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Wednesday, December 23, 2009

Friction Burns

++Dear Burn Surgeon,
My friend had a motorcycle accident. Though there was no fire the doctor says he has a “friction burn”. Can you please explain this?

Rajiv sood , Mumbai
Dear Rajiv, thank you for your question. When you rub the palms of your hands together, heat is created by friction. Similarly in the motorcycle accident when your friend fell off the bike, probably he was dragged on the road due to the momentum. The friction between the body and the road created a high temperature which caused the burn. However ‘friction burn’ is rarely a pure burn and there is often an element of traumatic injury (usually abrasions) involved in it, along with dirt and gravel that gets embedded in the burn wound. ‘Friction burns’ may either be deep or superficial depending on the drag and trauma involved. Friction burns that are superficial need only conservative management (ointment and dressings) after cleaning the wound to remove the dirt and debris. This is very important since tatooing of the wound may result from the dirt and debris which gets embedded in the wound. However deep burns may need surgery (skin grafting) as the skin will fail to heal by itself.
The picture on your right shows a ‘friction burn’ in a gentleman who suffered a motor cycle accident. There is a ‘third degree burn’ (see blog degree of burn) in the centre with 2nd degree burn in the periphery along with abrasions and the wound has debris embedded in it.

He was subjected to debridement (surgical cleaning of wound) following which a meshed skin graft (graft with holes in it) was applied over it.

The wounds healed well and the gentle man was advised to shift to a four wheeler and avoid two wheelers which are potentially dangerous. (I have still to see the owner of a two wheeler vehicle who hasn't had an accident). Friction burns can occur in sportsmen and wrestlers playing on mats, or on the carpet or the playground when they fall and their skin rubs against the rough surface.
Footballers who make a sliding tackle on a dry pitch may suffer from friction burns.
Other causes of friction burns include exercise treadmill at home which can cause accidental contact and friction burn from the fast moving belt. Rolling belts and fast moving belts used in industries can also cause friction burns.
Use of adequate protective clothing, headgear, knee and elbow pads, footwear and following proper safety precautions and protocols will be very helpful in preventing these burns in different situations. Friction burns should not be confused with redness and excoriation that may occur at different sites of the body due to infection or trauma. Tetanus prophylaxis should be given as per protocol if needed. Antibiotic are prescribed to avoid infection in patients who have dirt and gravel embedded in the wound.

The picture on your right shows a ‘friction burn” which was managed conservatively. Notice the scar with healing marks of the abrasions, obviously this was deep burn to begin with. This scar will need aggressive ‘scar management’ which is a topic by itself and I shall explain it in detail in a future blog.


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