Friction Injuries Research Articles

Friction injury of the central vein caused by catheter for hemodialysis: an in vitro study

Vascular injury such as central venous stenosis (CVS) is a common complication in hemodialysis patients with central venous catheters (CVCs), yet the impact of the microstructure and partial physic characteristics of catheter surface on the chronic injury of central vein has not been elucidated. In this study, the microscopic morphology of tips and bodies of six different brands of polyurethane CVCs was observed and their roughness was assessed. Subsequently, an in vitro model was established to measure the coefficients of friction (COF) between CVCs (tips and bodies) and the vena cava intima of Japanese rabbits under the same condition in a linear reciprocating mode, and changes in the intima of vessels after friction were observed. The study found that there was a significant variation in surface roughness among different brands of CVCs (tips P < 0.001, bodies P = 0.02), and the COF was positively correlated with the catheter surface roughness (tips P = 0.005, R = 0.945, bodies P = 0.01, R = 0.909). Besides, the endovascular roughness increased after friction. These findings suggest that the high roughness surface of CVCs may cause chronic mechanical friction injury to the central venous intima, which is one of the potential factors leading to CVS or occlusion. This provides a breakthrough for reducing complications, improving patient prognosis, and advancing catheter surface lubrication technology.

Leaflet to assess, prevent and treat friction injury

Objective: to develop and validate the content of a leaflet to guide health professionals in the assessment, prevention and treatment of friction injuries. Method: To create the leaflet, an integrative literature review was carried out using the MEDLINE®, Lilacs and SciELO virtual library databases. Articles published between 2019 and 2023 were researched. The leaflet was validated by 98 nurses who were experts in the field, using the Delphi technique. For data analysis, the Content Validity Coefficient test was adopted. Results: in the first evaluation cycle, the Content Validity Coefficient varied between 0.75 and 0.86. After corrections requested by the judges, the leaflet was resent for the second evaluation cycle, with the related Content Validity Coefficient varying between 0.93 and 1.0. Conclusion: the leaflet to guide health professionals in the assessment, prevention and treatment of friction injuries was evaluated by specialist nurses in the field, who reached a consensus regarding the content in the second evaluation cycle.

Limitation of microdissected thinning in free anterolateral thigh flap for hand reconstruction

BackgroundHand defects, especially complex defects involving tendon or bone exposure, are challenging to reconstruct. With the limited size and options of local flaps, the free-thinned anterolateral thigh (ALT) flap remains an excellent choice. However, many authors have described thinning procedures differently, leading to inconsistent outcomes. We present our clinical experience of immediate thinning ALT flaps depending on the anatomical structure of the perforator.Materials and methodsBetween 2007 and 2021, we used a free ALT flap in 42 cases to cover hand defects after crushing and friction injuries, burning and burn scars, and animal bite wounds. There were 38 males and 4 females; the mean patient age was 31.2 years. Thinning procedure was performed in all flaps. The primary and microdissected thinning procedure was performed for 35 single flaps and 7 chimeric flaps, including 14 flaps for the fingers (29%), 4 flaps for the palm (8%), 12 flaps for the hand dorsum (24%), and 19 flaps for combined areas (39%).ResultsThe mean flap thickness was 18.6 (11–30) mm before defatting and 6.0 (3–12) mm after defatting, an approximately 65% reduction. The retained fascia island around the perforator was ≤ 1 cm in 73.5% of cases, 2–3 cm in 18.4%, and the remaining 8.1% had a fascia size ≥ 4 cm. The incidence of a well-survive flap was 93.9%. Three cases had partial to total necrosis. None of the patients required a secondary defatting procedure.ConclusionEvery case has a perforator pattern after running through the fascia, which allows surgeons to choose the appropriate thinning method. Perforators that run parallel to the superficial fascia are not good candidates for thinning. Instead, the thinning process should be performed with more perpendicular perforators.Level of evidence: Level IV, therapeutic study

Endoscopic atticotomy for attic cholesteatomas using piezosurgery.

