508 The Unique Challenge of Road Rash Injuries: A Systematic Literature Review and Case Series Addressing A Poorly Understood Mechanism of Burn Injury

Abstract Introduction Road rash or friction burns present unique challenges to burn providers. These injuries may be contaminated by environmental bacteria and foreign debris. Descriptions of road rash in the literature are heterogeneous, and the natural progression of friction injuries and their optimal treatments have not been fully described. We performed a systematic literature review to describe friction burn characteristics. We also performed a retrospective review to assess our experience with treating this unique type of burn. Methods A systematic literature search was performed using PubMed, Scopus, and OvidSP MEDLINE databases as well as manually checking reference lists of relevant articles. The following keywords were used: road rash, friction burn, traumatic tattoo, and sheer injury. Case reports, reviews, and treadmill studies were excluded. We also performed an analysis of patients treated by our burn center for friction related injuries from January 1, 2017 to August 31, 2018. Demographics, interventions, and outcomes were evaluated for these patients. Results After abstract review of 22 pertinent articles, 7 were included for full-text analysis. After analysis, 4 articles, all with Level IV evidence, were reviewed and 184 patients were systematically evaluated. Friction burns occurred most often in young (22 years, mean) men (71%) because of motor vehicle accidents (78%). No studies recorded TBSA, but depth distribution was as follows: 29% partial-thickness, 49% full-thickness, and 31% had exposed vital structures (i.e. tendon, nerve, bone). For treatment, 36% received local wound care alone whereas 56% required surgery - 24% had local or free flap reconstructions. Similarly, our series of 9 patients were mostly young (21±17 years, mean) males (78%) involved in car accidents (100%) with a high incidence of full-thickness burns (44%), exposed structures (22%), and need-for-surgery (56%). We identified TBSA (6±6%), mean length of stay (14±15 days), wound infections rates (0%) and wound care regimens in 4 non-operative patients (2 silver sulfadiazine, 1 mupirocin, 1 silver-impregnated dressing). Conclusions Road rash injuries most commonly occur in young men due to car accidents, and, although most of these injuries comprise a small TBSA, nearly half are full-thickness and require surgery. Early bedside and/or operative debridement are necessary to prevent infection. Further prospective studies with long-term follow-up are indicated to better