What are the recommended dressings and treatments for road rash wounds?

Management of Road Rash Wounds

For road rash wounds, cleanse with warmed sterile saline or tap water, apply a non-adherent dressing to maintain a moist wound environment, and cover with an appropriate secondary dressing based on wound exudate level. 1

Initial Assessment and Cleaning

• Examine the depth and extent of the wound to determine appropriate treatment approach

• Clean the wound thoroughly using one of the following methods:

  • Irrigate with warmed sterile saline or clean tap water (100-1000 mL) to effectively remove bacterial contamination 1, 2
  • Consider pressure irrigation with saline for more effective cleaning of debris and contaminants 1
  • Use warmed solution to reduce pain during the cleaning process 1

• Tap water is a safe, accessible, and cost-effective option for wound cleansing with similar outcomes to saline 2

Debridement

• Remove any embedded debris, foreign material, or necrotic tissue from the wound 1
• For road rash with non-viable tissue, sharp debridement (using scalpel, scissors, or forceps) may be necessary 1
• Blisters should be decompressed by piercing and expressing or aspirating fluid, but the detached epidermis can be left in place to act as a biological dressing 3, 4

Wound Dressing Selection

• Primary dressing (in contact with wound):

  • Apply a non-adherent dressing directly to the wound surface (options include Mepitel™ or Telfa™) 3
  • For superficial abrasions, use a clean occlusive dressing to maintain a moist wound environment 1
  • Consider hydrogel or hydrocolloid dressings to maintain moisture in drier wounds 1

• Secondary dressing (for absorption and protection):

  • Use foam dressings to absorb exudate and provide cushioning 1
  • For heavily exudative wounds, consider alginates or foam dressings with higher absorption capacity 1
  • A secondary foam or burn dressing should be used to collect exudate (e.g., Exu-Dry™) 3

• For sloughy areas only:

  • Apply topical antimicrobial agents as directed by local microbiological advice 3
  • Consider silver-containing products/dressings for infected wounds, but limit use if treating extensive areas due to absorption risk 3, 1

Special Considerations

• For severe road rash with significant tissue damage:

  • Consider referral to a burn specialist for evaluation, especially if wounds cover large areas or show signs of infection 3, 5
  • For extensive injuries, newer technologies like autologous skin cell suspension (ReCell®) may be beneficial in reducing pain and improving healing 5

• For infected wounds:

  • Look for signs of infection including increased pain, redness extending beyond wound margins, purulent drainage, or systemic symptoms 1
  • Apply antimicrobial dressings (silver-containing, iodine, or medical-grade honey) 1
  • Consider systemic antibiotics for spreading infection or systemic symptoms 1

• For wounds with soil contamination:

  • Be vigilant for fungal infections, particularly in immunocompromised patients 6
  • Ensure thorough cleaning and consider more frequent wound assessment 6

Wound Care and Follow-up

• Apply a greasy emollient (such as 50% white soft paraffin with 50% liquid paraffin) to intact skin surrounding the wound 3
• Elevate the affected extremity and apply cold compresses for 24-48 hours to reduce inflammation 1
• Provide appropriate pain management during dressing changes
• Ensure tetanus prophylaxis is current 1
• Schedule follow-up within 24-48 hours to assess wound healing progress 1
• Instruct patients to monitor for signs of infection and seek medical attention if they develop redness, swelling, increased pain, or purulent drainage 1

By following this approach to road rash management, you can promote optimal wound healing while minimizing complications and supporting patient comfort.