Road Rash Care Guide - How to Treat and Prevent Scars

[ivy]

Hi
You may have read my post a week or so ago about the fear of getting back on my bike. Your responses were incredibly helpful and wise. I'm new to the sport of mountain biking and recently took a nasty spill in Tahoe. I broke my jaw and arm. In any case, I said I'd put together a road rash guide for anyone interested. I'm guessing most of you guys are perfectly happy with scars and see them as a badge of honor. I just didn't happen to want the badges of honor on my face.

I spoke with a dermatologist who is also an avid cyclist who helped me tremendously in understanding how best treat the rash and prevent scarring.If you have additional knowledge, let me know and I'll edit this guide. Mod - if this is the wrong place for this, feel free to yank.
Ivy

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Road Rash Care Guide – minimize scars and be less ugly

Road rash is a fairly inevitable part of biking. Some day, some how, you will likely come off your bike. If you’re reading this, you’ve had road rash, currently have it or you’re going to have it. Road rash is something like going to the spa and getting a deep exfoliating treatment…for free! Actually it’s not like that at all. It hurts, it bleeds, it weeps, and, depending on how you take care of it, it SCARS!

So, let’s minimize that scarring with some knowledge:

Degrees of Road Rash

Like burns and murder, road rash has different degrees:

First: Probably looks like a really bad sunburn. The surface of the skin is red, but not bleeding. The skin is not broken. Treatment isn’t really required here, though you’ll want to clean it just to be safe.

Second: Skin is broken and bleeding. People flinch when they look at you. However, the deep layer of skin is intact. How do you know if the deep layer is there? See below. This guide is for second degree road rash.

Third: Skin is gone daddy gone. You can see fat layers and tissue. When I called my dermatologist friend about my road rash, this was the first thing he asked: “Can you see fat?” If you can, head straight to the ER; damage like this can mean grafting.

Cleaning...

The first step is any wound care is cleaning. There are a number of things you want to avoid, like infection and tattooing. Tattooing is when you rash your face and embed dirt or street grit in your face. You want that gone or it will heal with the stain of the dirt underneath. This means scrubbing. It’s unpleasant, but necessary to avoid both tattooing and infection. For bad road rash, you’ll want to see a physician first, perhaps in the ER. They can clean it properly and scrape (I’ve had this done, it’s unpleasant, but a doctor can numb you first) out the dirt. A note about hydrogen peroxide before I go on: There seems to be some debate about using hydrogen peroxide to clean the wound as it can damage tissue, however the dermatologist I saw about this assured me it was a very small amount.

What to use to clean:

Iodine Scrubber. You’ll usually get some of these in the doctor’s office. You might try a pharmacy as well. I don’t know if these are generally available at drugstores, Iodosorb is the brand name.

Shur-Clens or 0.9 sodium chloride: Ideally, you want to irrigate the area to properly cleanse the area. If you’ve got a syringe handy, this will help give the liquid pressure which will help get the grit out. The area must be completely cleaned out. If necessary, use clean gauze to gently scrub the area. Do not scrub vigorously, as this can cause more tissue damage. Can't find either. Try an antiseptic wash like Band-Aid Antiseptic Wash. Soap and water will also work fine.

Gauze: No scrubber? Gauze is not only useful for covering but also for scrubbing. Use mild soap and water and scrub with a bit of pressure behind it. (Don’t go overboard, you don’t want to cause more tissue to the area.)

Once everything is clean…

Old wisdom about wounds like road rash, was to let things “dry out” and scab over. I actually heard this exact sentiment from my physician. My dermatologist set me straight: This is just plain wrong. Why?

• We all know scabs crack, and cracking scabs hurt and itch. Why add more hurt to the mix? Scabs are your enemy here.

• Scabbed areas are essentially dead areas, so they’re not getting oxygen so take longer to heal properly.

