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Road Rash
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I think I know the answer, but now in my 4th session of healing from a fair amount of road rash through the years I still do not have a process down in treatment. I hit a dog on June 10th at 30 mph and have various spots and most have healed by this point except two spots. One spot on my forearm is now about the size of a quarter and after a few days of wrapping and using Neosporin I started leaving it open to the air. It is small but deep and continues to break open and ooze a little while slowly improving. The worst is on my knee which took the hardest impact. The scrape went down to where the tissue looks white. I have kept my knee covered and change twice a day with a non-stick dressing, Neosporin and wrapped. It continues to ooze and some of that is a fair amount of fluid around the injured knee from the impact. There is a lot of pressure on my knee from the fluid, but some of that has dissipated and moved down to my foot where there is blood and fluid.

After a visit to the orthopedic on Friday the x-rays show no damage to the bones, but I will have to get a MRI this week to check for other potential damage. But one thing the orthopedic said to me was to start leaving the knee unwrapped and exposed to the air. Maybe I misunderstood what he was saying, but I tried leaving it open that evening and the open wound was an extremely uncomfortable burning sensation to the point I put Neosporin on it and wrapped it again.

When I read other articles regarding cyclists and road rash I noticed Duoderm being suggested a number of times and a doctor that treats road rash spoke highly of Duoderm and went into keeping the area moist and covered. It seems like that is part of the magic of a hydrocolloid dressing. I also noticed that changing Duoderm is easy on the wound when it is removed, but is a dressing that is left on once the wound is thoroughly cleaned until it is healed. The doctor that treats pro cyclists noticed that the wounds covered with a hydrocolloid dressing seemed to heal in a third of the time compared to traditional dry dressings.

If you are a road rash pro and have treatment down to a science what have you found to heal faster?
Open to the air or covered and keep moist?
Have you used Duoderm or similar and it worth keeping in your injury treatment inventory?
How does Duoderm compare to Tegaderm? (I read some positive and negative comparisons on the web this weekend, but if anyone wants to chime in with personal experience I would appreciate.)

Perhaps on my 5th road rash experience I will get better at treating.

A few years ago a very friendly cyclist (probably 40's in age) comes up on a rural road and asks if he could ride with me back to the parking lot. I noticed his left leg was very scarred and pitted looking so I asked him and he said he has raced nothing but crits since he was young and that was a result of crashing many times. So many that he could not count. That dude must have been a pro at treating wounds based on how bad his leg looked.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Most of what I have been reading tells me that the current advice is to keep moist with a petroleum base and covered. Some suggest keeping moist with an antibacterial. Nothing I am reading says expose to the open air.

Drying out apparently doesn't help with the cell regeneration. There is a short-term protective function from scabbing, but that doesn't help with long-term healing or reduction in scarring.

Good luck and heal fast!
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Not a road rash pro, but I've had very positive experiences with Duoderm. My routine goes like: clean/wash out with water, wash with betadine, then stick on a Duoderm. Leave it on till it falls off (I think it was about a week later); the skin below was all but healed.
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Re: Road Rash [mhepp] [ In reply to ]
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SBRinSD wrote:
Most of what I have been reading tells me that the current advice is to keep moist with a petroleum base and covered. Some suggest keeping moist with an antibacterial. Nothing I am reading says expose to the open air.

Drying out apparently doesn't help with the cell regeneration. There is a short-term protective function from scabbing, but that doesn't help with long-term healing or reduction in scarring.

Good luck and heal fast!
Thanks

mhepp wrote:
Not a road rash pro, but I've had very positive experiences with Duoderm. My routine goes like: clean/wash out with water, wash with betadine, then stick on a Duoderm. Leave it on till it falls off (I think it was about a week later); the skin below was all but healed.


Very good and thanks for the feedback. I think I may order a box of Duoderm since I could not find it near me locally.
Just the thought of leaving it on once cleaned sounds good. I am changing dressings twice a day and even the non-stick pads are sticking to the wound.
Last edited by: Felt_Rider: Jun 19, 17 6:35
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Felt_Rider wrote:

Very good and thanks for the feedback. I think I may order a box of Duoderm since I could not find it near me locally.

