Road Rash: The Definitive Guide

July 11, 2017

You crashed on your bike. You’ve got what cyclists for generations call “road rash.” Now what?

I asked Dr. Kazu Suzuki, a board-certified wound care surgeon from the Tower Wound Care Center and an attending physician at the Cedars-Sinai Medical Center in Los Angeles. He is also a long course triathlete and a Slowtwitcher. Wound care (along with long course racing) is his specialty.

Who needs wound care? Diabetics, cancer patients, dialysis patients, those who develop bedsores, venous leg ulcers and diabetic foot ulcers. Often these afflict older people but, occasionally, younger people with burns and road rashes need help. (Dr. Suzuki pointed me to a dropbox of images of wounds he deals with. Medical textbook stuff. You don’t want to see them. Or maybe you do.)

Dr. Suzuki wants me to add this disclaimer, that what follows is informational and is not a substitute for a proper medical assessment and treatment.

So, back to road rash, which is that rite of passage you probably either have gotten or will get if you remain a cyclist or triathlete for very long. What should you do if you end up with a road rash from a bike or run accident, assuming you think this is something you can treat yourself, without going to the hospital?

"The first thing you should do is wash and scrub the grime from your wounds,” Dr. Suzuki replied. "This grime may include dirt, rocks, dry blood, dead skin and any foreign particles that prevent your skin from healing properly. Medically, this process is called ‘debridement,' which means removing any debris. I'd suggest you hop in a shower immediately and wash out the wound really well under running water, then scrubbing it gently with your finger tips or clean washcloth and soap. “

Anybody who's dealt with a road rash knows this is easy to say. What if the wound is too painful to scrub?

"If it's too painful to scrub your road rash right away, you can apply topical 4% lidocaine cream to your wounds, available over the counter at pharmacies or online, and take a Tylenol 15 minutes before your washing routine."

Here’s good news! For those who’ve looked in vain for an actual reason, besides vanity, to shave your legs, Dr. Suzuki said that shaved legs “makes it easier to take care of your wounds. Smooth skin eliminates your hair from getting into your wound bed, and adhesive bandages, such as silicone bordered dressings, won't stick to a hairy leg.”

Here’s bad news. Yes, you need a tetanus shot if you haven’t gotten one in the last 10 years. Tetanus is a nasty and completely preventable disease with a vaccine, and you do need a vaccine shot, and a booster shot every 10 years. Dr. Suzuki gives his patients a tetanus booster in his office to patients that sustain a dirty injury gotten outdoors.

Should I use sterile saline to wash my road rash? Not necessary. "Saline is just a fancy bottle of weak salt water. Shower water, from any municipal water source, is clean enough to irrigate your wounds. You should aim to decontaminate by washing the wound with plenty of water to lower the number of skin surface bacteria, not so much as to create a sterile environment.” Dr. Suzuki noted that human skin is never sterile.

No need for alcohol, hydrogen peroxide or betadine for open wounds. These antiseptic solutions kill bacteria, but will also irritate and burn your wound bed. Dr. Suzuki’s rule: “Do not put anything in your wound that you wouldn't put in your eyes.”

Should you air out your wounds, so they heal faster? "Absolutely not. We've known since the 1970s that a moist wound healing environment heals the fastest with less scarring. Optimal skin healing is achieved when wounds are kept clean, moist and covered, thus protected from the element. If you air out your wound you are inhibiting the new skin cells from growing, and inviting new bacteria to enter your body. “

How should you cover your wounds, then? What you want is a non-adherent or "non-stick" bandage that can come off painlessly and without ripping off your new skin growth. Dr. Suzuki’s offices uses a lot of petrolatum-impregnated gauze (brand name example: Xeroform, it’s the yellow gauze pictured here), and silicone-adhesive based sticky bandages (such as Mepilex), among other products. If you have stubborn scabs that won't come off easily, you may use something like hydrocolloid (i.e., Duoderm), hydrogel, or manuka honey gel, as they hydrate the scab and help it come off easier. This is a process called autolytic debridement.

Dr. Suzuki recommends changing the bandage daily or every other day, depending on the amount of bleeding. More expensive silicone-based antibiotic bandage (Mepilex Ag) may be left on up to 7 days.

He’s not a fan of Neosporin, which is a triple antibiotic agent. “It has three strong topical antibiotics – Neomycin, Polymyxin B, Bacitracin – and many people can develop an allergic reaction, especially when used for weeks on end. Better off using Xeroform dressing or plain petrolatum ointment (i.e., Aquaphor) which will protect the wound bed and facilitate painless removal of the bandage.

Dr. Suzuki has a shopping list of bandage items you should buy, which he recommends purchasing them online "as you will pay a hefty markup if you buy them all at your local pharmacy.” This probably means buying them before you need them.

– Xeroform non-adherent gauze: to cover all kinds of road rashes.
– Abdominal gauze pads (also called ABD pads): these collect drainage and blood, placed over the non-adherent gauze (Xeroform).
– Surgilast elastic net: holds bandages in place on arms and legs (see the image highest above).
– Mepilex bordered foam dressing: to cover smaller & flatter wounds (the pink bandages with the rounded corners).
– Lidocaine cream & tylenol pills: optional for pain control.

What if your road rash is becoming red, warm and painful. What does this mean? These symptoms are often the early signs of skin infection. Dr. Suzuki recommends seeing your healthcare provider right away, as you may need skin specific antibiotics, such as doxycycline. If you are experiencing a fever and chills on top of it, you may need IV antibiotics, so, go to your nearest emergency room ASAP!

What about preventing scars? "If you have a deep wound beyond your dermis, the outermost skin layer, it's certain you will develop a scar, unfortunately,” reports the doctor. "You can reduce scarring by both taking care of the wounds properly as outlined here, protecting the scar from UV rays. Once the skin is healed, use of sunscreen and silicone gels are clinically proven to lessen the appearance of scar cosmetically."

You can resume training as soon as the skin heals & stops bleeding or leaking fluid. Sweating when you have a bandage covering your wounds may cause a nasty skin rash. Limit the swimming, too, as salt and chlorine may irritate the wounds, and the lifeguards and your lane mates may not appreciate you. If your wounds are painful to train, it is basically your body is telling you to slow down.