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  1. #1
    i ride a bicycle
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    How often do you change your Tegaderm?

    I have a few spots of road rash that I currently have covered with Tegaderm. Part of the whole concept of Tegaderm seems to be leaving it on for several days at a stretch to promote unaggrevated healing and reduced risk of infection.

    Problem is, when I ride (nearly every day): 1) I get sweaty and 2)the wound oozes more. This usualy results in at least a "pouch" of fluid under the Tegaderm, and on occasion the fluid finds its way out one edge of the dressing and I have a little river of pus-y, bloody goo running down my leg. Sorry for the gross imagery.

    So the question is, should I stick with trying to make the Tegaderm last several days, or change it after each ride?

    Mac

  2. #2
    Dirt-riding heretic DrPete's Avatar
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    If there's fluid accumulating under the tegaderm you should probably stick with something else.

    My personal recipe is xeroform or adaptic (both non-stick petroleum gauzes, but the xeroform is antimicrobial) directly on the wound, then some gauze pads, followed by an ACE wrap. This allows for good moisture transfer and if you wrap the ACE properly it's far less likely to come off while riding.
    "Unless he was racing there was no way he could match my speed."

  3. #3
    iab
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    If your wound is oozing, you need to change the dressing. Unfortunately, by riding you are aggravating your wound and negating the concept of Tegaderm. Tegaderm is pricey but it evens out if you leave it place for a few days. If you need to change the dressing everyday, DrPete's suggestion is good. I would also recommend an alginate. It is highly absorptive and you can get a silver version if you want antimicrobial activity.

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    Dirt-riding heretic DrPete's Avatar
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    Quote Originally Posted by iab View Post
    I would also recommend an alginate. It is highly absorptive and you can get a silver version if you want antimicrobial activity.
    True, but that gets awfully expensive... My REAL personal favorite for road rash is Biatain, but you can see why that might not be the best choice if you follow the link....

    http://www.qualitymedicalsupplies.co...MS/CTGY/WC-BTF

    Or for the soupier infected-looking stuff...

    http://www.amazon.com/dp/B000PJ775M?...0&linkCode=asn
    "Unless he was racing there was no way he could match my speed."

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    If riding is causing the wound to drain that heavily you need to stay off the bike until it heals. If that's what you decide to do, you can leave the Tegaderm in place for 72 hrs (3 days). Xeroform is great (alitte old school nowadays) and can also stay in place for 3 days if you stay off the bike.

    Keep the wound covered to allow your body's own enzymes to destroy bacteria and facilitate faster healing. You want that pocket of fluid to stay in place, so it can do it's job. It looks bad, but it's supposed to look that way.

    As mentined, Alginates are great if the wound is draining heavily. However, you can keep the wounds from draining heavily by staying off the bike. By continuing to ride you're increasing the risk of infection and scarring.

  6. #6
    Dirt-riding heretic DrPete's Avatar
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    Quote Originally Posted by kneed2wrydemore View Post
    Keep the wound covered to allow your body's own enzymes to destroy bacteria and facilitate faster healing. You want that pocket of fluid to stay in place, so it can do it's job. It looks bad, but it's supposed to look that way.
    I have to disagree here. Keeping a stagnant pool of fluid on top of a wound will do absolutely nothing good for it. In fact, the vast majority of the new products in wound care over the past several years have been developed to keep said fluid OUT of the wound. Tegaderm is OK for relatively dry wounds/abrasions, but a wound should stay moist, not wet, and Tegaderm is easily overwhelmed with just a little exudate.

    As for the "body's own enzymes," neutrophils and macrophages are attracted to the wound already, and they don't live in that wound fluid.
    Last edited by DrPete; 09-01-08 at 09:09 AM.
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    iab
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    Quote Originally Posted by DrPete View Post
    True, but that gets awfully expensive... My REAL personal favorite for road rash is Biatain, but you can see why that might not be the best choice if you follow the link....

    http://www.qualitymedicalsupplies.co...MS/CTGY/WC-BTF

    Or for the soupier infected-looking stuff...

    http://www.amazon.com/dp/B000PJ775M?...0&linkCode=asn
    I get a discount from Cardinal for the alginate, so I guess it could be pricey on the retail level. But it worked great for me, especially on removal.

