By Dr. Johnathan Edwards
If the many crashes of this year’s Tour de France has reminded cyclists of two things, it’s that 1. crashing is hard on the skin, and, 2, if dealt with properly, any amount of road rash doesn’t have to prevent you from riding – just ask Primoz Roglic!
Before diving into the treatment of road rash, the most important thing to consider after any crash is first to determine the extent of your injuries. Did you break anything? Did you hit your head? Do you have difficulty breathing, joint swelling, or difficulty moving about? Then you likely have an injury that needs a proper medical assessment, and you should go to urgent care or the emergency department.
Let’s assume that all of the above is fine, and now we are looking at your wound. Can you see beneath the skin? Can you see something that looks like fat or muscle? Can you see tendons? Has it been a while since your last tetanus shot? If any of these problems are present, you need to see a doctor. Nothing disrupts the rhythm of a great cycling experience other than looking for urgent care or a hospital, but it’s sometimes necessary.
SURVIVING ROAD RASH
CLEANING: Abrasions that do not penetrate deep through the skin can clean be self-treated. First aid solutions for washing wounds contain soap and water. The goal is to clean the wound thoroughly. The best products are those that contain soap and a pain killer such as lidocaine. Johnson & Johnson sells one called “Band-Aid Antiseptic” and Neosporin makes one called “Neo To Go.” Often these are easily found in any pharmacy. However, let the pain killer solution soak on the wound for about ten minutes. This way, the skin can become numb, making cleaning a wound nearly painless. If you don’t have any of these solutions, use soap and water and a towel between your teeth.
BANDAGES: First, cover the wound. Covering a wound with a bandage or your hand is nature’s way of decreasing the pain. This allows you to think through the situation. Just use regular non-adherent dressings. The idea is that the wound will ooze for a couple of days, and you will be performing daily dressing changes. Use a quality cloth or clear tape to secure the bandage.
WRAPS: A gauze wrap is something that keeps the bandages in place whether you’re moving on or off the bike. One such gauze wrap is called a Kerlex wrap which can absorb wound drainage and stay on reasonably well. Ace bandages work as well, but they tend to unravel. In my experience, the best wrap is a product called Coban – which is short for cohesive bandage. Coban is tough, and most importantly, it sticks to itself, and it is reusable. It even comes in various colors!
SEMI-PERMEABLE DRESSINGS: Tegaderm and hydrocolloid dressings. Tegaderm is a product manufactured by 3M corporation. It is a very thin, transparent dressing with adhesive on one side. It is particularly good at keeping the wound clean and lets the skin breathe. I like Tegaderm because it takes away the painful skin sensation and allows for better sleep, optimizing recovery. This can be crucial during long cycling trips. Hydrocolloid dressings are thicker and provide more protection for the wound. These are advanced dressings but can be well worth the time and effort.
STORAGE BAGS: It is always a good idea to keep zip-lock bags on hand, as they come in handy if you have access to ice. And remember that you can use an Ace wrap or Coban to hold an ice pack over the wound or a sprain.
CLEANING THE WOUND
1. Numb the injury with antiseptic wash by applying the solution to gauze and holding it over the wound, as discussed above, for about ten minutes. Waiting is the key.
2. When the pain improves, use soaked gauze pads to scrub the abrasion gently. Please don’t overdo it. Scrub the dirt out as best as possible. You will likely cause more bleeding. This usually is fine; keep holding pressure and then continue to clean. I advise against using hydrogen peroxide as it hurts like a dickens and kills the healthy tissue. If there is grease in the wound, then apply a dish soap solution such as Dawn. Remove all the debris to help avoid infection and permanent skin discoloration. If you cannot achieve this, then seek more advanced medical care.
3. Covering the wound. After the wound is reasonably cleaned, consider applying a light layer of antibiotic ointment such as bacitracin or Neosporin (assuming that you are not allergic). Start with a non-adherent dressing as described above, as the wound will ooze. Then wrap the wound with the non-adherent dressing with either Kerlex, Coban, or an Ace wrap. Then secure the wrap with some tape. Over the next couple of days, the oozing will decrease, and then you can change to a semi-permeable dressing such as Tegaderm or a hydrocolloid dressing.
4. Dressing the wound for riding. Use the methods above to wrap the wound very well with Coban or an Ace wrap. Tape it securely. Use duct tape if necessary. Always be sure there is an adequate range of motion. As with most dressings, it will work its way loose.
5. Continued care. It’s normal to keep the wound covered for 5-10 days, and full healing will take weeks. Replace the dressings as needed and each time, gently clean the wound with soap and water. The abrasion will form a whitish plaque which is called granulation tissue. This tissue is the body’s natural process to grow new skin. Try not to peel it off or let it dry completely and form a scab. Wounds heal slower when you do this. Finally, remember that new skin is susceptible to sunlight, so always cover it and use sunscreen.