent saddle sores — Vaseline petroleum jelly — the first aid kit in a jar.
Want to go all out? Add several non-stick Telfa pads and a flattened soft, adherent Coban elastic bandage, or cheaper variant. When you crash, cover your wounds, and go home to give your wounds the care they need.
The primary goal of wound care is getting the wound clean. The primary deterrent to cleanliness is pain. To prevent pain get a tube of ELA-max from your local pharmacy. This recently available topical over-the-counter Xylocaine preparation should be rubbed into the wound gently for fifteen minutes. Almost total pain control should be achieved. Scrub the wound aggressively with sterile gauze, sterile saline and Hibiclens®. Stop when the wound is red, raw and totally clean.
To stop oozing use pressure with sterile saline. If oozing stubbornly persists, use gauze and hydrogen peroxide (3%) which should almost totally stop bleeding and oozing within five to ten minutes. Hydrogen peroxide works because it is a gentle cauterizing agent. However, its use is now usually avoided for routine wound care because it is adding more damage, via cautery, to your wound. Use it only for stubborn bleeding.
Cover the wound with Vaseline petroleum jelly. A number of studies have shown that allergic contact dermatitis from topical antibiotics (especially neomycin-containing products, e.g. Neosporin, family antibiotic cream or ointment, triple antibiotic ointment or cream) is so common that you are much better off using Vaseline petroleum jelly (and not Vaseline petroleum cream). Cover the Vaseline with sterile Telfa pads. Use a Coban bandage, or coban-equivalent, to hold the Telfa in place.
Synthetic semi-occlusive wound covers such as Vigilan, Spenco Second Skin and others like Tegaderm may be used instead of the above. You can let them stay on unchanged for up to three days, but they are expensive and the rate of infection can slightly increase. Change your dressings once or twice daily for Vaseline and Telfa and every two to three days for synthetic dressings.
Cleanse the wounds with soap and water (use sterile saline if you don't trust your local water supply's chlorination program) before applying the dressing. The goal is to eliminate any chance of scab formation. A scab allows the wound to heal in the reverse image of the scab. The preceding technique will ensure that your wound will totally heal in from the bottom. When the wound is totally filled in and no raw skin remains you can stop dressing changes.
A sudden increase in redness developing at the pink wound site indicates the formation of a thick, elevated scar, also known as a keloid or hypertrophic scar. This probably will occur soon after the wound is totally healed. To prevent scarring, daily massage (five to ten minutes three times daily) with lotion or Vaseline is recommended beginning immediately after total wound closure.
Better yet, use a silicone gel sheeting held in contact with hypoallergenic waterproof first aid tape (hospital name Blenderm) for four to eight weeks. Curad silicone gel Band-Aids, which have just become available, can simplify this treatment for small wounds.
If you have large areas of road rash, make your own silicone gel sheeting. (See below.)
The purpose of this article has been to minimize the pain, misery and scarring of road rash. Your scars may not be near as impressive to future generations, but that should be greatly preferable to the discomfort of kneeling on your scars in future years or the inability to rest your elbows on a table because of the hardness or discomfort of the scars on your elbows. Perhaps taking a photograph if your bright, fresh wounds will be more impressive in the future than the painful scars that might result from them.
PS: Wear wool — its abrasion resistance is significantly effective in decreasing road rash.
How To Make Silicone Gel Sheeting
Instructions: Cover cookie pan with silicone gel to an even depth of 2-4 millimeters. Let dry. Cut into pieces large enough to cover wounds. Cover wounds after daily bathing. Remember to only use silicone gel sheeting on totally healed wounds. The chance of infection is high if you start it too soon. Remove before your next bath.
In addition to the previously mentioned substances containing neomycin, the use of Benzocaine or Solarcaine and topical Benadryl should be avoided in all wound care efforts. These substances can frequently cause allergic contact sensitization and severely exacerbate any wound and increase greatly the chance of scarring.
Dr. Dan Siegel's recipe for silicon gel sheeting: Put a marble sized dollop of Silicone window caulk into the center of a plastic baggy. Gently press down spreading the caulk out, but do not let it get to the edge of the baggy. Trim the edges, let it sit and dry for a day or two and then remove the plastic from the top and bottom and allow to dry further. If you make them in advance, or start just after your accident, you should be ready to use them when your wounds have healed.
How To Get It Cheap
Sterile saline: Sterile saline available in large bottles is usually considered not sterile after one use. It can also be very expensive. Go to Target store's contact lens supply department and get a one-pint bottle of Target Multi-use Sterile Saline spray Eyewash for $1.00 to $1.49.
Moore Medical Supply (www.mooremedical.com): Moore Medical is a medical supply company that offers individual personal accounts. A group of individuals or a bike club could easily order the amounts required from Moore Medical to make it worthwhile to assemble several kits at a reasonable price. Purchasing Moore brand products rather than the name brand products will typically save you 25-50%. I recommend that you consider Moore Non-Adherent pads (NA, item number 10776) rather than Telfa, and Moore Medi-Rip® self adherent bandages rather than Coban. This bandage easily rips rather than requiring scissors to tear it. Its item number is 17453. Moore gauze pads, item number 08251, are significantly less expensive than the name-brand products. In addition, Tegaderm® transparent dressing and Spenco Second Skin dressings are available at a reasonable price from Moore Medical.
Although I would normally recommend buying at home, finding these products at a regular drug store or medical supply store can be very difficult for non-medical personnel — like finding a nice lugged steel sports-touring frame in all sizes at your local bike store.
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web posted: 2 January 2004
last updated: 3 January 2004