Novel Technique for Management of Painful Road Rash Injuries: A Case Review

Road rash injuries include painful skin abrasions, burns or wounds resulting from trauma accidents on cemented or tarred surfaces. Wounds vary in severity, depth, and degree.1,2 Complications include pain, infection, sepsis and wound progression.3 Pain is often significant, resulting from the wound and from wound related treatments.4

Road rash frequently has embedded road debris, requiring cleaning and debridement, which is painful but necessary to remove debris and devitalized tissue. Routine treatments include topical antibiotics, petroleum and other moisture retaining therapies that require frequent painful dressing changes. Transforming powder dressing (TPD) is a novel modality containing biocompatible polymers which aggregate upon hydration to form a moist, oxygen-permeable matrix that protects the wound from contamination. TPD may be applied for up to 30 days and topped off without painful primary dressing changes. As the wound heals, TPD dries and flakes off.

Case Study: 20-year-old male sustained injuries in a motorcycle accident, including a subarachnoid bleed and multiple mixed partial deep and superficial thickness wounds on his arm and legs. Initial treatment was primarily focused on his head injury and maintaining neurological stability, precluding him from receiving pain medication. Cleaning and treating his wounds would be painful. As a result, the wounds were initially managed conservatively with simple petroleum based contact layers and absorbent pads. Upon his discharge after 4 days, he was treated at home by his caregiver, a wound nurse. Due to the high level of pain, she elected to treat him with TPD instead of topical antibiotics. She utilized mechanical and autolytic debridement to manage the exudate and remove the remaining embedded debris. TPD was applied after the wounds were cleaned.

A profound finding for both the WOCN and patient was pain relief immediately upon TPD application. TPD was topped off daily and secured with contact layers, absorbent pads, and a net dressing. On day 9 post injury, 5 days after initial TPD application, all wounds were epithelialized. There were no complications of infection or wound progression. Post healing scarring was absent to minimal.