Be sure to ask the druggist. He may point you to a product you don't notice. There are several comparable materials and I also believe that Duoderm itself is labeled in an alternative fashion. I had a dog collision last summer that caused a large amount of road rash, some of which took a couple of weeks to really heal. I did change out the hydrocolloid dressing after the first week just to get a better check on the wounds. I did continue to eject small gravel bits from the deepest wound for several months despite a very aggressive initial cleaning.

Genetics load the gun, lifestyle pulls the trigger.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Depending on the severity.....

neosporin + tegaderm + tubular stretch bandage

But you need to go to that right after the initial cleaning.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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I have had an injury like you have on your knee on my elbow. I was on the polysporin + tegaderm wagon for close to a week and not seeing much improvement when I also began having a localised reaction to the tegaderm (bumpy and itchy). A wound care specialist nurse saw me and bundled me up (as far as I recall) with adaptic cut to fit over the wound and then a large mepilex border. I could shower with it all on and she sent me home with spares in case I needed to re-dress the wound after the first bandage came off - I didn't.

She had me follow up with vitamin-E oil rubbed into the location once the new skin had formed - mainly I think to promote circulation. I just bought the walmart-brand one and now use it on all larger cuts that scar.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Manuka honey patches. With some tape around the edge to help them stay on. Blows away all the 'derms, in my opinion.

It sounds a little homeopathicy, and I was skeptical at first putting a layer of honey on the wound. My wife, a nurse who is decidedly not into homeopathic stuff, said they use them to dress c-section wounds in her hospital. The theory is that honey from bees that pollinate Manuka tree is infused the antibacterial properties. So it's kind of like putting a thick, really sticky layer of Neosporin on there. The results are really interesting. It seems to heal with very little of the constant scabbing that road rash tends to go through.

The honey also makes the patches very easy to replace. You can take them off with zero drama. They don't stick. They're good for about 3 days, though. I keep 'em on until the wound is just past the "goopy" stage.

They're not cheap. But worth it, for me.



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Re: Road Rash [SBRinSD] [ In reply to ]
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neosporin + hydrocoloidal gel pads + tegaderms (overlap until entire wound area is covered) + 1 week = totally healed!
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Re: Road Rash [ In reply to ]
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Thanks everyone and from the posts it looks like most agree that keeping it covered and moist is a good (better?) direction. I made an Amazon Prime order so in a couple days I can put the dressing on my knee until June 28th MRI. Maybe the wound will be somewhat healed by that point and more inflammation reduced considerably by July 6th doctor consult.

The ortho told me to get some motion in my leg even though he was not sure about the ACL until the MRI. I did some very slow cautious ultra light leg press using both legs for stability this morning mainly to get a deeper range of motion. When finished with that session walking in general felt a lot better. Most of the discomfort I feel at the moment is the pressure from fluid around the knee. I would like to try some very light spinning this evening and this week at ~100 watts at maybe 30 minutes to an hour each session. I tried light spinning on the trainer last week, but the discomfort was too intense at the top and fluid was seeping out of the wound from the pressure.

I am pretty eager to get back out on the road and I hope surgery is not needed.
Last edited by: Felt_Rider: Jun 19, 17 9:24
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Re: Road Rash [Felt_Rider] [ In reply to ]
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For areas where tegaderm covers and sticks well- Clean up, apply tegaderm, leave on until it falls off or starts to itch.
Pro tip- Buy Tegaderm ahead of time in the larger patches from Amazon. It is way cheaper this way and you can always cut the sheets down. Most pharmacies tend to carry the small size and they are pricey.

For areas that don't take Tegaderm well-
Clean the same way-
Apply Aquaphor- My dod told me that Aquaphor is better than a triple antibiotic ointment- Plus it stays on better.
Apply a layer of non stick and/or non-stick with padding. Sometimes I use two layers if I use the clear-ish non stick layer 1st.
Tape pad on- and use tubular gaze for holding pad on arm of leg- especially if you are riding or running.

Keep clean- keep moist.

Don't use any creams or ointments under Tegaderm- it makes is not stick.

