Too many choices, too little skin,

published at 11:06pm on 06/29/06

I recently fell off my bicycle.

It was a pretty hard fall, and I have nobody to blame but myself. I was coming off the bridge, thinking to myself, “self, you are going pretty fast, you should definitely slow down.” I remember thinking “wow, you’re going to hit that fence.” And I remember thinking “shit” as I overcompensated, the back tire kicked out, and I drove the front of my bike into the asphalt. I have a nice hole in my arm and some pretty nasty road rash.

When I was younger, I would get a Bandaid, stick it on my booboo and be done with it. I probably rubbed some aloe from the aloe plant in the kitchen onto the wound, all the while wondering how this plant was going to help heal me any faster. I was little, and my little body was pretty adept at patching itself up. Not much changed when I was in college, nor since then. In fact, I think that I’ve been using the same mega box of Bandaids since I first stocked up my medicine cabinet in my first post-school apartment. So here I am, with a bloody arm and a scraped up leg, and I realize that a Bandaid just is not going to cut it.

Time to go exploring at the local pharmacy1. First up are the Johnson & Johnson Triple Layer Non-Stick Pads. These wonders of modern wound management science are made up of a layer of absorbing cotton covered with a special non-stick porous layer which sits on top of the wound, wicking moisture away into the cotton, while remaining free of any clotting that may be happening in the wound itself. When it is time to change the dressing, the entire bandage pulls right away with nary an ouch. These were my best friends for the first couple of days post-accident, but they needed to be changed daily and the tape that held them to my body was constantly coming undone (one of my larger wounds is on my elbow area, which flexes a surprising amount over the course of the day).

The other problem was that I would leave the wound uncovered at night, thinking that letting it air out would be good for the underlying tissue that was re-forming. What I discovered, though, is that a wound that deep is going to “weep” a fair amount, and I woke up one morning to find my arm covered with what cna only be described as a layer of disgusting ick. I immediately panicked and did a web search for “what is road rash supposed to look like.” While I was unable to find any good photos of road rash, I did come across a very interesting blog post by an avid cyclist and new doctor in the middle of his residency. He described dressing his road rash with a hydrocolloid bandage which keeps the moisture from the wound trapped under a waterproof dressing, allowing it to air through the bandage while maintaining the perfect environment for the body to repair itself without having to worry about proucing scabs and such. In keeping the wound wet, these bandages also help prevent the scarring that I can only assume comes from tearing off dry, itchy scabs.

Johnson & Johnson to the rescue again, this time with their Advanced Healing Adhesive Pads in the big silver box. These bandages are a flexible plastic, that are completely adhesive on one side. When placed over the wound they create a waterproof dressing that you can keep on for days at a time. The dressing absorbs some of the moisture from the wound into the bandage, producing a white “bubble” just over the damaged parts of your body. This part of the bandage loses its adhesiveness meaning that when it comes time to remove or change the dressing, you are not tearing up any of the newly created skin or tissue that’s been formed under the bubble. It’s really quite magical.

The only trick to these bandages is that they do retain a lot of the fluid from your body, by design. This works fine for areas where the top layer of your skin has been removed and the wound is only weeping a bit. For my damage, I’m using this bandage on an area that is a combination of deep road rash and a small hole that has been slowly granulating inward but it still just exposed tissue. The bandage does its best to keep the fluids in but every couple of days I do have to change the bandage to keep it from leaking out from the edge of the bandage, which it will inevitably do.

I am now three weeks post-crash and can report that my arm has not yet fallen off. My leg, which I kept covered with one of the Advanced Healing pads is only slightly bruised, and you can not even tell where I had scraped it up. My arm, which has two significant wounds, is coming along nicely. Both wounds are growing new skin where appropriate, and I suspect that in a week or two I’ll be able to keep them both uncovered and just moisturize them throughout the day. I’m keeping an Advanced Healing pad on one of the wounds (the one that is a long stretch of road rash followed by a hole) in order to get the benefits of the hydrocolloid treatment, and am keeping the Non-Stick pad on the other wound as it is in the crook of my elbow and the amount of movement there means that no bandage can stay on any longer than a day, so I might as well just use a dressing that needs to be changed daily. When that wound is finally covered with skin I will probably change to the smaller Bandaid-sized Advanced Care bandages to help prevent scarring.

