Pro mtn and Cat 4 Road cyclist Heidi Gurov has had her share of road rash, cuts and scrapes from cycling injuries. Read on for excellent advice on wound management.
*A disclaimer to start… this is just my personal take on healing road rash, not official, legit medical advice in any fashion. When in doubt, seek the help of a healthcare professional!
It’s rather inevitable that if you ride a bike long enough you’ll crash in some form. Sometimes it’s soft landed, sometimes violent, sometimes comical, and a lot of the time not so fun. Luckily as humans, we have the amazing ability to regenerate our skin, and usually we can go about our lives and jump back on those bicycles! Sometimes it can take a bit of TLC, however.
I’m covered in scars, and always have been in part to clumsiness, an adventurous childhood, and well, wrecking a lot on my bike. I’m primarily a mountain biker, and mountain bike crashes tend to involve a lot of lacerations (cuts) and scratches. These wounds tend to clean up well, and I go about my day, letting them scab up and my body do its thing. I’m pretty low key when it comes to wound care – once while 2000 miles away from home at mountain bike nationals, I cut my shin down to the bone, and patched myself up with antibiotic ointment and some bandaids! This weekend, however, I was participating in a road race and went down in a pile up at 29 mph, landing head first, followed by my left shoulder and then left leg. Road bike injuries can be of a more violent manner due to the speed and fact that asphalt doesn’t have the “give” that dirt does. It goes without saying, that I donated some skin to the road that day, and had enough road rash that I knew I needed to attempt some proper wound care.
First, the awesome Wyoming Highway Patrolman that carried me off the road cleaned me up with some iodine swab sticks and covered my knee with gauze. This brings me to my first point… get cleaned up as soon as you can! At races and official events, there is first aid available, and you should utilize it! They’ll have the proper supplies and knowledge to at least get you a bit cleaner for the trip home. Later at the hospital, they used saline flushes to get the gauze off my knee (it had become rather stuck), and also covered my shoulder. The ER didn’t do any further wound care (the big concern was my noggin and cracked helmet, not really the missing skin on my knee, for obvious reasons), so once I got home I hobbled into the shower and wash my wounds. I have a decent stash of random dressings and medical supplies… so that brings me to the big point on dressings!
There’s numerous types, and I listed out the 3 most common below. Dressings are beneficial as wounds heal better in a moist environment. I know myself, and probably many others like me, have always assumed that letting a wound dry out and scab was the best thing. But scabs crack, can hurt when over a joint, and there’s always the temptation for some to pick at them. According to Convatec, the company that makes a dressing called Duoderm, “the advantages of a moist wound-healing environment include improved health rate, increased epithelialization, reduced infection, enhanced collagen synthesis, and the earlier appearance of more macropahages in the wound bed.” In plain English that means that a dressing is keeping the wound clean and bacteria and crud out, and the moisture helps your body start regrowing the skin and your immune system is more likely to respond and keep fighting off infection. It’s easiest if you already have a small stash on hand. Hopefully they’ll never get used, but if the time comes it’s a whole lot easier to go to the medicine cabinet and pull some out then driving around to different stores trying to find them (especially if you have injuries that may prevent a shopping trip), or waiting for shipping from an online source.
Tegaderm – this is a thin, membrane-like dressing, almost like another layer of skin. I found it to be great for road rash that is not heavily weeping or draining. Tegaderm isn’t absorbent, so on a wound with a lot of drainage they tend to leak. It keeps the wound moist, those unhappy nerve endings protected, and provides a good environment for wound healing. It’s also flexible and works well on joints. My trick is to fully bend (or bend as best you can) the joint and then smooth it on. I’ve been able to shower with Tegaderm in place. A perk is that Tegaderm is clear, so you can monitor easily for infection and also the stage of wound healing! This is also a product that is easy to find in your typical chain drugstores.
