Abrasions while cycling: TOUR gives tips for first aid and treatment

Abrasions while cycling

A bit of sand on the road, a puddle in the bend, a braking error on the descent, and it happens: the rear wheel slips, you lose control and skid along with your racing bike over the grey asphalt. At 30 kilometres per hour and wearing a short jersey. Ouch!

It's good when such an accident only results in abrasions. When the head and bones remain intact and only scratches to the skin and paintwork are visible when you pick yourself up again. When only the wallpaper is off, so to speak, as they say in cycling jargon. But abrasions should not be underestimated. They can only heal without complications and scars if they are treated properly.

In most cases, only the top layer of skin, known as the epidermis, is abraded in an abrasion. Small blood vessels are often damaged in the underlying dermis, which is why pinpoint haemorrhages can be seen in the wound. Because nerve endings are exposed in the dermis after the epidermis has been abraded, the wound burns painfully.

Treating abrasions: Erosion, excoriation or avulsion?

Dermatologists call such a superficial abrasion "erosion". If the dermis is injured as well as the epidermis, they call it "excoriation". A deep abrasion with leathering of the subcutis is called "avulsion".

>> The following appliesThe harder and rougher the surface against which the skin rubs in the event of a fall, the greater the abrasion and the deeper the wound.

"After bike crashes, we mainly see abrasions on the legs, but also on the buttocks, arms, elbows and shoulders. Sometimes abrasions also occur on the chest or face, especially on the chin," says Sebastian Zimatschek.

The specialist in anaesthesiology has been head of the Rescue team of the TOUR-Transalpwhich sees around 1000 cyclists cross the Alps in seven stages every year. The rescue team rushes to the aid of casualties on motorbikes or by ambulance and also treats them in the start and finish area.

Body check after the fall

Whether at the TOUR-Transalp or during training: Zimatschek advises cyclists to always think about safety first after a fall: "Often those affected are shocked at first and don't think about the fact that it is dangerous to stay on the road for too long," says the doctor. "But if the injuries allow it, you should get to safety as quickly as possible."

Dirt, soil, stones and clothing residues should be removed from the abrasion as quickly as possible. (Sebastian Zimatschek, specialist in anaesthesiology)

Zimatschek then recommends that everyone who has had a fall does a quick "body check", as he calls it: "Abrasions are often the first thing that catches the eye, but you should take the time to briefly check the whole body from top to bottom for injuries and move around: does it still hurt anywhere?" Sometimes you discover areas that you didn't even notice at first.

Treating abrasions - Not a normal plaster

If there are really only abrasions, it is important to clean them. Zimatschek recommends a non-stinging disinfectant from the pharmacy, which is best used together with other first aid equipment. (see overview below) in your jersey pocket on every ride. "Dirt, soil, stones and clothing remnants should be removed as quickly as possible," says the doctor.

If no disinfectant is available to treat abrasions, clean water from a drinking bottle will also work. Abrasions should then be covered with a sterile compress. "Non-adhesive wound dressings should always be used, as a normal plaster would stick to the wound and be very difficult to remove."

At the Transalp, the Rescue Team has plenty of wound compresses and disinfectant, gloves and splinter tweezers at the ready to treat abrasions as well as possible on the route. "A wound like this is still not sterile and surgically clean afterwards, so we always recommend that people take another look at the wound at the finish and have it treated with an antiseptic," reports the doctor.

Check first, then drive on

The rescue team offers to take injured people to their destination, "but most of them want to continue travelling if they only have abrasions," says Zimatschek. Whether this makes sense depends on the size and localisation of the wound and, of course, other injuries. "If the knee is just a little grazed, well disinfected and covered, you can of course continue cycling. But we always have to check whether the wound is really only superficial or whether it is deeper in places where there are stones, for example." If tendons, muscles or nerves have been damaged by the abrasion, continuing to ride is not an option, says the doctor. "It's not ideal for healing anyway if the injured skin is repeatedly moved while pedalling and comes into contact with sweat."

Zimatschek appeals to all cyclists to check their tetanus protection before their next fall if possible (see below): "The vaccination must be refreshed every ten years, otherwise even a small graze can be fatal."

Treating abrasions - Better not to brush

Anyone who has seen the 2004 Tour de France documentary "Höllentour" might have the idea of scrubbing their grazes in the shower with a coarse brush until they start to bleed again - as the coach of sprint ace Erik Zabel does with his wounds in the film. Rescue team boss Zimatschek cannot recommend this: "Theoretically, you refresh the wound in the same way that a surgeon would do to promote wound healing. But doing this so martially in the shower is not advisable for anyone. Firstly, it is extremely painful and secondly, a brush like this is certainly not hygienically clean. Today, we can do it better and, above all, more carefully." Thoroughly cleaning and disinfecting a wound and covering it to protect it from dirt, dust and sweat prevents infection and promotes healing. "Afterwards, it's best to rest the area and leave it to heal," says Zimatschek. Supposed household remedies such as flour, oil or onion juice have no place in wound care - such experiments can even promote inflammation.