The tricky thing about all of these bandages is that there are about a thousand different kinds of bandages at the local pharmacy, and about a thousand others at the one six blocks away (interestingly the Advanced Healing pads can only be found at Wallgreen’s, not Duane Reade or the Kmart pharmacy a block away from my apartment). Moving on to my scars, it was recommended that I start applying vitamin E topically to help prevent and break up the scar tissue that’s starting to form.

Vitamin E – the E is for Easy after all – proves to be a substance that has been marketed to within an inch of its life. First, there are vitamin E soft capsules which I was just planning on cutting open and applying to my skin. This would have been fine, except that I mad the mistake of asking the pharmacist for help. He then pointed out that there are now vitamin E gels specifically made for applying to the skin which were available in much stronger concentrations. The one that he was recommending was out of stock, so I picked up a bottle of vitamin E oil which was roughly the consistency of baby oil. On the way home, on a whim, I decided to stop at another pharmacy, which also had a collection of vitamin E oils, in various concentrations. One of them, the Sundown brand vitamin E oil (“So pure it’s clear”) seemed the highest concetration, and the thickest, so it seemed like a winner. Compared to the other oils, it certainly feels more substantial, but it is also significantly stickier, causing my arm to continually pick up lint and hair off my clothing, which I suspect is not really that great for a healing wound. Does the benefit of the 70,000 IU of vitamin E which attracts lint to my newly grown skin outweigh the 9,000 IU baby oil substance which will is a lot more comfortable but will probably rub off a lot quicker? Probably. Will I ever know? Definitely not. Why? Because nobody does comparrison of vitamin E oils and puts them online. Because in the end it doesn’t matter.

At the end of the day, the consumer is left with multiple options with which to fix themselves. I have the benefit of a doctor in the family with whom I can consult, via mobile phone, while standing in the aisle of the Duane Reade reading off labels, or while standing on the street corner in Brooklyn learning that while a cut can be stitched up, a hole will just have to be kept clean, free of infection, and left to heal on its own – you can’t sew up a hole. But the problem ends up being that in the absence of any “best” product, we are forced to make choices based on packaging, advice, and dumb luck. And the Internet. Like it or not, even before doctors, the Web is the first place that most people look for information on how to heal themselves.

Now if you excuse me, I have to go apply some vitamine E oil and turn myself into a human lint brush.

Hooray for skin!

Update: It looks like conventional wisdom (“air out your wounds”) is being replaced by the “keep it moist” school of thought (according to the New York Times).

1. Going to the pharmacy is almost as much fun as going to the hardware store, which is itself slightly more fun that going to Radio Shack, which is, itself, probably on par with Circuit City or Best Buy. The drug store is a tinkerer’s delight, if you happen to delight in tinkering with your own body.

Filed under: Observations

At 12:01 pm on 07.03.06, djd said,

My favorite wound/drugstore trip involved spending six-something bucks on strips that hold the edge of a cut together so you don’t have to get stitches. Sort of like sticky sutures. I am happy to report that I needed about one-twelfth of the box, and haven’t touched them since. I guess the expense was less than an ER co-pay.

At 1:18 am on 07.26.06, dot dot dot said,

Speak of the devil. I was trying to find more info on these strange new six dollar Johnson + Johnson Advanced Healing Adhesive Pads, since I fell of *my* bike last night, and what was I to find but your helpful update? Awesome!

At 6:31 pm on 09.12.06, jen said,

I just googled “road rash bandages” and your blog was in 8th position I believe. I had a nasty fall a couple days ago. I was going too fast down a hill around a bend when I saw two posts I would have to maneuver between. Since I’m not terribly confident in my accuracy I chose to brake and I did so with too much adrenaline which caused my tail to skid while the front wheel kicked out to the left. I have four nasty open wounds and a busted swollen knee. I like to think of myself tough but girly but I was a whimpering mess after this fall! Anyway, I’m going to make a trip to Ride Aid and hope I find these wonderful J &J bandages you speak of. Thanks for the tips.

