Ask the Doctor - with Dawn Richardson
Dealing with road rash
By Dawn M. Richardson, MD FACEP
This report filed May 14, 2003
You've probably been there before: Up all night between stages because you have a fresh batch of road rash and it's throbbing. Every time you roll over in bed, your nasty gooey aching hip sticks to the sheets and wakes you up in pain. Your significant other is grossed out and reminds you that you get to do the laundry for the next few weeks.
If you're a cyclist in a stage race, you probably dread facing the next stage because your body aches like an NFL lineman on Monday morning. You are leaking icky wound goo on your skin suit on the starting line the next morning. Yuck. Wouldn't it be great to make it all go away, start the stage pain-free, and forget about your injury as you challenge for GC?
Here are two lists of my favorite products for road rash. One is for those on a tight budget or without access to hospital grade supplies. The other is the best of the best and will make your road rash experience almost forgettably painless. Some superstitious people hate the idea of going to a race prepared for the worst, as if they are counting on falling. It happens to the best bike handlers, so get real. Make an agreement with your teammates that someone keeps the road rash kit in the back of their car for the season-you'll be grateful when one of you hits the deck.
The poor man's road rash kit
· Mild antibacterial liquid soap
· Gallon of bottled water
· Bottle of cheap generic Ibuprofen (Motrin IB)
· Triple Antibiotic Ointment (like Neosporin)
· Petroleum Jelly (Vaseline)
· Thin Maxipads with non-adherent top layer ("dri-weave')
· White drugstore ribbon tape
· Cheap support pantyhose in your size, and in a smaller size that fits your arm
· Clear fingernail polish
· Non-prescription topical anaesthetic
· Butterfly tapes
Feminine products for even the manliest athlete
Maxipads, pantyhose and nail polish?!?!?! Okay, okay. I admit it. Some of the stuff on the list sounds weird, but it works.
Here's what to do with your road rash: First, see if there is an ambulance staged on scene with a crew that is willing to help you out. One caveat: If you are uninsured, you may be sent a bill even if they don't transport you to the hospital. But more often that not you can get care from them for free. They may have plush supplies on the truck that they can use to clean and dress your wound.
If there is no ambulance on scene, the first thing to do is take two to four 200mg ibuprofen with food 45 minutes prior to cleaning you wound. The maximum dose is 800mg every six hours and no more than 2400mg in 24 hours. If you are prone to gastritis or ulcers go with Tylenol (Acetaminophen) 650-1000 mg, no more than 1000mg every 4 hours or 4 grams in 24 hours. Your pain tolerance will be maxed 45 minutes to one hour after you take the ibuprofen or acetaminophen. Don't skimp on the ibuprofen if you're in pain. It's especially helpful right before bedtime so you can get some sleep. An hour before your scheduled start time the next day is another good time for ibuprofen.
<B< and in>
Apply a thin layer of the non-prescription topical anaesthetic, scream, then wait a couple minutes for it to numb your throbbing road rash. If you are subject to dope control, notify them about the topical anaesthetic when you give your sample. Show them your road rash. U.S. Anti-doping lists lidocaine as a legal substance but you should also notify dope control to be safe.
Clean the wound with mild antibacterial soap and the washcloth and plenty of water. The time-worn saying among surgeons is: "The solution to the pollution is dilution."
Only scrub hard enough to get the gravel out to prevent gravel from tattooing your wound. Any harder is unnecessary and you risk damaging tissue and delaying the healing process. With wounds that sport that nice deep gravel, try soaking in the tub and then using tweezers to get out the really nasty stuff.
Keep it dry
Gently pat your road rash damp-dry. Apply a thin layer of triple antibiotic ointment to the wound. You may need an additional thin layer of petroleum jelly to keep the dressing from sticking to the road rash. As an aside, a layer of petroleum jelly or A&D diaper cream on your sensitive parts before a race will greatly reduce your chances of unpleasant chamois chafing on hot days.
My recommendation for thin maxipads may sound really goofy, but they are the cheapest possible wound dressing, and also provide a bit of padding. This is especially nice for road rash on hips or shoulders, the places most likely to hit the ground first. The maxipad keeps the road rash from rubbing inside your skinsuit, and minimizes the damage if you fall again on the same spot. Paper tape doesn't stick very well. I recommend ribbon tape, which has a little more adhesive, but may be more likely to cause a tape allergy.
Tape the maxipad in place. This is as good as it's going to get on a low budget. Change your dressing daily, washing gently in the shower. If your dressing is sticking to the wound, don't rip it off. Soak in the tub for 20 minutes and it should peel off easily.
In a hard next day race, the tape may fail, therefore go with the pantyhose. Again this sounds really silly, but if you can't afford the spiffy white fishnet that the pros use, this is your best option. Size the pantyhose to your wound and dressing and cut it several inches too long on both ends. Paint the cut ends with the clear nail polish to stop the cut panty hose from unraveling.
