Novel Technique for Management of Painful Road Rash Injuries

Authors: Lori O’Shea, BSN, RN, WCC; and Jenny A. Ziembicki, MD, FACS
 
Poster Number: CS-060
 
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 infection, sepsis, wound progression, pain (often significant, resulting from wounds and wound-related treatments^3,4), embedded road debris, and devitalized tissue. Routine standard of care includes topical antibiotics, petroleum dressings, or moisture-retaining therapies and requires frequent and painful dressing changes.
 
Transforming powder dressing (TPD) (Altrazea; ULURU Inc.) is a novel powder dressing composed primarily of biocompatible polymers (the same as those used in contact lenses). Upon hydration with saline, TPD granules aggregate to form a moist, oxygen-permeable matrix that protects the wound from contamination while helping to manage excess exudate through vapor transpiration, as well as some negative pressure effects on the wound. Once applied, TPD may be left in place for up to 30 days. Additional powder may be added as needed without requiring primary dressing changes. Simple secondary dressings may be used in areas of high exudation or friction. TPD dries and flakes off as the wound heals.
 
The case presented was that of a 20-year-old male who sustained multiple injuries in a motorcycle accident. Injuries included subarachnoid head bleed and multiple mixed partial deep and superficial thickness wounds on his arm and legs. Initial treatment primarily focused on the head injury and maintenance of neurological stability, which precluded use of pain medications. Because wound cleansing was reported to be highly painful, all wounds were initially managed conservatively with simple petroleum-based contact layers and absorbent pads. The patient was discharged from the hospital 4 days after admission and was treated at home by his caregiver, a wound care nurse.
 
Due to the high level of pain, his caregiver elected to utilize TPD to treat the wounds instead of application of topical antibiotics. Mechanical and autolytic debridement was performed to manage the exudate and remove the remaining embedded road debris. TPD was applied (sprinkled on the wounds), followed by a contact layer and gauze after the wounds were cleaned. TPD was topped off as needed, secured with contact layers, absorbent pads, and a net dressing. On post-injury day 9 (5 days after initial TPD application), all wounds were epithelialized. Immediate pain relief was reported by the patient following TPD application. There were no complications of infection or wound progression. Post-healing scarring was minimal to absent.
 
Based on the accelerated wound healing and pain reduction experienced by this patient, the authors conclude that TPD offered a safe and effective alternative to standard of care for the management of painful road rash injuries.
 
References:
1. Heller JL. Burns. MedlinePlus. Updated January 13, 2010. Accessed December 15, 2021.
http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm.
2. Warby R, Maani CV. Burn classification. StatPearls [Internet]. StatPearls Publishing; 2021.
3. Greenhalgh DG. Sepsis in the burn patient: a different problem than sepsis in the general population. Burns Trauma. 2017;5:23. doi:10.1186/s41038-017-0089-5
4. Upton D, Morgan J, Andrews A, Lumenta DB, Giretzlehner M, Kamolz LP. The pain and stress of wound treatment in patients with burns: an international burn specialist perspective. Wounds. 2013;25(8):199-204.
 
Poster reference:
O’Shea L, Ziembicki JA. Novel technique for management of painful road rash injuries. Poster presented at: Symposium on Advanced Wound Care Spring; April 6-10, 2022.