How should I describe a friction (abrasion) burn on physical examination?

Documenting Friction Burns on Physical Examination

Describe friction burns (abrasions) by documenting the anatomical location, total body surface area (TBSA) using the Lund-Browder chart, depth of tissue injury, presence of exposed structures, and any associated injuries. 1

Essential Documentation Components

Location and Distribution

• Document the precise anatomical location using standard anatomical terminology (e.g., "dorsum of right hand," "anterior right thigh," "bilateral knees"). 1
• Note whether the injury is isolated or involves multiple body regions, as this affects management decisions. 2
• For burns involving critical areas (face, hands, feet, flexure lines, genitals, or perineum), explicitly document these as they require specialist consultation regardless of size. 1

TBSA Measurement

• Use the Lund-Browder chart for accurate TBSA quantification, as it is the most accurate method and prevents both overtriage and undertriage that can increase morbidity and mortality. 1
• The open hand method (palm and fingers = 1% TBSA) is a practical alternative that limits overvaluation, particularly useful for scattered friction burns. 1
• Avoid the Wallace rule of nines for children, as it significantly overestimates TBSA. 1
• Document TBSA as a percentage and repeat the assessment during initial management, as initial estimates are often inaccurate. 1

Depth Classification

Grade the friction burn depth using a four-tier system when possible: 3

• Grade I: Isolated second-degree skin burn (superficial partial-thickness) with intact dermis
• Grade II: Full-thickness skin burn without exposure of underlying structures (tendons, fascia)
• Grade III: Deep injury with exposed tendons, fascia, or muscle
• Grade IV: Injury extending to bones and joints

Alternatively, document using standard burn depth terminology: 1

• Superficial (first-degree): Erythema only, no blistering
• Superficial partial-thickness (second-degree superficial): Blisters present, painful, pink base
• Deep partial-thickness (second-degree deep): Decreased sensation, white or mottled appearance
• Full-thickness (third-degree): Leathery, insensate, may have exposed deeper structures

Associated Findings

• Document the presence or absence of: 1, 2
  • Foreign matter embedded in the wound (gravel, dirt, debris)
  • Exposed tendons, fascia, muscle, bone, or joints
  • Neurovascular compromise distal to the injury
  • Signs of compartment syndrome if circumferential or deep
  • Concurrent traumatic injuries (fractures, head injury, internal injuries)

Pattern and Mechanism

• Note the pattern of injury (linear, scattered, clustered) as this provides information about mechanism and may have forensic implications in certain contexts. 1
• Document the mechanism (e.g., "motorcycle collision with road contact," "bicycle fall," "industrial machinery contact"). 2, 4

Wound Characteristics

• Describe the wound bed appearance: 1
  • Color (pink, red, white, yellow, black)
  • Presence of debris or foreign material
  • Bleeding or exudate
  • Surrounding tissue condition (edema, erythema, induration)
• Note if blisters are present, intact, or ruptured. 1

Clinical Context Documentation

Severity Indicators Requiring Specialist Referral

Document these findings that mandate burn center consultation: 1

• TBSA >10% in adults or any significant TBSA in children
• Deep burns affecting 3-5% TBSA
• Burns involving face, hands, feet, genitals, perineum, or major joints
• Circumferential burns of extremities or trunk
• Concomitant traumatic brain injury or high injury severity score 2

Time-Sensitive Observations

• Document time of injury if known, as cooling interventions are most effective within 30 minutes. 5
• Note if cooling has already been initiated and for how long. 5

Common Pitfalls to Avoid

• Do not underestimate injury severity based on visible surface damage alone, as friction burns often have deeper tissue destruction than initially apparent, particularly in high-energy mechanisms. 2, 3
• Avoid vague descriptors like "multiple abrasions" without quantifying location, size, and depth. 1
• Do not fail to document neurovascular status distal to extremity burns, as compartment syndrome can develop. 1
• Remember that 70-94% of TBSA estimates are overestimated, leading to excessive fluid administration—use structured tools rather than visual estimation. 1