This is the document on the obra site, labeled wound care
The most important thing about abrasions is to keep them from scabbing.
Scabs made sense from an evolutionary point of view since they limit protein
and fluid losses which is important if these things are difficult to come
by. Since modern man can stop at McDonald's and fill all those needs, scabs
no longer work so well for us. When a wound heals it is in part because the
skin cells slide in to cover the opening. If there is a scab then this is
inhibited and wound healing is delayed. Dressing materials also promote
wound healing by increasing the temperature locally at the wound site,
something that has been experimentally demonstrated to speed wound healing.
I use Tegaderm. There are many other brands of semi-permeable membrane
dressings and they all work more or less as well. The way I use it is to
first make sure that the wound is clean and dry. This means that the
bleeding needs to have stopped. Usually I will clean the abrasion first with
saline and a surgical scrub brush and then cover it with Vaseline gauze and
an absorbent dressing. This is what the OBRA first aid providers will do at
the bike race. At some point several hours to a day later I will wash the
wound again with soap and saline (or just water) and then apply the
semi-permeable dressing. First I paint around the wound with Mastisol or
tincture of benzoine. These are products that make the skin sticky so the
Tegaderm (or whatever brand you use) will stick to the skin around the wound
better. Be careful not to get this stuff in the actual abrasion because it
will sting like mad. I then take a Q-tip and some greasy stuff, like
Vaseline, and draw a line of grease from the middle of the abrasion to the
most dependant part. This line of grease will keep the Tegaderm from
sticking at that point and will allow the fluid that comes out of the wound
to drain out. The Tegaderm then goes over the abrasion. If the abrasion is
too big to be covered by one piece you can overlap the pieces to get it
covered. It is important that the Tegaderm extends out over about an inch of
intact skin. Now cover at least the opening of the drain created by the
grease with an absorbent dressing to catch the goo that will come out of the
wound. If you place the dressing this way you can usually leave the Tegaderm
on for 4-7 days. Obviously the absorbent dressing should be changed when
soiled but the Tegaderm stays in place and you can exercise and shower with
it in place. Remove the Tegaderm if you start to see red spots around the
wound. The red spots are infection focuses at the hair follicles. Usually
this will clear up if the Tegaderm is left off for a day or so.
There are lots of other ways that you can treat abrasions but this is the
least fuss way and it will heal the fastest. Unfortunately the
semi-permeable membrane dressings like Tegaderm are hard to find because
they are not marketed to the general public. You can buy them online at
places like WoundCareShop.com or you can
try pharmacies or medical supply places. I have been told that
Walgreens pharmacies carry it. Beaverton
Pharmacy (Canyon & Hall) carries it and sells it in "singles" (they also
carry tincture of benzoine). It should be available at places that sell
catheter or stoma care products. It is likely that any pharmacy or medical
supply house could order some for you, although they may require a minimum
purchase. Personally, I just buy the stuff in 100 count boxes. It takes many
years to go through that much but it is not like the stuff is going to go
bad or I am going to stop scrapping myself up. It also works well to put on
the kids' skinned up knees and such.
There are some products that combine the semi-permeable membrane with an
absorbent gel. These are actually a bit better than the semi-permeable
membrane products but I think they are not quite so user friendly and they
are considerably more expensive. Duoderm is an example of such a product.
These work very well for "drier" wounds, like bedsores or chronic leg
ulcers. My experience is that wetter wounds like abrasions will fill the gel
so rapidly that the dressing will need to be changed daily, negating the no
fuss aspect of the semi-permeables and upping the cost quite a bit.
Conventional dressings work pretty well too but they require daily dressing
changes. Since they can't be worn while bathing often this means more
frequent than daily dressing changes, particularly for the active athlete.
They also do not relieve discomfort as well as the semi-permeables. To use
conventional dressings appropriately they need to be layered. The first
layer needs to be a fine mesh "non-adherent" type material, like Adaptic,
Vaseline Gauze or Xeroform. "Non-adherent" is actually a misnomer since the
goal of this layer is to allow the stuff that comes out of the wound to go
through this layer and then be removed with the dressing change. A true
non-adherent dressing, e.g. Telfa or Band-Aid, does not work well since all
it does is absorb the liquid from the wound but is still allows scabbed
material to form over the wound. In addition, the plastics in these type
dressings often cause the wound margins to macerate, i.e. get full of water
and turn white, which will inhibit wound healing. The cheapest way to do the
non-adherent layer is to take an old bed sheet, cut it in the appropriate
size, smear it with Vaseline and then apply to the wound. The bed sheet
material has about the right mesh size. The non-adherent material should be
applied only 1 layer thick. Over the top of the non-adherent layer you put
some absorbent gauze pads and then hold the whole thing in place with some
elastic dressing retainer, like the fishnet material that the OBRA first aid
people use, or tape and/or Ace bandages.
On areas that it is difficult to cover with a dressing, like the face, it
works best to just clean the wound frequently, 3-4 times per day, and then
keep a good layer of something greasy like Vaseline on the wound. If you do
this the wound fluids will not be able to congeal together to form a scab
and the wound will heal quicker.
From: OBRA [mailto:obra-bounces@list.obra.org] On Behalf Of Leibowitz, Flora
Lynn via OBRA
Sent: Thursday, June 22, 2017 7:47 PM
To: obra@list.obra.org
Subject: [OBRA Chat] Using Tegaderm film
Yesterday I had the (dubious) honor of putting Tegaderm film on a patch of
road rash. I'm fully functional; worry not. Fortunately it was pretty
superficial so this is a kind of easy practice. Anyhow, I wondered about a
couple of things downstream and thought the various med people in OBRA could
fill me in.
How often are you supposed to change the film? Or is the idea that you don't
and it just peels off by itself, like dry skin once the wound starts to
heal?
Are you not supposed to submerge it when bathing? And if you do, is the only
downside is you'll have to apply a new pad if you do?