# Dealing with road rash - a Drs perspective



## WingNut (Oct 12, 2005)

Possibly this topic has been done to death, but I'd like to give my 2c worth.
I'm a new racer, in my first season, 41 yrs and a Dr here in NZ (Wanganui). Am a family Dr (GP) and also qualified in Accident and medical practice.
Had my first fall at speed in a race yesterday. Doing about 60km/hr downhill on a beautiful spring day in this part of the world. Car came opposite way, pack readjusted and I clipped the rear wheel of the guy in front and went down, bringing 2 others with me. I've read all about how to deal with a fall, which is inevitable in bike racing I'm told, books suggest rolling into a ball etc, my experience was it was so quick all I had time to do was scream like a baby before I was skidding down the road. Ended up in a dusty ditch.
Wrecked saddle, bar tape and both ultegra shifters, ripped all my clothes and my gloves.
Elbow and hip took the worst of it, then shoulder and back, all down the left side. Very sore to move L leg initially, could weight bear OK. Blood dripping from elbow.
Here's the advice (of course this is only for superficial wounds, if there are breaks, fat or bone exposed, get professional help. In fact if you are at all concerned about the possibility of a serious injury, see a Dr.)
1. Wash wounds immediately - .The sooner you get and dirt and debris out of a wound the better - also it hurts less to do it immediately than waiting even a few hours. Even if going on to medical care do this and do it early. At the scene I emptied my bottle (containing water) into my elbow, while vigorously rubbing the wound. Antiseptics kill cells and retard healing - in order to optimise healing use someting gentle - plain old water, and tap water is fine, and vigourous rubbing (with a clean hand) is all you need. Get somewhere with a shower as soon as possible and continue the cleaning - you don't need soap just clean water and lots of it and lots of rubbing, it will sting, but you're doing yourself a favour by doing this, and it gets worse the longer you leave it. I don't recommend topical antibiotics, I feel if antibiotics are required (and they probably wont be) get the wound professionally assesssed and take them systemically (by mouth) which is far more effective and less prone to invoking bacterial resistance.
Cover the wounds - don't let them dry into a scab which can crack, shrink and slow healing - There is a product called Fixomull which is outstanding (No shares owned by me) used for burns and this type of wound, shave around the area if hairy and apply plenty. A tip for optimising life of the dressing - use scissors to 'round off' any corners. This stuff needs to stay on for a week or more. I'd suggest Roadies consider having a supply at home.
(Blood and fluid will ooze thru the fixomull over the next day or so, just wash it off in the shower, it's important you don't remove the fixomull, let it stay and get stained and raggedy until it is ready to fall off ( week or more, you body is healing beatiuflly under it), the Fixomull is very adherent and will dry out and stay stuck-on)
Ice it as soon as you are out of the shower and the wounds are clean & covered - Use a cooler pad from yr freezer or get a zip-lock bag & put in ice and water and bandage it over the site.
This is what I did and this morning I am not feeling too bad, in fact will probably join the club for a recovery ride this morning, on my second bike unfortunately.
Hope this is of use to someone out there.


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## Spintogrin (Sep 23, 2005)

Thanks for posting. I will file for later use, much later I hoe. I wish I had this info a month ago, scabs kept cracking, it took weeks to recover. 

I hope your recovery is speedy and complete.


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## Spintogrin (Sep 23, 2005)

Thanks for posting. I will file for later use, much later I hope. I wish I had this info a month ago, scabs kept cracking, it took weeks to recover. 

I hope your recovery is speedy and complete.


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## WingNut (Oct 12, 2005)

WingNut said:


> This is what I did and this morning I am not feeling too bad, in fact will probably join the club for a recovery ride this morning, on my second bike unfortunately.
> Hope this is of use to someone out there.


Update, did ride this morning, but in no way as in good shape as I thought when writing the above... Managed a sedate 30 mins alone, and straight back home...


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## RoadRaven (Sep 21, 2006)

Ah... this sounds like the stuff I just tried to explain in the other thread about road rash - its brilliant.


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## itsjon (Nov 4, 2005)

Is Fixomull the same thing as Tegaderm?


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## WingNut (Oct 12, 2005)

*Fixomull different to tegaderm*



itsjon said:


> Is Fixomull the same thing as Tegaderm?


Fixomull is in the class of dressing known as a porous fixation sheet - its a polyester fabric with sticky backing, you can buy strips, but I recommend buying it in a roll, then you can cut to size/contour and stick it straight over the (well-cleaned) graze with generous overlap onto surrounding undamaged skin. 

Leave it in site for 7 days or longer (I recommend leaving it until it falls off) and wash the ooze off daily, or twice daily in a shower, it just oozes thru the fixation sheet. In effect this type of dressing becomes a substitute scab, that encourages healing but that wont crack or shrink. The problem of ooze into sheets and clothes is managed by having an absorbent dressing on top of the fixomull.

The brands for this type of dressing are: Fixomull, Hypafix & Mefix.