What you want to do with a wound like this is keep it moist. Once a wound has scabbed over, you diminish the skin’s ability to heal. It’s that simple. So…

Moist and covered:

Keep the wounds moist with ointment. Stay away from Neosporin. The rate of people who are allergic to Neosporin is significant enough (about 20%) that you’ll want to avoid it. Apparently the allergy appears very similar to poison oak. If you’re a mountain biker treating your road rash (and using Neosporin) you may think, oh great, poison oak too!? And now you’re on something for the poison oak as well, when in fact it’s the allergy to the Neosporin. You can also apparently develop an allergy to Neosporin even if you’ve never been allergic in the past.

I’m a fan of Aquaphor which I’ve heard referred to as “the dermatologist’s duct tape”. This will keep it moist, is unlikely to irritate and is a cheap over the counter solution sold in most drugstores. Aquaphor comes in a tube or a tub, you want the tube to minimize the chance of spreading bacteria every time you dip your fingers in the tub. You can cover with gauze, but this isn’t critical. You will however want to clean off wound as it weeps which will happen for a couple of days. Then reapply Aquaphor. Keep it moist. Always, always keep it moist.

Second degree road rash generally takes about three weeks to heal. At that point the skin will still look strange, discolored and the texture may feel rough in places. You may want to get some silicone sheeting to place over the discolored and areas with more texture. Neosporin makes a very cheap one, but I am currently using Cica-Care by Smith & Nephew and really like it. I can reuse it over and over again and it doesn't come off when I sleep. This is supposed to help flatten scars and minimize your chances of keloid scarring which you want to avoid on your face. It also is supposed to help with discoloration. I'm currently trying this as I'm 6 weeks from the accident, so I'll have to report back on its effectiveness. But I have seen studies that show it helps. Some people advocate using things like Mederma at this point to help minimize scarring. You may also hear people recommend Vitamin E. Some other products on the market I’ve read about (with varying reviews):

Bio Oil
Prefer On
Scar Zone
Sudden Change
Palmer’s Cocoa Butter

I personally have been using Bio-Oil. Whether or not it’s doing anything I’m not sure, but it seems to keep the skin soft and it’s cheap, and people seem to love it.

What I will say is that Vitamin E (either the serum or fresh from the capsule) has been proven to do…absolutely nothing. This is if you are a believer in randomized, placebo-controlled, double blind studies. If you are, like me, a believer in placebos, witchcraft and wishful thinking, go ahead and try it. It can’t hurt and it encourages you to massage the area, which may be a good thing.

Other considerations:

Duoderm and Tegaderm and other Dressings
It’s likely that parts of your road rash are worse than others. I had a particularly bad spot on my chin, that was very very deep. For that, you’ll want something like Duoderm. Duoderm is a dressing generally used for leg ulcers and other wounds that are slow to heal. It’s commonly used for wounds on diabetics. It’s opaque and skin colored (if you are Malibu Barbie) and non breathable. In this way it helps keep the wound from drying out. It’s similar to wearing a fake layer of skin, which, when you’re missing a layer, is a much more comfortable feeling while healing is going on. Duoderm is treated with some kind of gooey adhesive which apparently helps skin heal. With something like Duoderm and Tegaderm, you don’t need any ointment, in fact this will keep it from sticking. Tegaderm works much the same way as Duoderm. I’ve heard conflicting things about which is better. My own experience was that Duoderm worked shockingly well. I will caution you that Duoderm is both expensive and hard to find. Your regular drugstores might stock it in the pharmacy, but I did a pretty extensive search and was only able to find it online. A pack of ten 4x4 is $50-$60. You might also try getting it from a hospital pharmacy which is generally better stocked. Both these types of dressings come in pieces that can be cut to size. For larger areas of road rash, you’ll find Duoderm treatment can get pretty expensive. I will say, I was enormously happy that I chose to use it on my face. You can shower in the Duoderm, wear clothes, sleep in it, whatever. Generally you’ll want to put a new one on every couple of days. Peel SLOWLY, clean the wound and reapply another patch. Johnson & Johnson and Curad both make adhesive dressings that are decidedly cheaper. They are reviewed well, though I personally haven’t tried them and they don’t seem to be as revered by the dermatologists I spoke with as say, Duoderm.