Attic cholesteatomas can be exenterated by transcanal endoscopic ear surgery (TEES). In the limited operative field of exclusive transcanal endoscopic atticotomy, surgeons use either a piezosurgery scalpel or a drilling system to remove the posterior lateral bony wall of the epitympanum. We aimed to investigate the feasibility of using piezosurgery or microdrill for endoscopic atticotomy during exenteration of attic cholesteatomas. This study is a retrospective chart review of patients diagnosed with attic cholesteatoma, who were treated by exclusive TEES. The superior and posterior external auditory canal bones were excised using a piezosurgery scalpel or microdrill. Preoperative and postoperative hearing thresholds were measured by pure-tone audiometry. The postoperative follow-up duration varied from 6 to 37 months. There were no significant differences in age, sex, laterality of the affected ear, and preoperative bone conduction thresholds between the piezosurgery scalpel and microdrill groups. The operative duration was longer in the piezosurgery group than in the microdrill group (135.6 ± 19.5 minutes vs 117.3 ± 29.1 minutes, p = 0.042). Seven of 30 (23.3%) patients in the microdrill group, but none in the piezosurgery group, had a friction injury from the drilling. Postoperative testing at higher frequencies of 2000, 3000, and 4000 Hz showed no deterioration in the bone conduction threshold in the piezosurgery group. Endoscopic atticotomy performed using a piezosurgery scalpel is potentially safer but slower than using a microdrill for exenteration of attic cholesteatomas.

Dependency-related skin lesions in the prone critical patient. Incidence study

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL: (pressure ulcers [PU], moisture-associated skin damage [MASD] and friction injuries [FI]), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: chi-square test, t-test or Mann–Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170PP were performed.Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95%CI: 31.6–58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III).The median age of the lesion group (LG) was 66.5 [61.8−71.3] vs. 64 [43−71] years old in the non-lesion group (NLG), p=0.04. Eighty percent of the LG had PVD vs. 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 [56.1−149.4] vs. 38.2 [18.8−57] of the NIG, p<0.001. Multivariate analysis selected total PP hours (OR=1.03; 95%CI:1.01–1.05) and PVD (OR=8.9; 95%CI:1.3–58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity.The accumulated hours in probe position and peripheral vascular disease favor their development.

Lesiones cutáneas relacionadas con la dependencia en el paciente crítico pronado. Estudio de incidencia

ObjectiveTo determine the incidence of dependence-related skin lesions (DRSL) in patients in prone position (PP) and to identify the predisposing factors. MethodFollow-up study in two polyvalent intensive care units. Patients undergoing invasive mechanical ventilation and PP with no skin lesions on admission were included. We recorded the 3 types of DRSL:(pressure ulcers (PU), moisture-associated skin damage (MASD) and friction injuries (FI)), demographic variables, diagnosis, length of stay, PP episodes, postural changes, APACHE II (Acute Physiology and Chronic Health Disease Classification System), prealbumin level on admission, body mass index (BMI), diabetes, hypertension, smoking, peripheral vascular disease (PVD), vasoactive drugs, Braden scale and mortality. Bivariate analysis: Chi-square test, t-test or Mann-Whitney U test. Multivariate analysis: logistic regression. ResultsForty nine patients were included and 170 PP were performed. Forty-one DRSL appeared in 22 patients with a cumulative incidence of 44.9% (95% CI: 31.6-58.7). PU accounted for 63.4% (73.1% facial; 76.9% stage II), 12.2% were MASD (60% inguinal; 60% stage II) and 24.4% were FI (50% thoracic; 70% stage III). The median age of the lesion group (LG) was 66.5 (61.8-71.3) vs 64 (43-71) years old in the non-lesion group (NLG), P=.04. Eighty percent of the LG had PVD vs 20% of the NLG, p=0.03. The median total hours on PP of the LG was 96.9 (56.1-149.4) vs 38.2 (18.8-57) of the NIG, P<.001. Multivariate analysis selected total PP hours (OR: 1.03; 95% CI: 1.01-1.05) and PVD (OR: 8.9; 95% CI: 1.3-58.9) as predisposing factors for developing DRSL. ConclusionsThere is a high incidence of skin lesions related to prone decubitus dependence, mostly pressure lesions, although of low severity. The accumulated hours in probe position and peripheral vascular disease favor their development.

The versatility of biodegradable temporising matrix – A 63 paediatric case series with complex wounds

IntroTreating complex paediatric wounds is a challenge for many clinicians. Biodegradable Temporising Matrix (BTM) is a completely synthetic product that has shown promise in adults with acute burns, complex wounds, and reconstructive procedures. Currently, there is little documentation regarding the use of BTM in the paediatric population. MethodA retrospective chart review was conducted of all children who required application of BTM for wound treatment. Children were grouped into categories according to the type of injury or condition including thermal, friction, and electrical injuries, scar reconstruction, and various wound defects. Outcomes of interest included infection rates, time to application of BTM and split-thickness skin graft (SSG), dressings used, and overall functional and cosmetic outcomes. Results63 children were identified. Thermal (19/63) and friction (10/63) injuries represented the largest groups. Males accounted for 68 % of total children with lower limbs and feet most often affected. The median time for application of BTM was 7.5 days and 27 days from time of application of BTM to SSG. BTM provided satisfactory options for early wound closure and the ability to convert complex wounds, however it still does not negate the need for scar management. ConclusionFrom our review, BTM is a versatile product that has shown positive results for the treatment of complex wounds in the paediatric population. It represents the largest consecutive BTM case series in either adult or paediatric populations to date.