At 11:08 pm on 07.10.07, Lorraine said,

I too, fell off my bike because I braked as going through mud…so you can imagine the fall! Double the impact! Not only do I have to drop out of the approaching Sprint Triathlon..I will have permanent scars. I have holes in my arm, near the elbow..and a hole the size of a quarter in my knee. I did goto the ER and had the wounds debrided and was told I would have permanent scars. Very upset with this news, I became obsessed with scar products and best healing methods. I’ve lived at every pharmacy in my area and have asked every wound specialist at my work for info. I also have googled numerous sites. I found out that peroxide is a “no-no” as well as Vitamin E. Mederma, they say, is the best for regrowth of skin. I am trying the Advanced Healing Pads..and also burn pads. The problem is that the wound stays moist for so long…that I cannot swim or enjoy the summer. Why couldn’t this have happened in the winter. Let me know how the scars turn out and if the pads work??? I plan on getting ultrasound to assist with the lessening of the wound. Preventing a scar is a lot of work!

At 11:55 am on 07.12.07, jcn said,

The pads work, but they get messy. I alternated between the Advanced Healing pads and these non-stick gauze pads to absorb the moisture. I also ended up eating a lot of hamburgers to get more protein into my body!

My arm has scarred up quite a bit, but at least I don’t have a hole there any more.

At 2:58 pm on 09.02.07, wrs said,

Having had a dime-sized skin biopsy taken from my back about a month ago, after 3 weeks it was still not healed. It was a big nuisance because it always leaked through to my shirt. Desperate for some kind of wound cover, I went to Walgreens and found the J&J Advanced Care Healing Pads. They worked fine, did not loosen or leak and solved the dirty shirt problem. After 4 days I removed the first bandage and applied a second one. A few days later it seemed the wound was healed, so I did not apply a third. Probably not a smart move because while the wound now had a thin layer of skin on it, it was not healed sufficiently to take the beating of sitting in chairs or rolling over in bed. The wound had shrunk from dime-size to a quarter-inch, but was oozing again. Since the Advance Care bandage keeps the wound moist, I want it to dry up and scab over so I am using a standard band-aid applied loosely to promote air circulation. It seems to be working OK so I will keep the remaining two Advance Care Pads for future use.

One closing thought, don’t let your dermatologist take a biopsy from your back unless you have someone living with you who can help with bandages, cleaning, observing, etc. In fact, it might be a better idea not to have the biopsy at all but instead do a surgical procedure to remove the lesion deep enough to be able to stitch it closed so it would heal faster. I would rather assume that the biopsy will indicate more than a simple basel cell and have the surgery to remove it, even before the results are in. If the results indicate the surgery was not needed, at least I would not have gone through the frustrating process of trying to heal a dime-sized surface lesion located where I can’t reach it to treat it for several weeks!

At 12:04 am on 04.19.10, Mike said,

I know this comment is coming very late after your post, but I’m glad you found these pads. Back in ’06, I had a gnarly motorcycle accident that left me with a bit of road rash on my back. Like you, I went searching the internet and found out about these Compeed-based bandages. Prior to that, I had been changing some really nasty bandages daily and hating showers.

After about 2 weeks, I was healed enough (didn’t have any *really* deep wounds) that I no longer needed the bandages. A year later, and there is NO visible scaring on my back.

Oh, and I feel your pain on the price, but consider for a moment that it took me 16 bandages (that’s 4 boxes) each time I needed to change mine 🙁

I came across your blog post because I just ate shit snowboarding, and was googling around trying to find a place with the best pricing.

At 8:50 pm on 05.01.11, notmyrealname said,

How about using these for surgery wounds? I have used them for biking accidents, even for wounds that probably could have used stiches. They all healed fine. Now I have them on the 1/2″ wounds from laproscopic surgery on my stomach. They seem fine so far, I just don’t know how long to leave them on. I found with the other wounds, the longer the better. Best if you can leave one on until it’s healed. How long for these is my question?

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