Abrasions
Scenario:
We're all familiar with abrasions. If you don't get scraped up, you aren't really mountain biking. Most biking abrasions involve knees, back of the elbows and upper forearm, and shoulders.

Description:
An abrasion is a scrape. It's caused by a rubbing injury that strips off the outer layers of skin. Large and deep abrasions are more serious. (If the injury changes shape significantly when pulling on the skin, or it fat tissue is seen, this is NOT an abrasion -- it's a full-thickness avulsion, a complete loss of all layers of the skin.)

Typical "sandstone kiss" from dropping a knee down during a four-point landing from an endo.
Typical "sandstone kiss" from dropping a knee down during a four-point landing from an endo.

Concerns:
Any deep abrasion will leave some scar tissue behind. On the face, scars are unsightly. Over joints, a bad scar may prevent full motion. Proper treatment will minimize the scar, making it less noticeable and reducing stiffness. An abrasion is often contaminated with dirt, gravel, and other foreign material. Infection is a risk, especially with deep, crushed, or dirty abrasions. In some severe abrasions, the skin will die -- leaving the equivalent of a third-degree burn.

An abrasion should hold its shape when the skin is moved or stretched. If any part of the wound gapes or changes shape, this is a more serious injury.

See the doctor if:
    there is mushy tissue exposed that changes shape easily
    the scrape is extremely dirty or won't come clean
    the scrape is very large
    the scrape is on a critical area: face, genitals, hands

This abrasion, caused by a high-speed touchdown on the back of the forearm, has a gouge in       the center that exposes fat. This injury should be treated by your doctor.
This abrasion, caused by a high-speed touchdown on the back of the forearm, has a gouge in the center that exposes fat. This injury should be treated by your doctor.
Aggressive cleaning decreases infection risk, and lets you check for deeper damage.
Aggressive cleaning decreases infection risk, and lets you check for deeper damage.
Immediate care:
Relieve pain with an anesthetic spray or pain relieving gel. Wash the scrape thoroughly. If necessary, soak in the tub. The quicker you start scrubbing the abrasion, the less it will hurt. Be aggressive. Use a plastic pot-scrubbing mesh if necessary.
During the cleaning, look closely for punctures within the scraped area. If there is ANY hole in the skin, no matter how tiny, see the doctor. You may have a small rock underneath that hole.

After the initial washing, scrub with Betadine, Bactine, or another antiseptic on a gauze pad. If you can't get the abrasion clean, go see the doctor.

Young or tenderhearted bikers may need help cleaning the     scrape properly.
Young or tenderhearted bikers may need help cleaning the scrape properly.
Polysporin or Neosporin are examples of antibiotic ointments that help abrasions heal faster.
Polysporin or Neosporin are examples of antibiotic ointments that help abrasions heal faster.
Apply antibiotic ointment to the abrasion. To prevent sticking of the bandage, use plenty of ointment for this first dressing.

Bandage the abrasion. Usually, a non-stick pad, then gauze, then a kling wrap protects a larger scrape well. A self-adhesive wrap, such as Coban, helps hold everything in place. The wrap should be wide enough, and snug enough, that it doesn't slip around. But it shouldn't be "tight." If it feels uncomfortable, loosen it up.

Ongoing care:
Change the dressing daily. If the bandage sticks, soak it in warm water with a drop of soap. Dilute hydrogen peroxide can help soften a thickly crusted bandage. The scrape will heal much more quickly if it's bandaged for the first few days.
"Knuckle" bandages, shaped like the letter H, are also useful in areas that move and stretch, such as elbow and knee.
"Knuckle" bandages, shaped like the letter H, are also useful in areas that move and stretch, such as elbow and knee.
Four-day old abrasion is now painfree to touch and dry. At this point, it's reasonable to let the scape stay open, even though healing is faster if dressings are continued.
Four-day old abrasion is now pain-free to touch and dry. At this point, it's reasonable to let the scape stay open, even though healing is faster if dressings are continued.
Most bikers prefer to let the wounds dry (and remain uncovered) after 3 to 5 days of bandaging. Depending on the depth of the abrasion, healing can take from 1 week to 4 weeks.

Watch for:
See the doctor if there is redness around the wound, red streaks, swelling, drainage, fever, tender bumps in the groin or armpit upsteam from the wound, or an unexplained increase in pain or tenderness. See section on infection.