Distally-extending muscle fibers across involved joints: study of long muscles and tendons of wrist and ankle in late-term fetuses and adult cadavers.

It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively. We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30-40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint. The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants' movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.

Friction-Aggravated Skin Disorders-A Review of Mechanism and Related Diseases.

Abstract Skin is subject to frequent friction injury. Friction affects different structures of the skin, including keratinocytes, melanocytes, fibroblasts, and follicular units. Friction can also stimulate cytokine production. Friction is sensed by the mechanoreceptors, resulting in signal transduction to the nucleus, activating transcription factors and mechanoresponsive genes. Numerous friction-aggravated diseases have been identified, including inflammatory, depositional, follicular, genetic, infectious, and vesiculobullous disorders. Friction, as a potential modifiable aggravator, should be considered when skin diseases are located at friction-prone areas.

Outcomes of grafted skin on the dorsum of the foot after car-tire friction injuries.

BackgroundA car-tire friction injury on the dorsum of a child’s foot often results in hypertrophic scarring of the wound margins. This study describes the clinical appearance of the injured areas and surgical complications that occurred during the follow-up period in a series of children with car-tire friction injuries who were treated with split-thickness skin grafts (STSGs). We describe the clinical features that we believe need to be highlighted when initially treating car-tire injuries in children.MethodsFrom May 2003 to June 2016, our retrospective study included 15 patients with car-tire injuries on the dorsum of the foot who were treated with surgical excision and STSG to cover the wound.ResultsA total of 15 patients with car-tire injuries were treated. The average age was 6.26 years old. The average injury grade was 3.26. Two patients were treated using delayed repair, and 13 patients received STSG for initial management. Four patients experienced no complications, while 11 patients had hypertrophic scars and/or scar contracture after surgery.ConclusionsA car-tire friction injury on the dorsum of a child’s foot often results in hypertrophic scar formation or scar contracture even if proper management is undertaken. Since the occurrence of these complications in childhood can lead to a secondary deformity, it is important to properly treat car-tire friction wounds, inform patients and caregivers about potential complications, and ensure regular follow-up evaluations over a 12-month period following the initial surgery.

Pathophysiology and classification of iliotibial friction injuries

As a result of the frequent endurance sports that are being practiced nowadays, many techniques have been introduced to this field with favorable outcomes regarding to the management approaches of the different injuries. However, no previous investigations have adequately discussed the pathophysiology of iliotibial band friction syndrome (ITBS) based on recent evidence from the current studies in the literature. In the present investigation, we have discussed the pathophysiology and related classification of iliotibial band friction injuries based on the current studies in the literature. The current evidence about the pathophysiology of the condition is still controversial, although epidemiological investigations indicate that ITBS is becoming a more prevalent condition among runners and other endurance athletes. Furthermore, many factors can attribute to the development of the condition and have been reported to take essential roles in the pathophysiology of the disease. Some of these factors include gender, iliotibial band tightness, rearfoot eversion and weak hip abductors. Further investigations are still needed to completely understand the pathophysiology of the disease to help clinicians aim to achieve better interventions to enhance the outcome of practicing endurance and excessive exercises.

Outcomes of Early Surgical vs Nonsurgical Management of Pediatric Hand Friction Injuries Caused by Treadmills.

Pediatric hand friction injuries caused by running treadmills are ever more prevalent due to the increasing presence of home exercise equipment. These and other related injuries have received recent attention in the media, leading to mass product recalls in some cases. These friction injuries are similar to deep thermal burns, and these patients are usually cared for in the pediatric burn unit at our institution. We sought to describe our recent experience managing 22 patients with these injuries. Patients were queried from our urban pediatric burn center database. After Institutional Review Board approval, a retrospective chart review of all patients admitted for a treadmill-related hand injury over a 5-year period was performed. Data collected included patient demographics, initial treatment methods (surgical vs nonoperative), type of dressing used, hospital length of stay (LOS), and compliance with follow-up. We collected patient-centered outcomes included the time to healing and the need for subsequent surgical and/or nonsurgical interventions to treat the sequelae of these injuries. Our center treated 22 hand friction injuries caused by treadmills over the 5-year period. Five patients (23%) underwent early surgical intervention (<30 days from injury), with a median time from injury of 7 days (interquartile range 1.75-13.5). This cohort required additional interventions to treat postoperative sequelae with 2 (40%) requiring additional surgery and 3 (60%) managed nonsurgically. Of the 17 (77%) who were initially treated nonoperatively, 5 (29%) healed completely with dressing changes only and required no further treatment. Eleven (65%) had injury-related sequelae and were managed successfully with nonsurgical interventions. Only 1 patient (6%) required scar modification by Z-plasty. Average LOS was 14 hours and the median number of weekly follow-up visits was 4 until complete healing. Given the excellent outcomes observed in patients treated without acute surgical intervention in this case series, nonoperative management appears to be feasible, safe, and may reduce the need for operative intervention. These injuries, although small, are deep and require a prolonged period of dressing changes and aggressive therapy including posthealing time commitment to scar management in order to achieve best outcomes. Our study supports the need for increased community awareness of this type of injury.