Cover tegaderm when sleeping with pads, guaze, or even arm/knee warmers- much less mess in bed,
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Re: Road Rash [mhepp] [ In reply to ]
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mhepp wrote:
Not a road rash pro, but I've had very positive experiences with Duoderm. My routine goes like: clean/wash out with water, wash with betadine, then stick on a Duoderm. Leave it on till it falls off (I think it was about a week later); the skin below was all but healed.
Duoderm is what ER used on me, and they gave extra supplies to redress with at home. It worked very well.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Sorry to hear about the crash. About this time 2 years ago I was run off the road by a car (accidentally I am sure but the car took off). I locked up my brakes and went down at 65km/h and slid for an awfully long way losing a lot of skin off my butt, hip, leg, knee, back, both arms and hands. Fortunately my coach was not too far behind and gave me a lift to emerg where I was scrubbed down (OUCH) and bandaged up.

The recommended protocol was to absolutely slather a thick coating of Polysporin (or similar) before applying non-stick bandages which were all held in place with gauze wrap. Suggested pain medication was both over the counter Advil and Tylenol (I didn't know you could do both at the same time). The wounds were to be covered and kept moist all the time (i.e. reapply immediately after showering).

I kept up the same bandaging protocol and it was pretty close to 3 weeks to heal up entirely. No swimming for two weeks from the time of the crash (we were travelling to a tropical locale so there are more organisms in the water and so forth).

IG: @shaggyrider
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Oh- and when it heals, use really strong sunscreen over the area for the rest of the season.
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Re: Road Rash [bootsie_cat] [ In reply to ]
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bootsie_cat wrote:
Oh- and when it heals, use really strong sunscreen over the area for the rest of the season.

Protip that I need to remember. I am fair skinned to start.

I am grateful for everyone sharing tips today.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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My son had a serious water burn (2nd degree) and the hospital gave him this prescription for topical application:
http://www.webmd.com/drugs/2/drug-4910/silvadene-topical/details
I had a lot left over and have used it on saddle sores as well as road rash and its quite amazing. If you can get a prescription for this medicine it works wonders.
There is also this stuff that is over the counter for areas of your body that dont move much:
Mepilex Ag Antimicrobial Soft Silicone Absorbent Foam Dressing with Silver
http://www.rehabmart.com/product/mepilex-ag-4in-x-4in10-x-10cm-27644.html
Last edited by: gte534j: Jun 19, 17 15:13
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Re: Road Rash [trail] [ In reply to ]
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Manuka honey is awesome. I'm an infectious disease and wound nurse practitioner and we use it all the time. There's good scientific evidence for why it works. 1) The honey is antibacterial (so are silver products) and in my opinion better than using antibiotics like neosporin. Manuka honey specifically has hydrogen peroxide (small amount compared to the bottle stuff) activity which is why it works. FYI don't clean wounds with straight peroxide. It will kill bacteria, but also new healthy tissue thus causing delayed healing. Using antibiotic ointment is overkill and increases risk for antibacterial resistance. 2) Honey, because of the high sugar content, draws moisture to the wound which is a good thing.

The key to wound care is to keep wound moist, but not saturated/macerated. So something like a Vaseline gauze (xeroform) works if there's minimal drainage. If there's a lot of drainage you need something that will draw that extra moisture away.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Another vote for hydrocolloidal dressing. I can't recommend this stuff enough!

As others have mentioned, clean the wound, apply a hydrocolloidal dressing (like duoderm, no cotton/cloth), and leave it on until until it falls off or the edges become itchy. Repeat until the skin is healed.

I've had several instances of burns and road rash that have healed surprisingly scar free using hydrocolloidal dressing.

The key to avoiding scarring and prolonged healing is to keep the wound from developing a scab, while keeping it moist and sterile. The hydrocolloid dressing seems to have an additional side effect of practically eliminating local stinging pain by merely keeping damaged skin moist and covered.
Last edited by: codygo: Jun 19, 17 16:09
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Re: Road Rash [ In reply to ]
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I really like the Duoderm. I put the first Duoderm on my knee Wednesday evening and immediately it just felt better compared to what I was using. Up to that point the two spots on my knee were constantly burning. I did not do a good job putting the first one on so Friday evening after a light spinning session I had to put a new one on it is like having a second skin. I am using a light elastic wrap and tubular net bandage to protect the Duoderm from lifting around the edges and just to protect the dressing.

