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Road Rash, Torn Up Skin, What To Do by John Post, MD

“Ain’t no doubt about it we were doubly blessed, ’cause we were barely 17 and barely dressed.” Meat Loaf, Bat out of Hell

Possibly without intending, Meat Loaf was describing the amount of protection one gets from cycling clothing when you hit the asphalt. Barely dressed. But, you look good doing it. Right?



What would you think if this were your elbow? You crashed hard, went to the local urgent care and got sewn up…but things went down hill quickly when you started to develop a fever. Then, rather than having less pain as time passed it only increased. And then you started to sweat. Heck, you’re a veteran. You served 5 years as an instructor at the Naval Nuclear Power School, you can handle this. Why, it’s just a cut, right?

You visit your friendly local Orthopedic Surgeon who cultures the wound (put in a cotton tip, send it to the lab to see what unexpected bacteria can be found in what should be a sterile environment). Then you’re told that your next stop is the operating room…NO, you cannot go home to let the cat out or turn off the sprinkler because you’re being prepped for immediate I&D, irrigation and debridement. You meet the holding area team, the anesthesiologist, the circulating nurse for the OR as she seats you in the center of the operating table, etc. You’re surprised how cold the operating table is against your unclothed butt! Just the first of many unfamiliar sensations.

This is all a true story. A triathlete suffered a fairly involved injury, without broken bones, to her arm above the elbow and the above sequence occurred. This picture is her arm.  She’s also under the care of an Infectious Disease specialist to help manage the antibiotics as appropriate to the organisms cultured at surgery. So what are the lessons that we take away from this? Well, it’s hard for many of us to get thru a full season without dumping our bikes at least once – or more. If we’re lucky it’s just a skinned knee or lateral ankle scrape that with a minimum of local care heals uneventfully assuming an intact immune system. What about that dog bite? Or that more significant skin embarrassment with depth and significant bleeding?

I’d suggest beginning by lavage of the area as best you can with the contents of your water bottle(s). I know a number of athletes who drink very little from them, particularly in cooler weather, and carry them for just such an emergency. You’re prepared for a flat, loose spoke, broken chain, etc., why not be prepared for this is their motto. While you probably wouldn’t use water from the creek, tap water from the nearest source to irrigate out any debris while still fresh helps a great deal. If there’s any doubt, seek medical care. If the wound is over a joint and sizable, if it’s at all deep, if you see a tendon, bone or joint, these are all reasons to proceed to the local Urgent Care right away. The longer you wait, the more time any foreign matter has to set up shop. You can also update your tetanus at that time. In fact, I know one athlete who called his docs office within minutes of an unprovoked dog bite, was told to “come now”, which he did, and had the wound cleaned, tetanus administered, etc. in about an hour allowing him to finish his ride. Can’t leave that log book space white, even for a trip to the doctor, now can we? (See “Once a Runner”)

How can you possibly not PR with this on your head?

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