A Novel Approach to Managing Traumatic Dermal Abrasions (Road Rash)

Clinical Problem: Traumatic dermal abrasions, such as road rash, painfully present in Emergency Departments (ED) as a result of cycling and motor vehicle accidents. Current management protocols suggest that these abrasions are treated by removal of foreign debris and managed similarly to thermal partial-thickness burns (PTB) with antimicrobial dressings.¹Current Practice and Research:  Antiseptics and creams, impregnated gauzes, and non-adherent gauzes have been traditionally used but create many challenges for clinicians and patients including frequent, painful dressing changes.² Advancing the Practice:  In March 2012, our facility began using a silver-impregnated sodium carboxymethylcellulose (Ag NaCMC) dressing reinforced with nylon, to manage PTBs. Our success with the product led to an abstract being presented at the 2012 Advances in Skin and Wound Management Conference.³ We expanded our use of the Ag NaCMC dressing to manage road rash patients. The goal was to develop a single dressing protocol that would eliminate dressing changes and minimize pain, minimize risk of infection, limit exposure of the wound to the outside environment, and standardize care for patients presenting with partial-thickness burns or abrasions. The Protocol:  1. Confirm depth of partial thickness skin loss, 2. Cleanse wound with soap and water; selectively remove visible debris, 3. Overlap the dressing onto healthy tissue by 1-2 inches, 4. Secure Ag NaCMC dressing with gauze, 5. Remove gauze and inspect Ag NaCMC dressing every 2-3 days; trim any detached edges, 6. Moisturize new skin with 43% petrolatum ointment after Ag NaCMC dressing removal or natural detachment. Results: The Ag NaCMC dressing was effective in managing road rash abrasions in all three cases. No dressing changes were necessary and as the wound healed, the dressings completely detached within 12 (two cases) to 17 days (one case) after application. All abrasions healed without infection. It was noted that the dressing was comfortable to wear.