I hope this heals on its own because it is a deep scrape. I have a coworker that crashed a few years ago and had to have skin grafted on some of his wounds at a burn clinic. It turned out to be a real mess for him with infection and he was out of work for weeks. So far the fluid still weeping out is clear for the most part. At least the constant burning has stopped since I put this hydrocolloid dressing on the wound.

Good stuff IMO
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Acutely, clean it really well. We tend to use an iodine based cleaner. Then non-adhesive pads.... It is a burn (friction burn) not a cut, many race first aid people don't get this (for us here, ski patrol gets it, st. john's ambulance tends not to get it, and thus have a high rate of infection a few days later), and use gauze, which heals into the wounds and results in infected road rash.... We usually some tape, and then a mesh wrap to hold everything in place. The next day I usually apply some polysporin, change the pads, and re cover it similarly to before. Usually by day 3, I switch to Tegaderm. That approach has never let me down in terms of cleaning road rash, and thankfully it has been a decade since my last crash now (but I've had to help countless others, and have had some road rash like abrasions from stupid things like obstacle racing, or rope burns from rappelling...).

Never seen that honey stuff... my gut reaction is to reject it as homeopathic BS, but should I be unfortunate enough to require such treatment again, and I see it, maybe I'll give it a shot.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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http://www.latimes.com/health/la-he-wound-care-20160725-snap-story.html


This is a good start.


I'm a triathlete and an ABWM board-certified wound care surgeon. Maybe I should do "Ask me anything" thing.


Basic rules:
1. Don't put irritating agents (harsh antiseptics...betadine or alcohol) into your wounds - you will make it worse.
2. Keep it "moist" as it heals the fastest. - Duoderm is okay, but it's little antiquated. Manuka honey hydrocolloid is great and we use tons in our hospital.
3. "Dry out your wound" is a bad advice, in general.
4. Neosporin isn't meant to be used long term. It's a triple antibiotic agent & it may cause you allergic reaction in some cases. Aquaphor is my choice.


In general, for road rashes, wash it well in shower to get all the road grimes and debris out --> cover with moist dressing (vaseline gauze, gauze pads) and secure with elastic net, or alternatively use some kind of silicone-adhesive bordered foam dressings (Mepilex-brand border dressing is expensive, but all the World tour teams use it).


Also, I recommend buying the supplies from Amazon, as your local pharmacy charges 2x-3x the price.

Lastly, see if you can "google" and visit "wound care center" locally. It really takes a special set of knowledge and dressings/supplies to take care of wounds. If we take care of your wounds appropriately and swiftly, you would heal your road rashes the fastest with minimal scarring.


my 2 cents... and get well soon.
Last edited by: Shiv88: Jun 23, 17 7:05
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Re: Road Rash [Shiv88] [ In reply to ]
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I appreciate the inside tips/advice and suggestions. I will get some of these products to keep at the house (and hope I don't have to use them).
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Among every thing else already mentioned, let me just reiterate...only use Neosporin/Antibiotic cream for a day or two after the injury. Then keep it moist with Aquaphor or Vaseline.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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Felt_Rider wrote:
I appreciate the inside tips/advice and suggestions. I will get some of these products to keep at the house (and hope I don't have to use them).

Some good advice here. Unfortunately over the last few years my wife and I have had opportunities to try a lot of different road rash products:( What works for you can vary a lot depending on whether you are continuing to ride and workout. If you are working out, then Duoderm just doesn't seem to do well with sweating. Depending on the wound location Tegaderm is also challenging.

For a recent particularly bad set of wounds received during one cycling trip and requiring continued treatment during a followup cycling camp, we used Cover-Roll tape with gauze pads. The Cover-Roll really sticks well and can be cut to fit. Same with the gauze. Rx burn cream went on wounds, covered with gauze soaked in sterile water, plus another layer of gauze and then taped with Cover-All. This was for back, hip, forearm/elbow. It does need to be changed regularly, but held well during rides.

We've also used the gauze netting before for knee wounds or similar and it works well too.
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Re: Road Rash [Felt_Rider] [ In reply to ]
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I douse in hydrogen peroxide after a shower for the first day or two, followed up by neosporin, and just let it air out from the get-go.

I don't mess with any of the other stuff. Just let it do its own thing once it's cleaned out.
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