Management of Rope Friction Injuries of the Hand.

Abstract

Rope friction injuries result from rapid, repetitive contact with coarse ropes or chains, causing combined mechanical and thermal damage. These injuries commonly affect young individuals during activities such as tug-of-war, climbing, air acrobatics, and rope handling. Although superficial and deep burns are most frequent, injuries may also involve vessels, nerves, tendons, and bone. This study presents our experience managing rope friction burns and reviews functional and aesthetic outcomes. We retrospectively reviewed 23 patients with full-thickness hand defects after rope friction injuries. Functional disability was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Scar quality was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Seventeen patients were male and 6 were female. Six patients had bilateral defects and 17 had unilateral defects. The mean defect size was 6.8±1.5 cm². Nine patients had associated vascular, nerve, or tendon injuries. Reconstruction included debridement and primary repair (n=11), full-thickness skin grafting (n=5), local flaps (homodigital rotation-advancement and transposition flaps; n=4), and superficial circumflex iliac artery perforator free flaps (n=3). Functional outcomes improved significantly after reconstruction (mean preoperative DASH: 83.9±4.02 vs. 12-month DASH: 6.65±2.57; P<0.00001). Mean patient and observer POSAS scores were 2.8±0.19 and 2.87±0.17, respectively, with no significant difference (P=0.106845). Rope friction injuries frequently extend deeper than expected and may involve critical underlying structures. Careful evaluation is essential. Most defects can be managed with primary repair, grafting, or local flaps, while free flaps provide reliable functional and aesthetic reconstruction when local options are inadequate.