Vacuum cleaner friction injuries in paediatrics: A 10 year review of national trends

Our regional burns service has gained experience in managing paediatric hand friction burns due to vacuum cleaners (VC).We aimed to evaluate our 10 year experience managing these injuries as well as reviewing national data trends in order to identify those at risk of injury. Materials and MethodsA International Burns Injury Database (IBID) request was made to review the number of burn injuries recorded due to Vacuum cleaner injuries (VCIs). In addition, a local IBID request was made to identify the number of burn injuries managed within our regional burns service. ResultsWe identified 288 VCIs which have increasingly occurred in England and Wales between 1996–2020 and 32 children who sustained these injuries within our regional burns service. A general theme from both national and local data highlighted that these injuries occurred in males (78%, n=25) with a mean age of 20 months (9 months–4.5 years) affecting children’s hands (94%). In 25 cases (78%) these injuries involved an interphalangeal joint. 85% (n = 27) of injuries were deep dermal/full thickness with eleven children (34%) undergoing surgical excision and skin grafts. DiscussionSignificant paediatric burn injuries can be sustained from VCs. Greater awareness is indicated for these injuries and legislation should be considered in order to improve the safety of vacuum cleaners. International burn societies are urged to collect data of these injuries in order to co-ordinate improved prevention strategies and change within the VC industry.

Incidencia, tipología y medidas de prevención y tratamiento de las lesiones cutáneas asociadas al uso de EPI en profesionales sanitarios durante la pandemia de COVID-19 en España. Estudio colaborativo GNEAUPP-Cátedra de estudios avanzados en heridas GNEAUPP - FSJJ - Universidad de Jaén

Introduction: The recent COVID-19 pandemic has represented the use by health care professionals (HCP) of different personal protective equipment (PPE), resulting in the appearance of skin injuries associated with PPE (PPE-SI). Knowing the epidemiology, characteristics and factors related to the use of different types of PPE and the prevention and treatment of PPE-SI can be very useful to understand the scope of the problem and to define strategies for its prevention and treatment in possible future pandemics. Methods: To this end, the GNEAUPP proposed the performance of a cross-sectional study, in the geographical area of the Spanish state, by means of a self-administered survey using a Google forms questionnaire. The study universe was HCP, from any discipline and from any level of care or type of institution with patients who have been in contact with COVID-19 patients or COVID-19 suspects and have used PPE during the first wave of the COVID-19 pandemic in Spain. Main results: We obtained 2078 questionnaires, 75.5% from nurses, 10.79% from nurse aids, and 6.6% from physicians. Of these, 84.7% were women and 15.3% were men with an average age of 43.7 years. In 18.2% of the cases the institution of the professional had a protocol for the prevention of PPE-SI, in 10.2% the professional did not know if it existed or not and in the remaining 71.3% the institution did not have such a protocol. 29.9% of the professionals always used some prevention product and 25.3% sometimes. 52.4% of respondents reported having submitted at least one PPE-SI, of which 39% had submitted one, 35.8% two, 14.3% three, 2.2% four and 8.6% more than four. In relation to PPE-SI, 74.3% were defined as pressure injuries (PI), 11% were friction injuries (FI), 8.5% were combined or multicausal injuries (CMCI) and 6.1% were skin injuries associated with moisture (MASI). The mean duration of incident injuries was 11.6 days (9.7 days for PI, 10.2 days for FI, 19.9 days for CMCI and 19.4 days for MASI). More detailed Information is presented in the paper by type of device causing, typology and severity of injuries per device as well as preventive measures used.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study.

