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Dealing with road rash

Philippe Gilbert is patched up during the 2013 Tour De France.

Dealing with road rash 01/02 2014 by Adrie Post

At some point, probably sooner rather than later, you're going to fall off your bike. The road will act like a cheese grater and you will lose skin. Obviously you want to avoid that situation in the first place, but when it does happen there are a few techniques to aid healing and almost eliminate discomfort which I'll share with you here.

Healing Process
Example of rapid healing with correct dressings. Crash at 45kph, lycra shredded, backside raw. Used Jelonet dressing covered by a light dressing to absorb leakage and Flexigrid to keep it sealed. Would healed within 10 days. Remember to rest and eat correctly to aid healing. Dec 2013.

To begin I must make it clear that if you have anything more serious than road rash, then you need to visit accident and emergency. This applies to head injuries, deep wounds where you can see bone, wounds that require stitches or where you suspect a broken bone.

If you have lost consciousness, then get checked out at hospital. A brain hemorrhage can take hours, even weeks for symptoms to become apparent. Helmets will only give so much protection. Your brain is delicate and floats in fluid, and is easily traumatized.

The road rash I'm talking about here is the usual loss of skin to knees, elbows and hips following a slide down the road. The wounds will be stinging, may contain grit and will be accompanied by underlying bruising.

Pre-crash preparation
The first thing to consider is preparation prior to getting injured.

Ensure you have had a tetanus jab within the last ten years.

The medical supplies mentioned below should be purchased in advance and taken to events in case of need. You may feel that this is tempting fate, but everybody crashes at some point and you will be grateful for having the supplies on hand when you do.

Duoderm - Hydrocolloid plasters <- essential item
Ibuprofen - to be taken with food
Antibacterial wash - Shur-Clens or Hibiclens
Anesthetic cream - lidocaine jelly
Jelonet - guaze dressing
Fishnet Mesh or tights to hold the plasters in place

Note that medical supplies only have a finite life and should be replaced when expired.

For larger areas which can't be covered by Hydrocolloid dressings, a burns gauze like Jelonet works well. It can stick a little to the wound, so prepare to grit your teeth when you change the dressing. Working slowly is best, and a soaking in saline solution helps to unstick it from the wound.

Cleaning the wound
After your crash your first concern is infection. Clean the wound as soon as you can. Antibacterial washes such as Hibiclens or Shur-Clens are antiseptic and antimicrobial and can be swabbed over the injury and used to rinse out gravel. It doesn't particularly sting. Water will of course work well, but won't be sterile and will sting more.

Do not scrub the wound as recommended by Eric Zabel in the 'Hell on Wheels' movie, as this will only increase cell damage, hurt like hell and delay healing.

Pain relief
Once the wound is clean, pat it dry then apply some 2% Lidocaine gel. Higher dose gels are available, but these are not intended for the treatment of cuts. If you don't have the gel, then don't worry about it.

Also take a couple of 200mg ibuprofen tablets. This must be taken with food to avoid stomach ulceration. You may dose up to 800mg every 6 hours with no more than 2400mg per day. Try to take the minimum necessary. Note that cheap supermarket brands of ibuprofen will work just as well as branded versions which could be ten times more expensive. For example you could buy 200x200mg Ibuprofen for $4 from Wal Mart.

Hydrocolloid dressings
These plasters are a miracle cure for road rash. After washing the wound, the plasters are applied directly to the skin. The liquid secretions of the wound (exudate) cause a gel in the plaster to be activated and this aids healing. Consider shaving the skin around the wound before applying the dressing. It'll make life a lot easier when the time comes to change the dressing.

Hydrocolloid dressing
I fell off and got a cut on my knee, about 2cm diameter. This hydrocolloid dressing was applied and changed 2 days later, then after 3 further days. By day 8 the would was pretty much healed. I forgot to put sun tan cream on the new pink skin and it got burnt!

Every 2-3 days you rinse and clean the wound, inspect for infection and apply a new plaster. After approximately 7-8 days you will find that the wound has healed without forming a scab. The new skin will be pink and thin but will not be weeping or prone to infection.

If you spot the signs of infection then seek medical advice. Look out for reddening around the wound, oozing pus, bad smell or fever.

The key is to avoid letting the wound form a scab. In the 'old days', I would clean the wound, dry it, apply some antibacterial powder then spend the next few days getting stuck to the bed sheets, leaking fluid and in pain whilst the wound was getting infected.

With these plasters, you no longer stick to the sheets, pain is greatly reduced, it is possible to shower, the chance of infection is minimized and healing time is three times faster. Truly remarkable.

The hydrocolloid plasters can be bought at pharmacies and even supermarkets and can be costly, but it is worth it. Try looking for online nursing supplies as these will be much cheaper than going to a pharmacy, but you'll have to buy in bulk. Trade names are Duoderm, Granuflex, Ultec and 3M Tegaderm.

If you can't get your hands on these dressings, then the next best thing is to treat the wound like a burn and use a gauze. Keep the wound moist with antibiotic cream and Vaseline. Don't let it dry out or get infected. Cover the gauze with a thin layer of padding and then shrink wrap it all with Opsite Flexigrid.

Keep the plasters in place with either a pair of women's tights or medical mesh. You probably won't need to secure the dressings in this way unless cycling the next day. For the majority of cyclists, a few days off would be advised to aid healing.

Try to eat well after the injury to aid healing, and stay hydrated. Light exercise the next day seems to help with the healing process by getting the blood flowing.

Your new skin
Remember that newly formed skin is thinner than mature skin, and also has less resistance to UV rays. Make an effort to cover it up or use sunscreen on it, otherwise it'll get burnt.

I recommend P20 sunscreen. It is a Danish brand. The lotion works well and is very water and sweat resistant.

Modern technology has brought us these hydrocolloid dressings which are a miracle cure for road rash. With very little discomfort or inconvenience you could be almost completely healed within a week.

I hope this advice helps you should you fall off. I certainly wish I knew this 20 years ago! Please let me know how you go.

Excellent article on dealing with road rash from Dr Dawn Richardson.

P20 lotion. Best I've used.

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