536 Road Rash: Understanding a Challenging Form of Burn Injury

Abstract

Abstract Introduction Road rash is a unique burn injury due to imbedded foreign debris and deeply seeded bacteria. Literature on this injury fails to address its unique mechanism and ways to reduce scarring and infection. Given the paucity of data, a retrospective review was performed at a single level 1 trauma center to study friction burn characteristics and outcomes from these injuries Methods We performed a systematic literature search with PubMed, Scopus, and OvidSP Medline databases using the following keywords: friction burn, traumatic tattoo, and road rash. Subsequently, we analyzed all patients treated by our ABA verified burn center for friction related injuries from January 1, 2015 to September 15, 2019 and evaluated demographics, interventions, and outcomes. Results Twenty-four pertinent articles were identified. Seven articles were included after full-text analysis. Analysis of 225 patients from these studies identified an average age of 23±7 years with 66% male. Most occurred from motor accidents (74%) with industrial (11%) and blast (10%) mechanisms accounting for the majority of the remaining cases. None of the studies recorded TBSA, but 49% were full thickness and 36% had associated injuries. Most patients (58%) required surgery. At our institution, 44 patients met inclusion criteria and the majority were young (25±18 years), men (75%), involved in motor accidents (75%), and low TBSA burns (6.3±5.6%). Over half (57%) had full thickness burns and 72% required surgery. Length of stay was 12±11 days. Of the 27% of patients with traumatic tattooing on admission, 92% successfully had all foreign debris removed by discharge. Eight (18%) patients had wound infections. Importantly, 75% of patients with wound infections had delayed evaluation by a burn practitioner; elucidating a strong and significant correlation (p< 10–5, Cramer’s V 0.84). Conclusions While road rash injuries are often small TBSA, the majority tend to be full thickness, often involve underlying critical structures and frequently require operative intervention. Significantly, patients who developed wound infections were often not evaluated by a burn provider. Applicability of Research to Practice The unique trauma of road rash causes a high degree of superficial and deep tissue injury with high risk for contamination, infection, and scarring such that rapid debridement is critical for optimal care. Burn surgeons should be consulted early as these patients have a high risk of wound infection when not consulted by wound experts.