Sunscreen:

You don’t want to radiate the skin while it’s healing. Stay out of the sun as much as you can, especially during the first weeks and months. Wear a hat. If you refuse to wear a hat, slather up with sunscreen, with a minimum SPF of 30. Reapply every two hours. Cautionary tale: I am currently healing from a bad bout of road rash and went to a county fair wearing SPF 45. It was a bright sunny day and even with the sunscreen, I noticed I’ve got some tiny white blisters on one area of my road rash. Sorta wish I’d worn the hat.

**If anyone has additional knowledge or suggestions feel free to let me know and I'll edit this guide.

[rearviewmirror]

Good write up! This summer I had a bad crash in a road crit. Had severe road rash on my right leg. 3 1/2 weeks later I crashed my MTB on the road on the exact same leg. So much for healing up.

[kark]

One thing I've found helpfull for the scrubbing bit is prior to the
'scrubbing'
'irrigating'
'making yerself cry'
step is to slather on the polysporin with the anesthetic in it. Let is sit for a couple minutes to calm down the nerve endings and then use guaze 4x4s to wipe off the polysporin and the process of wiping it off will do a lot of the cleaning right there.

You'll still have to scrub a bit after, and pick out the rocks and stuff and it still hurts like a bastard but the topical anesthetic takes a bit of the sting out so you're a little less likely to hit the high notes.

I've used tegaderm on a few occasions also and I found that it's suitablity is on a case by case. If you have a large rash thats weeping a lot the tegaderm will just fill up until the adhesive on the margins can't hold and it basically bursts. yuk. but if you have to go to work or othewise can't lay on the couch or in a burn tent until you're healed it may be the best option.

oh yeah, Ivy, I read your initial post crash post. Sorry to hear you got smashed like a bowl of eggs but it seems you've got a great attitude so I'm sure you'll be o.k. with getting back on. maybe as some mentioned stick well within your comfort zone until you *want* to push it and you'll be super-fine. ..maybe some flowy trail riding would get you back in the fun zone.

cheers,

[DIRTJUNKIE]

[SIZE="5"]Super Glue[/SIZE]

[Flo Rida]

Good write up... but I'm pretty sure chicks dig scars. At least thats what I have heard.

[tombo615]

"I’m a fan of Aquaphor which I’ve heard referred to as “the dermatologist’s duct tape”. This will keep it moist, is unlikely to irritate and is a cheap over the counter solution sold in most drugstores. Aquaphor comes in a tube or a tub, you want the tube to minimize the chance of spreading bacteria every time you dip your fingers in the tub. You can cover with gauze, but this isn’t critical. You will however want to clean off wound as it weeps which will happen for a couple of days. Then reapply Aquaphor. Keep it moist. Always, always keep it moist."


Total thumbs up on the aquaphor, works perfect for any types of road rash or dry skin. Also works great for tattoo aftercare

[HubbaMan]

Very good information thanks - I'm happy you didn't follow the typical "thread is useless without pics" logic here

[HandyMan]

Some other tid bits I've learned after my MANY motorcycle and bicycle caused road rashes...

Clean it QUICKLY! The longer you wait to clean out the wound the more it hurts. If you can do it within the first five minutes or so you barely even feel it!

If your using gauze for dressing, use non-stick.... trust me

If its small enough to use a bandaid, be careful with the them. After 3 or so weeks of use they will tear your skin if left on for too long in between changes or the skin gets wet and fragile before you remove them. On my shoulder I have a scar in a nice square pattern from the bandaid, which surrounds the scar from the actual road rash. Try to get bandaids that are bigger than they need to be so you can move them around and stick them to different parts of skin.

In between dressings rinse out the wound with saline solution. Also let it sit for a while with ointment but no dressing in order to let the skin recover from being compressed 99% of the time.

I'm working on an entire right arm sleeve of scars... I'm about half way there at the moment.

[nuclear_powered]

Excellent information - I'll have to find the Australian equivalents of some of the aforementioned products.