On second thought maybe a leftover bottle of your ex-girlfriends fire engine red toenail polish would be more stylish. Perhaps a loud color to match your team kit. Come on... express yourself! The color possibilities are endless.
Slide the pantyhose in place and you're good to go. Your dressings should stay in place. You can get really creative with the scissors and cut out the pantyhose only where your chamois goes to keep hip, thigh and butt road rash dressings in place.
Check your wounds daily for increasing redness, swelling, pain, pus or foul smelling drainage. These are all signs of infection and you should seek medical attention. If it's been 5 years since your last tetanus shot, go to the ER. Dying of lockjaw would be a pretty stupid way to finally get your name in VeloNews. After a couple of days you may want to let your road rash air out daily after you shower to keep it from getting too gooey.
The butterfly tape is for deeper cuts that don't quite need stitches. Again, flush out the wound with plenty of clean water, pat dry and tape it. If the edges of the wound pull apart widely, if it has some depth to it, if it's really filthy, or it won't stop bleeding, you need medical attention and probably stitches. No room for stoicism here-it can take weeks for these cuts to heal on their own and they leave much uglier scars without attention.
Premium road rash kit extras
· Duoderm 4x4 Extra Thin CGF Dressing (ConvaTec/Bristol-Myers Squibb)
· Surgical scrub brushes
· 2% lidocaine jelly* (AstraZeneca)
· 4x4 gauzes
· White fishnet mesh-2 sizes to fit arm and leg
If God made road rash cream
As a cyclist and a doctor, I am convinced that if there is a god he made these for road rash. Believe me, the manufacturer isn't paying me to say this.
Buy Duoderm and the fishnet mesh at a medical supply store. You're unlikely find them at the local drugstore. Duoderm is designed for chronically ill elderly people with non-healing diabetic wounds. It'll blow a little road rash on a healthy cyclist right out of the water.
In layman's terms Duoderm has magical physiological goo in the adhesive that makes a gel with your oozy wound secretions and accelerates wound healing. These patches make the deepest road rash go from throbbing weeping raw nerve endings to happy pink nearly completely healed skin in about a week. They completely bypass the scab and pain stage. It's like a fake layer of skin, so you don't feel more than a slight ache under your skinsuit or even lying in bed with your weight on it.
Some people get a slight skin allergy to the adhesive after a couple of days, but this is far outweighed by the benefits. Another downside is the cost. A box of 10 4x4 Duoderm patches costs about 50 bucks, and they don't sell them singly. But look, if you're out there plying the roads on a $4000 bike, it may be worth your while to spring a few bucks on this stuff.
The dressings stay in place for days under normal conditions, but in a stage race they may fall apart and need to be changed daily. Perhaps you and a friend can split a box, or your bike store or team manager can buy a box and sell them in singles.
Tegaderm is a thinner bioocclusive dressing that works well, but not nearly as well as Duoderm. If you are too cheap for Duoderm or Tegaderm, 4x4 cotton gauzes can be used for your dressing. Be sure to apply triple antibiotic ointment and petroleum so they don't stick. Skip the triple antibiotic cream and Vaseline if you are using Duoderm-you want the adhesive right up against your wound. 4x4 gauzes can also be taped strategically on your Duoderm because there will be some goo leakage from the dressing.
Two-percent lidocaine jelly is available by prescription. It's much stronger than the non-prescription variety. If you've lost a lot of skin, use it sparingly because there is a limit to how much lidocaine is safe. Again, show dope control your road rash if you are tested, document that you used the lidocaine and you should have no problems clearing dope control.
Shurclens is the best wound cleanser. It does the job without damaging the tissues. Please don't pour peroxide on your wound-it's too damaging and will delay wound healing. Hibiclens is the next best wound cleanser. Disposable surgical prep sponges with bristles on one side and a sponge on the other impregnated with sterilizing skin cleanser are nice, but don't scrub any harder than you need to get the gravel out.
Even the best bike handlers drop and roll sometimes. It doesn't have to ruin your race or your training for the next week. If you try these products after the next time you slide out, it will change everything and turn your experience from misery to nuisance.
Have fun, stay safe and if you do hit the pavement, treat your wounds right.
Dawn Richardson is a board certified emergency medicine physician in practice at Saint Anne's Hospital in Fall River, Massachusetts. She is frequent contributor to SG: surf snow skate girl magazine, and is interested in health-related issues for cyclists, and women's health. She welcomes medical questions pertaining to cycling, bearing in mind that if it ain't emergency medicine she may have to do some work to figure out an answer. Please send your questions or issues to "Ask the Doctor" in care of WebLetters@7Dogs.com