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Cycling Road Rash; Wound Care Bonus Edition

Less is More

There is a right way and a disastrous way to start the care for your gnarly abrasion.  Less is more when it comes to road rash and cycling battle-wounds.  First, clean with saline or water, only if possible.  Nothing else unless you crash into a pile of roadkill, which likely did not happen.  Ensure the wound is clean of bacteria and debris to start with but be gentle.

 

 

Avoid Man Made Agents

If your wound looks pretty and red. STOP! Resist the urge to harm it. Almost all man made agents kill white blood cells, aka cause big problems from the get go.  The long standing myth is that the bubbles of hydrogen peroxide have magical powers.  FALSE! Hydrogen peroxide is cytotoxic (harmful) and barely bacteriostatic, meaning bacteria is not afraid of those little bubbles.  A few examples of cytotoxic chemicals include: alcohol, Betadine, anti-bacterial soap. If you just absolutely have to clean it with something use a gentle soap, only once. 

Transparency is Key

Take a photo to help with daily tracking of the healing.  Feel free to post it on Instagram for street cred, but make sure to #pedalfitpt.  Cover the wound with a clear bandage such as 3m Nexcare Tegaderm (transparent film), OpSite flex grid (you may have to order online), or Duoderm (unfortunately not transparent).  

Stop with all the Ointments

Before you follow your gut and coat the wound with ointment.  STOP! Ointments, such as Neosporin and Polysporin, are not always the answer you think they are.  Ointments are essentially grease traps for your otherwise happy and healing wound.  The effects only last a few hours or so and after that they arrest the good and attract the bad.  Your wound requires healthy natural cell and enzyme migration (movement). If these key players are unable to move freely they will not be able to fight off bacteria and rebuild skin.  Ointments also may cause discoloration of the wound which makes it hard to discriminate healthy and infected tissue.  If used, the ointment should be removed after a few hours with saline. 

Let It Be

From this point on, let your wound heal itself.  The best part about the bandages/dressings I recommend is that they can be left on for several days and are transparent.  This keeps the wound environment moist with it’s natural fluid. It keeps bacteria from entering the wound.  Allows for bathing without stripping the wound of it’s integrity. And most importantly, allows for ongoing monitoring.  

Ignore the “air it out” Mentality

There are many myths when it comes to wound care but the worst is to “air it out” and “dry out the wound”.  Your body has a job to do in the wound, allowing it to dry out blocks transport of all that is good about wound healing.  Areas such as hands, feet and face are a little more difficult.

 

Get Real Advice!

If you are reading this in time, great! If not don't worry. I have made a detailed guide. Follow these steps to get back in the saddle without infection, loss of flexibility of the affected joints, and in time for your next event. As you know it is always best to consult a qualified health care professional. Yes, I am a qualified health care professional, writing this blog for people like you. However, I have not seen your wound. There may be intrinsic and extrinsic involved in your healing. Be safe and get help. 

DAY 1-10 “Damage Control”

Your new wound will start to feel tight, extremely sore to touch and will limit your range of motion.  This happens because healing occurs in 2 ways, contraction and re-epithelization. Basically the periphery (outside) of the wound starts to close in, while cells/enzymes clean up and rebuild within the wound.  Despite previous misconceptions, normal inflammation is not our enemy when it occurs as it should.  Inflammation is our bodies natural alarm; it calls in the clean up and repair crew.  As you take on the task of inspecting and maintaining your wound, it is important to know the difference between natural inflammation and infection. 

Signs and Symptoms of Infection

  • Change in mood, depression
  • Fatigue 
  • Suppressed appetite (my theory is a strange and overwhelming need for SUGAR!)
  • Fever
  • Redness around the borders of the wound
  • Red lines or streaking coming from the wound
  • Change in color of the-especially yellow turning to green or blue
  • Change in rate of healing
  • Increased drainage (check color)
  • Increased pain or tenderness 
  • Foul odor (keep in mind all wounds have a smell)
  • Failure to produce evidence of healing tissue
  • Increased temperature

DO and DO NOT of DAMAGE CONTROL

DO: 

