Sabina Edwards debunks the 'Let the scab air' myth. Facts, history, advice, Shakespeare, gore photos and a step by step guide of how to turn small plasters into big plaster. It's a flash course in how to treat road-rash and avoid those disgusted looks from friends, relatives and other halves!
We all want to come away from the event with a trophy - and oh! How our grazes, gashes and other gnarly gnasties are some of the best! But only for a while. I, for one, like to sit down and that is not easy when a chunk o' cheek is missing. So, knowing we are going to get scraped because we aren't going to give up doing this stuff, what can we do to minimise healing time?
(It is a given that the points made here are in the context of superficial injuries, on a hill, in the middle of nowhere, at an event you don't want to leave and that you will be wanting to continuing skating. If you can see fat, muscle or bone, the wound has jagged edges far apart, continues to bleed after 15 minutes of continued pressure or you have sustained bigger injuries, breaks or dislocations then straight to A&E, okay?)
So, let's look at every skaters friend 'Road Rash'. It comes in varying depths, but initial treatment will always be the same: clean it and cover it. “Dirty wounds don't heal, clean wounds do”, to quote Tregaron medic, Ed Sharp.
The most important thing is to remove as much grit and dirt as possible. Using water to flush the wound is perfectly acceptable, with a bit of gauze to carefully dislodge bits of grit. Antiseptic wipes can be used but be very gentle as I recently read it can cause more damage to tissue as well as allergic reactions.
Ethan Robins Kear-Davies
Once clean, cover it .... “No!” I hear you shout, “leave it to breathe!”
To cover, or not to cover, that is the question:
Whether 'tis nobler in the mind to suffer
The stings and aches of downhill misfortune,
Or to take arms against a sea of troubles
And by opposing end them .....
Certain injuries in specific places definitely need arming against ... I wouldn't want these left in the open, for instance, not least from a public interest point of view. It is obvious they are going to be in contact with clothing which will continue to irritate the wound and cause more discomfort. (I understand from the afflicted that his treatment succeeded as a result of team effort, 'herbal medicine' and West Country cider – I also understand there is video evidence?)
Talking of evidence, here's the science bit:
Did you know that way back the ancient Mesopotamians dressed their wounds with fine linen soaked in oil, the Greeks applied animal fat and wrapped the wounds whilst the Romans applied ashes, oil and herbs before wrapping wounds. Experimentation with cellophane for wound dressings was carried out in the early 1900's, now used commonly for covering and protecting new tattoos.
The first controlled study was carried out in 1962 by Dr. George Winter. He found that covering the wound and keeping it moist allowed a 'soft' scab to form and, because new skin is formed by cells below the wound migrating upwards and from the edges of the wound inward, did not hinder the formation of new skin cells. Whereby, allowing a 'hard' scab to form by leaving it 'to air' delayed this process. Allowing a 'soft' scab to form also reduced pain and scarring.
Meanwhile, back on the hill ...
Your own road rash is now nicely cleaned up. Put an adhesive dressing on it – there, you're done. A bit of extra tape may be needed to keep it secure – Gaffer tape, obviously ...
Now, carry on skating.
Once home, you are in a better position to check and treat your wound, after giving it another good clean. A long soak in the bath works wonders. Then ensure the wound is entirely dry before deciding how best to cover it.
If the wound is light, and not oozing, covering with a thin layer of antiseptic/antibiotic cream (Savlon and Sudacrem seem to be the ointment of choice on the hill) may be all that is required. If you do have an allergy to antiseptics then Vaseline comes highly recommended as a cover. It may not have any medicinal value but it does provide a barrier to infection and keeps the wound moist, promoting the healing environment mentioned above. If your wound is very light and not oozing or leaking in any way, and is not in contact with clothing, this may be all you need. It is recommended that you apply it twice a day.
If there is weepage, do use an adhesive dressing. The last thing you want is to stick to clothing or bed sheets and having to peel yourself off. If you do find yourself in this situation, soak the area so that the cloth comes away easily without disturbing the wound too much. If there is no improvement after a couple of days, and the oozing is creamy/green and a tad smelly, get it seen to professionally – it has become infected.
Sometimes a wound just continues to ooze and the soft scab doesn't occur. When this happened to me the nurse at our local medical centre used an iodine patch and covered it with a lightweight dressing, advising me to leave it on for three days before checking it. When I did it was nicely dried up and well on the way to healing. I now keep my own supply so I don't have to both the nurse – it also prevents having to run the inevitable gauntlet of “aren't you a little too old to be skateboarding?”
You might also find your standard plasters aren't big enough to cover that red and raw area, below is a quick trick-tip on how to turn little plasters into big plasters.
Healing usually begins within a week for an upper body injury and up to two weeks for a lower body injury. As it heals, the area around the wound will become pink and warm, and you will get that annoying itch and desire to pick. If it becomes red and hot and starts throbbing, you will probably be looking at infection so get it looked at professionally, as soon as possible.
Dr Richard Steffen, Sports Medicine Associates, sums up: “There are three phases to road rash care. The first is to be bandaged 24/7. Phase two is to be covered during the day and open-to-the-air at night. Third is unbandaged 24/7, dried up and scabbed over.”
Finally, make sure you are up-to-date with your Tetanus shots and wear protective pads and clothing where and when you can. Oh and Skate Safe.
Anahad O'Connor, New York Times, reporter for Health and Fitness
Andrew Evans, Injury consultant writing for British Cycling Federation
Gloria Liu, MSA, RN, CWOCN, Optimizing the Wound Healing Environment, Nursing Excellence, e-Edition Issue 9
Dr Prentice Steffen, physician with experience of working with professional cycling teams
Dr G D Winter, Formation of the Scab and the Rate of Epithelization of Superficial Wounds in the Skin of the Young Domestic Pig, Nature 193, Jan 1962.
Ed Sharp, Tregaron Medic
Rosie the Paramedic
Robbie Roadkill Stevens
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