Tegaderm is semi permeable and a transparent film (other brands include Opsite)

I believe the porous fixation sheet is preferable to the transparent film (tegaderm/opsite) for road rash, for the following reasons:
1. You don't get pooling behind porous fixation sheets as they allow the blood and lymph inflammatory fluid to ooze thru and be easily washed away. 
2. You'll be frequently changing tegaderm if you have an oozing road rash wound.
3. The collection of fluid behind tegaderm can be a precursor for infection. 
4. You don't need to change the dressing with porous sheets (much less pain), just wash the ooze off twice a day in the shower and the wound will heal beneath it.

The First table on the link below titled "Dressing choices" compares the relative merits of different dressings for this type of wound
http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=9751


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## magnolialover (Jun 2, 2004)

*Disagree...*



WingNut said:


> Fixomull is in the class of dressing known as a porous fixation sheet - its a polyester fabric with sticky backing, you can buy strips, but I recommend buying it in a roll, then you can cut to size/contour and stick it straight over the (well-cleaned) graze with generous overlap onto surrounding undamaged skin.
> 
> Leave it in site for 7 days or longer (I recommend leaving it until it falls off) and wash the ooze off daily, or twice daily in a shower, it just oozes thru the fixation sheet. In effect this type of dressing becomes a substitute scab, that encourages healing but that wont crack or shrink. The problem of ooze into sheets and clothes is managed by having an absorbent dressing on top of the fixomull.
> 
> ...


With Tagederm, I've gone down many times, and this stuff has saved me from much pain. Yes, it will pool around the wound, but by draining it out, I have found it to be the best stuff going. You also don't need to change the dressing with tagederm, it'll stay on for days on days, as long as you drain it out when necessary. 

Just from my own extensive personal experience.


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## doughboy_88 (Aug 22, 2006)

Since Fixomull dries and sticks to the wound, is there a need to soak the dressing in solution prior to removal? How does it work with regards to bonding with the wound...or does it not bond at all?


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## doughboy_88 (Aug 22, 2006)

Nevermind...I found the answer. This sounds like quite a process:

1. Coat dressing with oil (peanut, baby, cooking, olive) making sure the dressing is well soaked.
2. Wrap the whole dressing in glad wrap and a crepe bandage if necessary to prevent oil from staining your clothing or bed linen, or cover with an old clean T-shirt or sock.
3. Leave wrapped in place for a minimum of four hours. This can be overnight.
4. Wash carefully in shower or bath and remove dressing.

(Taken from http://www.westcoastdhb.org.nz/publications/patientinfo/ae/burn.asp)


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## WingNut (Oct 12, 2005)

*Priciples of dealing with Road rash Abrasions / grazes*



magnolialover said:


> Yes, it will pool around the wound, but by draining it out, I have found it to be the best stuff going. You also don't need to change the dressing with tagederm.


Tegaderm and that class of dressings are excellent as you and others have found. Personally I prefer the Porous adhesive dressings for the reasons above and use it myself.

To go over the Principles of Dealing with Road Rash

1. Meticulous cleaning - Essential - the wound must be thoroughly cleaned, as soon as you can. Even if its a friction burn under your shorts with no ripping and the wound looks clean, it must be thoroughly cleaned - this is crucial and if not done properly it doesn't matter what you put on it, healing will be retarded and pain increased.
2. Use a dressing that encourages moist healing - I prefer the porous adhesive dressings as outlined in earlier posts, but there are alternatives that are very good, including the Polyurethane films like tegaderm and Opsite, and the more expensive Hydrocolloid films (Duoderm).


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## WingNut (Oct 12, 2005)

doughboy_88 said:


> Nevermind...I found the answer. This sounds like quite a process:


Personally I leave the dressing on until it falls off, takes a few weeks but eventually loses its stick. I know of plastic surgeons who recommend keeping this stuff in place for 3-5 months after scarring in order to minimise scar formation (With weekly-fortnightly changes).Also if you shave before applying it you'll find hairs will grow thru it, doesnt seem to rip them off when you remove the dressing.


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## doughboy_88 (Aug 22, 2006)

Not to argue your point as I'm sure you're qualified to give the advice and Fixomull sounds like a great product, but "weekly-fortnightly changes" still require the removal of the dressing...which then requires the procedure outlined above on a weekly basis.

With emphasis to minimal pain and effort, would any of the other products be better?


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## WingNut (Oct 12, 2005)

doughboy_88 said:


> Not to argue your point as I'm sure you're qualified to give the advice and Fixomull sounds like a great product, but "weekly-fortnightly changes" still require the removal of the dressing...which then requires the procedure outlined above on a weekly basis.
> 
> With emphasis to minimal pain and effort, would any of the other products be better?


Weekly - fortnightly changes recommended by some plstic surgoens for scarring, put that in my earlier post as an interest point. Personally I have never used oil to remove this type of dressing and just leave it on till it falls off or becomes so unsticky that it is effortless to remove, the stickiness is negligible by about 2 weeks, and in high use areas like hands it lasts less than this and will fall off without oiling.
I think the porous sheets do minimise pain and effort as opposed to the alternatives, I'm always open to suggestions of something better, but IMHO this is a good simple treatment
Hope this is of some help, thanks for yr comments.


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