I don't know if this is more of an anecdotal remedy or what, but it is my own experience so I thought I'd suggest it in case it helps. It's not road rash, but a graze nonetheless. I had a head versus rocky slope incident last year which resulted in a broken nose and some bleeding grazes across my face. I am not overly knowledgeable when it comes to looking after wounds, but i knew enough to keep it clean, and I also remembered as a kid that cuts would heal quicker whenever I swam in the ocean. Just so happens a few days after this crash I had a weekend in the clear, cold waters of Wilsons Promontory (most southerly point of Australian mainland). 2 days with plenty of submersion in the salty ocean and the scabs that had formed flaked off a few days later to reveal completely unblemished skin. Quite extraordinary compared to some of the other riding accident scars on my body.

[Rotmilky]

I’m a fan of Aquaphor which I’ve heard referred to as “the dermatologist’s duct tape”..

This is indeed true. My wife is a dermatologist and it's her front line weapon for everything.

Nice writeup. My wife treats my road rashes and pretty much does as you described above. I can tell you it works great for me.

[EJP]

Good write up... but I'm pretty sure chicks dig scars. At least thats what I have heard.

But perhaps not on their own faces......

[grungePoodle]

Wow, that is an awesome write-up. I am going to copy and paste that. Thank you!

[HotBlack]

I put mud on wounds out on the trail. Within 24 hours, everything's healed nicely. But then I've always healed really quick, so the mud might not have anything to do with it. Still, no scars. Grandpas old recipe: mud with high clay content, followed by a shot of whiskey.

[Bail_Monkey]

I have used this stuff. It's OK, not sure if it helps a lot as their site mentions. (Everyone is different)

http://www.bravesoldier.com/antisept...g-ointment.php

Article:http://www.bravesoldier.com/road-rash.php

[Anonymous]

I put mud on wounds out on the trail. Within 24 hours, everything's healed nicely. But then I've always healed really quick, so the mud might not have anything to do with it. Still, no scars. Grandpas old recipe: mud with high clay content, followed by a shot of whiskey.

If horses ever use the same trail, that's a good way to end up with Gas Gangrene.

I'm already butt ugly. I don't worry about scars.

Good post. Not everyone is as ugly as me.

[HotBlack]

If horses ever use the same trail, that's a good way to end up with Gas Gangrene.

I suppose I can't just throw that out there without being a little more specific.

1. Don't do this. It's safer to go to a hospital.
2. Especially don't do this, if you happen to be in an urban, or even semi-developed area. Anywhere humanity has tread its foul foot, you can pretty much consider the soil and water hazardous to your health. Frickin humanity...
3. And if you do, don't use the mud from on the trail. Find clean mud. You know the stuff. Thick, consistent clay from a couple inches down, under trees. Mix with fresh water into a foamy paste, slather open wound, grind it in a bit, rinse, cake some more on and let it harden. It'll get ya back to camp.

Again, I've got an immune system like a hobo (though, putting biologically charged mud in my open wounds for 30 some years could have something to do with it), so your results may vary. It's a risk I take. You might not.

[Anonymous]

I've got an immune system like a hobo (though, putting biologically charged mud in my open wounds for 30 some years could have something to do with it),

I'm with you. I grew up drinking out of irrigation ditches, with a cow pie 20 feet up stream. I have no problem with the water in Mexico. I've found that most US folks don't have the same immune system.

[Lady Gravity]

thanks ivy. i've made a note to try and find that aquafor and will stock it in my first aid kit. we have polysporin (in canada) which is likely the same thing as neosporin. never heard of the allergy thing, but i have heard that it can cause scarring. teatree oil (pure essential oil) is also good as a natural antibiotic, but i have personally found that it's not strong enough to treat 2nd or 3rd degree rash injuries.

i got a 3rd degree rockface scrape on my hip almost a month ago, got stitches for part of it, and managed to use the polysporin effectively against infection. ended up with a lovely scar however...somewhat immaterial since it's on my hip, but i wish i would have known at the time about the other options.

i read about your crash - sounded horrible! best wishes to you on your recovery.

[kmoodymz3]

Great information. I got 3rd degree rr sliding down a hill on my shoulder, were talking I could see bone. My ER doc gave me the above advice, keep the wound open and let it heal from the inside up and out and it worked beautifully.

On really deep wounds my only additional advice is once the skin is healed, continue to massage the area 2-3x day with a moisurizer or oil to prevent scar tissue build up and thickening.