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    Quote Originally Posted by DrPete View Post
    I have to disagree here. Keeping a stagnant pool of fluid on top of a wound will do absolutely nothing good for it. In fact, the vast majority of the new products in wound care over the past several years have been developed to keep said fluid OUT of the wound. Tegaderm is OK for relatively dry wounds/abrasions, but a wound should stay moist, not wet, and Tegaderm is easily overwhelmed with just a little exudate.

    As for the "body's own enzymes," neutrophils and macrophages are attracted to the wound already, and they don't live in that wound fluid.
    If the pocket of fluid is large, or filled with purolent drainage yes, by all means, change the dressing. If there's that much drainage a transparent, such as tegaderm, wouldn't be a wise choice anyway. I just don't like to expose the wound to air (thus decreasing optimal healing temp, which takes up to 4 hrs to regain) and disrupt the process of re-epithelialization by changing the dressing too frequently.
    Last edited by kneed2wrydemore; 09-01-08 at 11:34 AM.

  9. #9
    i ride a bicycle
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    Yikes some of that stuff is expensive! I got my Tegaderm when a local Albertson's grocery store was going out of business and selling off everything in the store for 70% off or more. I literally bought everything they had left for something like $1.50 a box, so I am stockpiled with seven or eight boxes of the stuff.

    So you day Tegaderm isn't the best choice for a wound that is still oozing. Would these new-generation bandages be any better (I also got them at the grocery store clearance)? The ones I have are Johnson&Johnson Advanced Healing Adhesive Pads, like this:

    On the box at least, they advertise that they allow for some evaporation while still keeping the wound moist.

    Or should I just go buy some Adaptic pads at my local Walgreens?

    Mac

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    Quote Originally Posted by DrPete View Post
    If there's fluid accumulating under the tegaderm you should probably stick with something else.

    My personal recipe is xeroform or adaptic (both non-stick petroleum gauzes, but the xeroform is antimicrobial) directly on the wound, then some gauze pads, followed by an ACE wrap. This allows for good moisture transfer and if you wrap the ACE properly it's far less likely to come off while riding.
    I had that stuff all over my face and legs after my crash. It works really really well.

  11. #11
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    Quote Originally Posted by ridethecliche View Post
    I had that stuff [xeroform] all over my face and legs after my crash. It works really really well.
    CVS and Walgreens websites say they do not carry it.

    Would there be somewhere else I should look for it locally?

    I would ask my wife (a nurse) if she had access to any "samples", but she works in the NICU - so anything she came home with would be like a 1"x1" square.

    Mac

  12. #12
    Senior Member Brian Ratliff's Avatar
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    My experience with my most recent crash which involved lots of road rash are that if you use Tegaderm, you must leave a little outlet for fluid to escape so it doesn't build up under the bandage. Tape a piece of gauze over the outlet to catch the fluid that drains out.

    Also, there this stuff behind the pharmacy counter that's really expensive but works very well. I forget the name of it though, but I used it for road rash on my butt cheek and it worked extremely well. It came in a 8" or so square and was on the only thing besides standard gauze that was big enough to cover the road rash patch.

    EDIT: "Duoderm" is the name of the aformentioned product. OBRA has a guide to wound care which can be helpful too.
    Last edited by Brian Ratliff; 09-01-08 at 10:55 AM.
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  13. #13
    Schleckaholic K&K_Dad's Avatar
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    Would there be somewhere else I should look for it locally?
    Local ? Web, yes.
    We but all our EMS supplies here.

    http://www.buyemp.com/product/1111102.html

    We have that stuff stocked all over the truck but I've yet to use it on anyone.
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  14. #14
    Dirt-riding heretic DrPete's Avatar
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    Quote Originally Posted by K&K_Dad View Post
    We have that stuff stocked all over the truck but I've yet to use it on anyone.
    Yeah, couldn't see much use for it in the field... I basically use it for chest tube dressings, moist road rash, and very little else.
    "Unless he was racing there was no way he could match my speed."

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    Senior Member Scorer75's Avatar
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    After my recent accident, a good friend of mine who is a well respected plastic surgeon in NYC basically seconded what Dr. Pete said when I asked him about Tegaderm.

    His recommendation was "no need for Tegaderm, just use any non-stick petroleum gauze".