Mepilex Border – this is our gold standard at the hospital that I work at for wound care. We slap these babies on everything from surgical incisions to pressure ulcers to skin tears. Mepilex consists of an absorbent foam-like pad, with an adhesive border to help keep it stuck to ya. The pad draws away any drainage, and keeps the would bed moist to provide an excellent healing environment. The dressings can stay on for up to 7 days. I honestly do not know the waterproof status of these dressings, so I cover mine when I shower. Like most specialty dressings, Mepilex can be pricey. They’re not found in mainstream stores, but are available online through numerous retailers, and you might be able to find them at more specialty drugstores that sell home wound care supplies. There is a version that is impregnated with silver, which is an antimicrobial.
Tough Pads / Duoderm / Hydrocolloid Dressings – these are another favorite among wounded cyclists. I have not personally tried them, but do know people that swear by them. They can be hard to find in stores, so best bet is building a stock of them from an online retailer. Like Mepilex, they absorb and draw drainage away from the wound and provide a moist environment for healing. They are usually waterproof, and are squishy and gel-like. Most products are clear enough that you can see the wound to check on healing and for infection. They work well on joints and parts that move. Pricey, but once again they’re meant to stay on for a number of days.
First thing I did was slap Tegaderm on my shoulder, which was decently superficial and not draining/weeping. I then put some on my deeper area of road rash on my knee, which was moderately-to-heavily draining “serosanginous” fluid (the clear-ish juice that is in your body tissue, along with some blood). Below my knee on my calf I have a large patch of superficial road rash that I was going to let just dry out, but the breeze from my ceiling fan on those angry nerve endings was making me jump out of my skin, so Tegaderm went on that area as well. My shoulder and calf have done great with the Tegaderm, and two days out I already can tell that it’s healing up nicely. My knee, however, was not a good application for Tegaderm due to the drainage, so I switched to a Mepilex after 24 hours.
Regardless of the dressing applied, it’s very important that the wound is thoroughly clean before applying anything. Bacteria LOVE warm, dark, moist environments, and flourish and grow in these conditions. So putting a dressing on a dirty wound could be a disservice! I usually jump in the shower to clean all my wounds, as it’s harder to hear my cries in there (just kidding… maybe). Plain soap and water can do the trick, doesn’t have to be anything fancy. If there’s a lot of embedded dirt and crud, I use some gauze from a sterile package to “scrub” the wound. Some people will use a clean washcloth. I sometimes use a Bactine wound cleansing product I have that contains topical lidocaine, which will numb the wound to an extent to make the process more bearable. Make sure the wound is all dry before attaching a dressing, and avoid any lotions or other products that could make the adhesive not stick as well. Having a helper to apply the dressings is nice, if not necessary, for some locations. My Tegaderm on my shoulder is a bit wrinkled and not so pro looking since I was doing it with one hand and a mirror.
Always be on the look out for signs and symptoms of infection. These can include increased redness, any drainage that just doesn’t seem right (pus, foul smelling, odd colored), increase in pain, and even body-wide symptoms like fever and chills. When in doubt, go get it checked out! I’d rather look silly and go get checked out and know I don’t have any infection, than wait to see what happens. I’ve seen my share of infected wounds (on others), and that’s not a path you want to go down if you don’t have to!
Your new patch of skin will be pink and rather fragile when it’s ready to come out into the world. Make sure to protect it with sunscreen if it’s in an exposed area. Scar tissue can be easily reinjured and can be harder to heal on subsequent tries, so personally I like to loosely cover any freshly healed areas like my knees with a simple gauze pad and tape (or Coban wrap – sometimes called “vet wrap”) if I’m going to be racing or riding in a manner where there’s increased chances for wrecking. This will at least provide a bit of cushion and hopefully the ground/rock/tree/whatever will just rip up the gauze and not my skin!
So that’s a bit of my thoughts on post-crash wound care and things to help you get back on the bike! I hope no one ever has to use them, but if it does happen, hopefully this makes it a bit easier to narrow down products or to have some rough guidance!