What is the treatment for extensive road rash over the legs from a motorcycle accident?

Treatment of Extensive Road Rash from Motorcycle Accident

For extensive road rash over the legs from a motorcycle accident, immediate wound cleansing with warmed sterile water or saline followed by application of non-adherent dressings is the recommended first-line treatment. 1

Initial Assessment and Management

• Perform thorough wound cleansing by gently irrigating with warmed sterile water, saline, or a mild antimicrobial solution such as chlorhexidine (1/5000) 1
• Take swabs for bacterial and candidal culture from three areas of lesional skin, particularly sloughy or crusted areas, to identify potential infections 1
• The detached epidermis may be left in situ to act as a biological dressing; blisters should be decompressed by piercing and expression or aspiration of fluid 1
• Apply a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin over the entire affected area, including denuded areas 1

Wound Dressing Protocol

• Apply non-adherent dressings to denuded dermis (suitable options include Mepitel™ or Telfa™) 1
• Use a secondary foam or burn dressing to collect exudate (suitable options include Exu-Dry™) 1
• For sloughy areas, consider applying a topical antimicrobial agent (choice should be guided by local microbiological advice); silver-containing products/dressings may be beneficial 1
• Change dressings regularly based on exudate levels and wound assessment 1

Infection Management

• Administer systemic antibiotics only if there are clinical signs of infection 1
• If infection is suspected (failure to respond to topical treatment, presence of painful skin lesions, pustules, yellow crusts, discharge), obtain bacterial cultures and administer appropriate antibiotics for at least 14 days based on sensitivities 1
• Consider antiseptic baths such as potassium permanganate in a concentration of 1:10,000 for infected wounds 1

Advanced Management for Severe Cases

• For extensive road rash with significant tissue damage, consider referral to a burn center, especially with evidence of clinical deterioration, extension of epidermal detachment, subepidermal pus, local sepsis, or delayed healing 1
• In a burn center setting, surgical management may include:
  • Removal of necrotic/loose infected epidermis under general anesthesia 1
  • Debridement with specialized tools such as Versajet™ 1
  • For large confluent non-infected areas with early presentation, consider physiological closure with biological dressings 1
• For severe cases, autologous skin cell suspension devices such as ReCell® have shown promise in creating results comparable to split-thickness skin grafting while requiring significantly less donor skin 2

Pain Management

• Ensure adequate pain control during wound care procedures 2
• Consider premedication before dressing changes 1
• Proper wound management with appropriate dressings can help reduce pain during healing 2

Ongoing Care and Follow-up

• Monitor wounds regularly for signs of healing or deterioration 1
• Avoid frequent washing with hot water as this can delay healing 1
• Avoid skin irritants such as alcohol-containing products 1
• Apply alcohol-free moisturizers at least twice daily to promote healing 1
• Use sun protection on healing areas to prevent hyperpigmentation 1

Special Considerations

• For deep or extensive injuries, assess for potential damage to underlying structures 1
• Road rash injuries can vary in severity from superficial abrasions to full-thickness burns; treatment should be tailored to the depth of injury 2
• Despite most road rash injuries affecting less than 5% of body surface area, many patients may require surgical debridement and/or skin grafting in an operating room setting 3