GRAZE MANAGEMENT

● wound location ● stage of healing reached ● how long will dressing be in situ ● cost ● does casualty have further access to medical staff care ● inhibition of movement ● how conspicuous when in situ?

Also in the case of competitive cyclist can race clothing be worn over the top? They will rarely tolerate dressings that restrict movement or are conspicuous.

Photograph 2: Elbow wound showing granulating tissue with Opsite applied

It is important not to mistake the natural granulation process and granulating tis- sue (which is part of healing) for slough and try and remove it (photo. 2). A gran- ulating wound has a reddish or pink hue due to the growth of new capillaries and it may have a thin pale, yellow coating which is a normal part of the healing process but is often mistaken for dead skin. Granulation may take anything between two days to three weeks depend- ing on the severity of the wound.

It is very important to change the dress- ings and carry out wound care regularly as this accelerates the healing process and reduces the risk of infection.

Dressings Continuing to compete or cycle recre- ationally may increase the risk of infec- tion by exposing wounds to further cont- amination, so it is imperative that the wound is protected.

Many cyclists are reluctant to dress wounds as they traditionally believe that allowing the wound to ‘dry out’ speeds the healing process. Choosing appropriate dressings will create a micro environment conducive to healing as well as acting to encourage the person to protect the injury.

Dressings might be selected on the basis of the following factors ● wound type

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Semi-permeable film dressings are one of the most tolerated dressings since they are easily managed, are undisturbed by bathing, are inconspicuous and flexible and therefore unaffected by the move- ment of cycling. They also allow the wound to be monitored for infection. They can also be left in situ for several days if no infection is present, making after care simpler and cheaper. All major high street chemists will stock semi-permeable film dressings, trade names include Opsite Flexigrid, Tegaderm or Cutifilm.

If there is any exude a small piece of non- adherent absorbent dressing such as Melolin can be placed beneath the semi- permeable film dressing. This film dressing can be replaced by a non adherent absorbent dressing at night to more effec- tively deal with exude. A paraffin jelly dressing can be used beneath the absorbent pad to prevent any adherence. If it does get stuck to the wound, soak off with a saline solution ie. salt water.

Management Many competitive cyclists will not keep appointments if they are travelling fre- quently and will need advice about how they can manage the wounds themselves with limited equipment and dressings. Generally absorbent dressings need to be changed daily while film dressings can be left for up to 5-7 days as long as the seal on the skin is intact. Some cycling teams have nurses or physiotherapists as support staff; if this is the case it may be useful to supply the cyclist with written instruc- tions for follow up treatment to be passed on to the relevant staff.

Referral is required ● if there is a high risk of scarring and

the wound site is conspicuous ● if the wound is sited where there is inadequate viable tissue to allow rapid healing eg. over a joint, these wounds in severe cases may need skin grafts ● if healing appears to be arrested or not commencing at all

Further reading 1 Kerstein M. The scientific basis of heal- ing.

Advanced Wound Care

1997;10(3):30-36 2 Mallett J and Bailey C. The Royal Marsden NHS Trust Manual of Clinical Nursing 4th Edition. Blackwell Science, London, 1999 3 Oliver L. Wound cleansing. Nursing Standard 1997;11(5 Feb)No.20 4 Pudner R. Managing traumatic wounds. Journal of Community Nursing 1997;11(Nov):Iss 11