Monday, July 14, 2008

How To - Road Rash Care

Disclaimer: I am not a doctor, nor do I play one on TV. The following is based on personal experience and may be in fact dangerous for your health. Any real doctors feel free to pipe up.

Okay, I didn't crash, but someone I know did. And then there were some other internet folks who tumbled and needed to take care of their wounds. I, unfortunately, have some personal experience with crashing. I crashed frequently for about ten years, crashing at least once a year for ten years straight. I think my record was 4 pretty spectacular wrecks in 5 weeks, all in crits, all causing road rash, and eventually requiring me to replace a frame, fork, wheels, and a bunch of drivetrain stuff.

Over those ten years I learned how to deal with crashes, and I'll share the bulk of what I know here (I can't remember anything else to share but I'm sure there are things I've forgotten).

There are a few magical things you need to heal quickly after rubbing skin with the pavement (and whatever else):
- clear stuff
- numbing stuff
- tape stuff
- money

First up, the clear stuff. It's either Tegaderm or Second Skin. I would link Spenco's Second Skin site except it's not working.

Note: Tegaderm looks like Saran Wrap. 2nd Skin looks like 2 layers of Saran Wrap with a layer of clear gelatin 2mm thick between the two layers of the Saran Wrap. I think 2nd Skin is more soothing for fresh wounds because it feels cool (cold cool, not Fonzie cool), I think Tegaderm is better for smooth or healing wounds because it's smoother.

The clear stuff sits directly on a clean wound, protecting it from air (which causes pain), dirtiness (which causes infection), and dryness (which causes scabs which crack and promote pain and infection). Because the wound stays moist, it stays flexible. And because the clear stuff doesn't absorb moisture, scabs don't form through it (like gauze). This means it's less painful to change.

Let me point something out: don't use Saran Wrap on your wounds.

Second, the numbing stuff, specifically "hurt free antiseptic wash". I have good luck with the following, although there are generic and store brand versions as well - look for the claim of "painless" somewhere on the packaging, that's key unless you're a real masochist:

Finally (I'm not going to explain the money part because once you start adding up how much this stuff costs, you'll know how much money you'll need) get some gauze and something to hold the gauze in place - first aid tape (for road rash type things I'd recommend going full bore and getting 1" tape, and pick up some razors if you don't already have some), ACE type bandages, the white fishnet stuff, or the wrinkly sticks-to-itself disposable wrap.

Use the gauze on top of the clear stuff (Tegaderm/2nd skin) to keep the clear stuff in place. Put lots of gauze on and then lots of tape to keep the gauze in place. For large swaths of clear stuff cover gauze and then hold the gauze in place with fishnet stuff (check out Valverde's leg in this year's Tour) in warm weather or ACE type bandage/wraps in cold weather.

Shave anywhere the tape will go. It'll be hairless after the first time you change the dressings but if you shave it first, it hurts less

Note: you have to cover the clear stuff, otherwise your very expensive Tegaderm/2nd skin gets peeled off when you put your shirt or pants on. So that $20 of clear stuff peels right off 3 minutes after you finished putting it on your wounds. Not a good use of money. Get the gauze, shave all the hair off around the wound, and tape tons of gauze on top of the clear stuff.

Keep the clear stuff on for a while, i.e. days - take it off only when it gets gross underneath (you'll know it when you see it - yellow, green, brown, anything except pink/red/white). If your wound is still bleeding then give yourself a little drain area in the clear stuff so the fluid has somewhere to go, and put tons of gauze there to absorb the fluid.

When your wound is close to healed you might leave the clear stuff on for a week or two, at least that's my experience. Second Skin, because it has so much water in it, gets a bit mushy after a week. Tegaderm is better for the long haul (2 weeks, at which point you're probably good to go).

Use the numbing antiseptic liquid to clean the wounds. I use the above translucent blue bottle with a squirt top. First spray down the wound. Wait about 30-60-90-120 seconds to let the numbing part get going, otherwise there is no numbing. Spray a lot to get more of that numbing stuff on. Then, after a few test touches with a gauze pad (the wound will feel swollen but it won't hurt), go to it and scrub out the wound using clean gauze or a sterile scrubby thing made to clean out wounds. Rinse generously with the numbing antiseptic stuff, you want things clean. Then put your new Tegaderm/Second Skin on.

