How should I manage a road‑rash abrasion?

Road Rash (Abrasion) Management

Immediate Wound Irrigation

Irrigate the wound thoroughly with large volumes (100–1000 mL) of warm tap water or sterile saline until all visible debris and foreign material are completely removed. 1, 2

• Tap water is as effective as sterile saline and superior to antiseptic agents like povidone-iodine for wound irrigation 2, 3
• Room temperature or warm water is acceptable and more comfortable than cold water while remaining equally effective 2
• High-volume irrigation is the single most important factor influencing subsequent wound healing and infection prevention 4, 5
• Do not use antiseptic solutions (povidone-iodine, chlorhexidine) for initial irrigation—they provide no benefit over tap water and may impair healing 2, 6

Topical Treatment Selection

Apply plain petrolatum or a petrolatum-based ointment without antibiotics as first-line topical treatment after cleaning. 1

• Petrolatum-based products are appropriate for superficial abrasions and may be used alone or with honey or aloe vera 1
• Topical antibiotics are optional and have not been shown superior to plain petrolatum for clean superficial abrasions 1, 4
• If topical antibiotics are used (e.g., mupirocin), apply three times daily and cover with gauze if desired 7
• There is no evidence that antibiotic ointments improve healing or decrease infection rates in properly cleaned wounds 2

Wound Coverage

Cover the treated abrasion with a clean occlusive, non-adherent dressing to maintain a moist environment and promote optimal healing. 1, 2

• Occlusive dressings result in significantly shorter healing times compared with no treatment or dry dressings 1, 2
• The wound can get wet within the first 24–48 hours after dressing without increasing infection risk 4
• Change dressings as needed to maintain cleanliness and moisture 1

Tetanus Prophylaxis

Administer tetanus toxoid promptly if the patient's last booster was more than 10 years ago. 2, 4

Antibiotic Considerations

Do not prescribe systemic antibiotics for clean, properly irrigated road rash. 1, 4

• Superficial wounds that have been properly cleansed and dressed do not require prophylactic oral antibiotics 1
• Reserve systemic antibiotics only for wounds developing clinical signs of infection: increasing pain, spreading erythema, swelling, warmth, purulent discharge, or fever 1, 2

High-Risk Wounds Requiring Immediate Medical Evaluation

Any abrasion contaminated with human or animal saliva, or caused by a bite, requires prompt medical facility evaluation for possible systemic antibiotic prophylaxis. 2

• These wounds carry significantly higher infection risk, especially hand bites 2
• Standard road rash from pavement/asphalt does not fall into this category unless secondary contamination occurred 2

Patient Instructions for Infection Monitoring

Instruct the patient to seek immediate medical care if any of these develop: 2

• Progressive redness or spreading erythema beyond the wound edges
• Increasing pain or tenderness beyond initial injury levels
• Swelling, warmth, or induration at the wound site
• Foul-smelling or purulent drainage
• Systemic symptoms such as fever or chills

Common Pitfalls to Avoid

• Do not use antiseptic irrigation solutions—they damage tissue and impair healing without reducing infection 2, 6
• Do not apply ice directly to abrasions—this can cause tissue ischemia 2
• Do not prescribe prophylactic antibiotics for clean wounds—this promotes resistance without benefit 1, 4
• Do not allow wounds to dry out—occlusive moist healing is superior 1, 2