Typical signs of infection

These are heavily reddened wound edges, pus and throbbing pain. "If the surrounding lymph nodes are already swollen, for example in the groin after a knee abrasion, then it's high time to see a doctor," warns Zimatschek. The same applies if you have a fever, an abrasion is very painful, is bleeding heavily or still looks dirty despite cleaning. A very deep wound may also require stitches. "So it's better to go to the doctor once too often than once too little," advises Zimatschek.

Treating abrasions - good wound healing is important

Dr Andrea Demmler can only agree with this. The dermatology specialist has her own practice in the Main-Spessart district, is a triathlete and spends a lot of time on her racing bike: "A wound can start to fester or develop erysipelas even a few days after the fall."

The dermatologist therefore advises that healing should be monitored closely and, if necessary, supported with a wound healing gel. It is also important to protect an abrasion from the sun for the first three to four days. "UV light interferes with healing and increases the risk of scars remaining." Good wound healing is also important in order to restore the skin's natural protective function.

As long as a wound is oozing, plasters or compresses should be left on anyway. A dry wound, on the other hand, can do without plasters after a few days. "You should then avoid swimming or bathing for the time being," says Demmler - because of the risk of infection and because it interferes with healing. For showering, the doctor recommends applying special shower plasters.

The body protects itself

According to Demmler, how quickly a wound heals is partly genetically determined, but also depends on age and previous illnesses: "The younger someone is, the faster abrasions heal. In contrast, it sometimes takes a long time for people with diabetes." An infected wound also takes longer to heal.

The body's repair mechanisms do not begin after the initial treatment, but directly after the accident, starting with haemostasis, which causes the vessels in the wound to constrict in order to minimise blood loss. "A protective yellowish-transparent layer then forms on the wound surface, like a kind of plate," explains dermatologist Demmler. "This is the so-called fibrin. Underneath it, inflammatory cells of the immune system cleanse the wound, eliminate germs that have penetrated and produce growth factors." After a few days, specialised cells, known as fibroblasts, begin to build up new skin from the edges and gradually close the wound. "A superficial abrasion heals by about one to two millimetres per day," reports the triathlete. "After about a week, the worst is over, and after two weeks there is often hardly anything left to see."

Very important: sun protection

This at least applies to superficial abrasions where only the top layer of skin has been rubbed off. The deeper the wound, the more likely it is that a scar will remain. To avoid this Sun protection The most important thing, says dermatologist Demmler - even if the scab has long since fallen off: "For the rest of the season, you should always protect the area with sun cream, because the new skin is as sensitive as a baby's bottom." Those who neglect sun protection risk not only an unsightly scar, but also red spots and pigmentation differences. Depending on the depth of the injury, it can take 10 to 15 years for a scar to fade significantly.

If you don't want to wait that long, you can have the scar cosmetically treated at a dermatological practice, says Demmler: "We can inject cortisone into excessive, raised scars to flatten them out, or we can reduce them with a laser." This is also used to lighten red scars. Icing, as with some warts, is another option.

You shouldn't wait too long to start treatment, warns the dermatologist: "The fresher the scar, the sooner you can do something about it." But in the best-case scenario, the graze was only superficial. And was then treated so well that a few weeks later, only the scuffs on the racing bike frame are still visible.

The structure of the skin

Treating abrasions - when should I see a doctor?

• if the abrasion continues to bleed
• if very large areas of skin are abraded
• if the wound is dirty
• if the wound is suppurating or oozing heavily
• if the wound edges appear red and swollen
• if the wound throbs painfully
• if fever or general malaise are added
• if the tetanus protection is unclear
• if the wound has not largely healed after two weeks in the case of circulatory disorders

(modified from www.mediset.de/schuerfwunden/)

Treating abrasions - is the tetanus vaccination still effective?

The Standing Committee on Vaccination recommends that everyone is vaccinated against tetanus. The dreaded tetanus is caused by the bacterium "Clostridium tetani", whose resistant spores can be found almost everywhere outdoors and can enter the body via small stones or splinters in wounds. All it takes is a tiny scratch. If there is no vaccination, symptoms can appear as early as three days after infection, sometimes the first signs can take three weeks to appear.

It is not the bacterium itself that is dangerous, but the toxin it excretes. The symptoms begin with tingling and numbness near the wound, headaches, fatigue and restlessness. Painful spasms of the jaw follow, with those affected appearing to grin - the so-called devil's grin. The muscle spasms spread further as the disease progresses and become so severe that in the final stage patients suffocate or their spine fractures.

If left untreated, a tetanus infection is fatal, and even with modern intensive medical treatment, 10 to 20 per cent of those infected die. Children should therefore be immunised against tetanus. Adults must have a booster immunisation every ten years. Because most people are immunised against tetanus, the disease is rare: Fewer than 15 people contract the disease in Germany every year, most of whom are over 45 years old.

This belongs in the first aid kit for the jersey pocket

• Non-stinging wound disinfectant
• Sterile wound dressings
• Non-adhesive wound dressings
• Rescue blanket
• Disposable gloves
• Emergency telephone numbers