This cleaning step is critical since it keeps everything nice and clean and fresh.

If you smacked your head, check your head/scalp for bruising. You will be surprised at what you'll find. If you have someone that you feel comfortable examining your scalp, have them do it.

Based on your findings (there will be bruising), you can re-examine your helmet and be even more amazed at how much shock it absorbed. Days after my biggest ever helmet impact, someone pointed out the side of my head was purple, a huge area, basically ear to top, all the way from front to back, but all in my hair line. I checked and it was purple. I also realized at that time that the side of my head hurt, it felt a bit soft, and it was basically one huge bruise. I then looked at my helmet and saw that not only did it crack in a couple spots (which were obvious), the whole side was compressed about 1/2". Insane. I didn't realize the shell wasn't supposed to be loose and squishy.

And right after I hit the ground I claimed to be totally fine. Luckily the EMT there disagreed with me.

Once your head is okay the rest follows quickly.

It won't be cheap buying all this stuff if you have a lot of road rash, but it really, really helps. It reduces pain, speeds up healing, reduces scarring, and gets you riding quicker. I think it's easy to spend $100-200 per incident in wound cleaning and protecting supplies, but having made do without the expensive stuff (i.e. the clear stuff) I highly recommend laying out the dough and getting the clear stuff.

Figure 2-3-4 or even more boxes of the clear stuff per round of changes (varies based on road rash, but look at the labels and calculate how much stuff you need to cover all your wounds), twice that much area in gauze, and appropriate tape/ACE/whatever to hold the gauze. I'd use almost a full bottle of that spray stuff per round too.

Figure 3-5 rounds of clean/redress before the wounds are nice and pink and have virgin skin on them. I have, leftover from my last forays onto the pavement, maybe a dozen plus ACE bandage rolls (mostly washed and re-rolled), a few left over "sticks to itself" wrinkly white faux-ACE bandage disposable stuff, about 10-20 boxes of mostly used gauze pads of varying sizes, and maybe 10 mostly used rolls of first aid tape (incidentally I like 1/2" to 1" tape, the skinny stuff is useless). I use up all the antiseptic wash I buy, and I have a couple half used antiseptic goo stuff. I also got some first aid kits for the Bethel Spring Series but those have been plundered over the years (at the Series).

Oh, finally, don't skip the little spots, the little scrapes. You'll pay a lot of attention to the big scrapes everywhere and ignore the tiny dime-sized road rash. In a week that dime sized road rash will be stinging and swollen and hurt like a mofo while all the big stuff is almost healed.

Take care of EVERY SINGLE wound.

Bandages with lots of antiseptic goo for the little ones (cover the bandaid with first aid tape if it's in a "high traffic" area), 1/2 pieces of tegaderm covered in gauze and first aid tape for the coin-sized bits. The little Tegaderms you'll leave for a while, just make sure they're all cleaned out before you dress them up.

If you take care of the dime sized ones then the rice crispy sized ones (bandaid plus goo) will be the ones causing you to lose sleep. When I say take care of every wound, I mean it. Take care of all of them. Leave them alone once they have new skin underneath and they don't hurt.

Hopefully you won't need this info but it's good to have if you ever need it. If you crashed away from home, get all this stuff on the way back home because you won't want to leave the house until you've dressed your wounds.

Keep the tire side down and the body side up!


Anonymous said...

Having been a recent SDC "patient" I can totally vouch for the efficacy of the products he recommends here.

Do exactly what he says and you will be surprised at how (relatively) pain free road rash can heal.

Viva La Tegaderm!

Anonymous said...


Thanks Aki! Came in handy this past sunday after a downhill chain slip @30mph, and a "Dude! Where's my bike!" moment.

Dave (SoCal)

Aki said...

Dave - lol ouch. I'm glad you were able to use the info but I'm sorry that you had to. I hope you're on the bike again soon.

John said...

Awesome write up. My wife took quite a spill today on a hard windy ride with about 20+ miles left in the ride. Your post has some great info. Would you mind if I link it in my blog?

Aki said...

Not at all. There's an illustrated version but that one isn't as complete. Hope your wife recovers quickly.