Objective:to estimate the incidence of medical adhesive-related skin injury in the peripheral venous catheter fixation region in critical cancer patients, to identify risk factors, and to establish a risk prediction model for its development.Method:a prospective cohort study with a sample of 100 adult and aged patients hospitalized in an intensive care unit. The data were analyzed using descriptive, bivariate and multivariate statistics with Cox regression.Results:the incidence of medical adhesive-related skin injury was 31.0% and the incidence density was 3.4 cases per 100 people-days. The risk factors were as follows: alcoholism, smoking habit, hospitalization due to deep vein thrombosis, acute respiratory failure, immediate postoperative period, heart disease, dyslipidemia, use of antiarrhythmics, blood transfusion, friction injury, pressure injury, turgor, edema, hematoma, petechiae, low values in the Braden scale, clinical severity of the patient, elasticity, moisture, texture and color. The predictive model consisted in the following: decreased skin turgor, presence of hematoma and edema.Conclusion:medical adhesive-related skin injury at the peripheral venous catheter insertion site has a high incidence in critical cancer patients and is associated with decreased turgor, presence of hematoma and edema, evidence that can support the clinical practice.

Development of educational material for the prevention and treatment of friction injuries

Objective: to develop and validate an educational booklet to help health professionals to prevent and treat friction injuries. Method: methodological study. An integrative review of the literature of journals published between 2009 and 2019 was carried out in the main databases of Health Sciences. The evaluation of the educational booklet was conducted with 32 nurses, using the Delphi technique. The statistical analysis used was the Content Validity Index. Results: the judges considered the content of the educational booklet between the concepts “inadequate” and “adequate”, in the first assessment; after the corrections requested by the judges, the booklet was forwarded to the evaluators and the content of the educational booklet was rated between “adequate” and “totally adequate”. The overall Content Validity Index was 0.8118 in the first assessment and 1.0 in the second assessment. Conclusion: after the integrative literature review, the material was constructed and validated by professionals with experience in evaluating and treating individuals with wounds, obtaining consensus among the evaluators in the second evaluation.

Desenvolvimento de um material educativo para a prevenção e o tratamento das lesões por fricção

Objetivo: desenvolver e validar uma cartilha educativa para ajudar o profissional da saúde a prevenir e tratar da lesão por fricção. Método: estudo metodológico. Foi realizada revisão integrativa da literatura dos periódicos publicados entre 2009 e 2019 nas principais bases de dados de Ciências da Saúde. A avaliação da cartilha educativa foi conduzida com 32 enfermeiros, utilizando a técnica de Delphi. A análise estatística utilizada foi o Índice de Validade de Conteúdo. Resultados: os juízes consideraram o conteúdo da cartilha educativa entre os conceitos “inadequado” e “adequado”, na primeira avaliação; após as correções solicitadas pelos juízes, a cartilha foi reenviada aos avaliadores e o conteúdo da cartilha educativa foi avaliado entre “adequado” e “totalmente adequado”. O Índice de Validade de Conteúdo geral foi de 0,8118 na primeira avaliação e 1,0 na segunda avaliação. Conclusão: após a revisão integrativa da literatura, o material foi construído e validado por profissionais com experiência em avaliar e tratar de indivíduos com feridas, obtendo consenso entre os avaliadores na segunda avaliação.

Lesões por fricção em idosos internados

Objetivo: identificar a prevalência e os fatores associados à lesão por fricção em idosos internados em uma unidade de terapia intensiva. Método: estudo transversal, com amostra de 133 idosos internados em um hospital de ensino, entre julho de 2017 a julho de 2018. A coleta de dados contemplou consulta ao prontuário para levantamento sociodemográfico e clínico, exame físico de pele para avaliação de Skin tears. Os dados foram analisados pelo software Stata® versão12. Resultado: constatou-se prevalência de lesão por fricção em 10,5% dos idosos, com associação significativa ao índice de massa corpórea (p=0,004). Conclusão: Acredita-se que os resultados do presente estudo possam contribuir para sensibilizar o enfermeiro e sua equipe, quanto à realização de ações efetivas de prevenção e de cuidado às lesões por fricção, com o objetivo de melhorar a qualidade de assistência prestada aos idosos.Descritores: Enfermagem Geriátrica; Idoso; Envelhecimento da Pele, Hospitais Universitários, Unidades de Terapia Intensiva.

737 Treadmill Friction Hand Injuries in the Pediatric Patient

Abstract Introduction Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (&amp;lt; 30 days) surgical intervention compared to delayed intervention. Methods Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (&amp;lt; 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury. Results Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58). Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing. Conclusions Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option. Applicability of Research to Practice Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.

Friction Injury Versus Deep Tissue Injury: Level of Tissue Involvement: A Comparison of 2 Cases: Erratum.

Friction Injury Versus Deep Tissue Injury: Level of Tissue Involvement: A Comparison of 2 Cases: Erratum.