  16. #16
    Surf Bum
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    I used the Johnson and Johnson product pictured above recently for some major road rash (not cycling: downhill skateboarding - crashed at 30mph+ going down Claremont in Berkeley/Oakland!) and I left them on for nearly a week. Unfortunately I could only find them in like 2" squares so I had to overlap several pads to cover the whole wound. The pads soak up fluid and let stuff evaporate out a bit but keep germs from getting in. When they got too soggy after a week or so, I changed them. In less than two weeks it healed up with absolutely no scabbing and no scaring at all - I thought for sure that at 40 years old my skin wouldn't heal that fast and would scar but I was amazed by how well keeping it covered and not letting it scabbed worked.

  17. #17
    Tandem Vincitur Ritterview's Avatar
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    Lke Gaul, the treatment of road rash is divided into three parts.

    What is needed is Tegaderm, Lidoderm patches, and DuraPore tape.

    Keep the Tegaderm on as long as it will stay on, it is no big deal if it comes off.

    Tegaderm is the bomb when it comes to covering road rash. All other dressings are good to the extent they resemble Tegaderm.



    If the road rash is painful, put a Lidoderm patch under the Tegaderm, and change it every 24 hours. The Lidoderm makes the road rash pain free. It is real sweet, like especially when the nerves are growing back, and it is itching/painful like crazy. You need a prescription to get it. If you are ever seeing your doctor, ask for a prescription to keep handy for when you eventually get road rash. They'll probably give you samples, which most primary care doctors will have in their cupboards (Lidoderm has lidocaine in it, and is intended for use in treating pain from shingles, but is good for whenever you need the skin numbed). The patch works great as a dressing applied directly to the rash.



    You can keep the Tegaderm (and Lidoderm patch) on longer, if you reinforce the edges with 3M Durapore tape. This tape adheres strongly, but is very pliable and stretchable, and thus comfortable to keep on.


  18. #18
    SpIn SpIn SuGaR! FIVE ONE SIX's Avatar
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    Quote Originally Posted by sac02 View Post
    CVS [snip] websites say they do not carry it.
    the pharmacy department in CVS deals with Cardinal, ask the pharmacist or tech if they can order it for you. it will take at least a day or so to get it if they can get it, but it's great to have around the house just in case, and i'd rather have something i don't need than not have something that i do need when it comes to first aid...
    Last edited by FIVE ONE SIX; 09-02-08 at 12:27 AM.

  19. #19
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    Quote Originally Posted by sac02 View Post
    I have a few spots of road rash that I currently have covered with Tegaderm. Part of the whole concept of Tegaderm seems to be leaving it on for several days at a stretch to promote unaggrevated healing and reduced risk of infection.

    Problem is, when I ride (nearly every day): 1) I get sweaty and 2)the wound oozes more. This usualy results in at least a "pouch" of fluid under the Tegaderm, and on occasion the fluid finds its way out one edge of the dressing and I have a little river of pus-y, bloody goo running down my leg. Sorry for the gross imagery.

    So the question is, should I stick with trying to make the Tegaderm last several days, or change it after each ride?

    Mac



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  20. #20
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    psa.

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    Too bad I didn't see this thread a week ago. I've just been putting Neosporin on it and covering it with a non-stick bandage pad. Washing in the morning and at night. Are these other solutions that much better?

    I've been leaving the bandage off and just using Neosporin during the day for the past few days. Is it better to just keep the bandage on all day?

  22. #22
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    see the thread I started yesterday...
    Road Rash Cure - my experience
    '09 Scott Team Cyclocross, '08 Madone 5.5 Pro, '06 Trek 5000, '02 Redline BMX Cruiser Class, '01 ProConcept BMX XL

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    +1 to Dr. Pete.

    Xeroform is weird as hell, but it works really. I went through a ton of that stuff last year. Had it all over my face and leg.
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  24. #24
    your nightmare gal chipcom's Avatar
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    Early on, while the wound is still oozing, Duoderm, gauze and an Ace bandage FTW
    "Let us hope our weapons are never needed --but do not forget what the common people knew when they demanded the Bill of Rights: An armed citizenry is the first defense, the best defense, and the final defense against tyranny. If guns are outlawed, only the government will have guns. Only the police, the secret police, the military, the hired servants of our rulers. Only the government -- and a few outlaws. I intend to be among the outlaws" - Edward Abbey

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