  • Insulate and protect the wound. Our skin’s primary job is to insulate and protect our organs. When it’s missing we must do this for it. Use the bandages I mentioned in the first paragraph.
  • Perform GENTLE range of motion exercise. The wound is weak at this time. The point of doing range of motion exercises is not to tear the tissue or stretch. Did you hear me? DO NOT STRETCH. Instead what you want to do is move the joint in a way that is not painful. Movement at this stage prevents further limitations in movement as the area repairs itself and brings healthy blood flow. 
  • Inspect your wound
    • What do these colors mean when referring to the inside of the wound?
    • RED in the wound bed, means go. Red is good. Red says cover me and leave me alone I’m doing just fine on my own.  Red/Pink is not a good signs if talking about a ring around the wound. 
    • YELLOW means slow and slough. Not sloth the cute little creature. Slough indicates necrotic tissue (death) or the result of some ointments. This is not always an indication of infection. Regardless, yellow means that healing is slowed down. The cells/enzymes can not move freely as they need to. 
    • BLACK- black leathery tissue is called eschar. Eschar is also necrotic tissue that has dried and acts as a barrier for healthy healing. 
    • BLUE or GREEN- It is time to see your doctor. These colors could mean you need treatment. (see below for a list of possible treatments)
  • Nutrition considerations from the dietitian Lauren Collins, RDN
    • At least 8-10 glasses of 8oz of water
    • 25-35 calories per kg of body weight
      • 1 kg equals 2.204 pounds 
      • pounds/2.204 x 25 or 35
    • 1.5 to 2.5 grams of protein per kg body weight
      • pounds/2.204 x 1.5 to 2.5= amount of protein for wound healing
    • An extra: 500 mg of vitamin C, 200 mg of zinc, 400 of magnesium and iron
      • This is about what you would get in a multi-vitamin
      • Lauren says bell peppers and berries are good for vitamin C while mushrooms and shell fish are good for zinc. 

DO NOT

  • Do not touch it! Not with your finger, or the metal object you cleaned with fire. Seriously, just don’t. It’s fragile. 
  • Avoid pressure or restrictive clothing. 
  • Avoid extreme temperatures, hot and cold. As well as UV exposure
  • Do not soak the wound. This will cause maceration making the healing tissue weak and stripping the wound of everything that is good. 
  • Do not let the wound dry out. It is a myth that wounds need to be “aired out”. Following the recommendations for bandages will help keep the wound environment friendly. 
  • Do not stretch forcefully
  • Do not use man made products unless instructed to do so by a qualified health care professional. 
  • Do not place dry gauze on the wound while it is wet. It may damage the integrity when removed. You wouldn’t lick a metal pole in the winter, would you?

Wound care Q and A

Q: What are intrinsic and extrinsic factors that slow healing? 

A:

  • Intrinsic factors: 

    • Disease processes such as diabetes 
    • Age
    • Decreased circulation
    • Malnutrition
    • Smoking
  • Extrensic
    • Steroids, certain medications
    • Excessive pressure
    • Harmful chemicals
    • Poor use of dressings
    • Infection

Q: What are the potential treatments, by a qualified health care professional, for infection?

A: 

  • Antibiotics 
  • Sharp debridement
    • This sounds painful but it should not be. Sharp debridement is the selective removal of dead tissue only. Find a clinic that specializes in wound care and offers sharp debridement. This is usually done by a Physical Therapist
  • Wound Cleansing- This is the non-selective removal of the good and bad with specific agents.  Your qualified health care professional should be the one to tell you what to use. 
  • Irrigation- This is often selective and helpful in the same way that sharp debridement is. 
  • Specialized wound dressings. Often by prescription only and can be expensive so you want to involve the insurance if possible. 

Q: What does aging have to do with wound healing? 

A: 

  • As we age skin irritation lasts longer
  • There is increased risk of skin shearing and repeat offenders due to changes in our skins integrity. 
  • As we age we actually feel less pain in the skin. Pain is a protective mechanism to tell us to “stop”. This makes it easier to aggravate the wound. 
  • It is harder to diagnose infection in an older adult

Natalie Collins

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