Escharotomy

Excerpt

Circumferential third-degree burn of the limbs results in a non-distensible and leathery eschar. During the first 48 hours of burn, massive fluid accumulates in the interstitial and intracellular spaces due to the fluid shift caused by an increase in capillary permeability along with the fluid resuscitation. The non-compliant nature of the circumferential eschar will eventually lead to an increase in compartment pressure and may progress to ischemia of the tissues within the compartment with subsequent tissue loss, infection, or contracture. The same concept can occur in the chest and abdomen areas whereby a large full-thickness burn can prevent adequate chest and abdominal expansion causing respiratory and hemodynamic compromise. Early surgical intervention by doing escharotomy can prevent these detrimental consequences and improve the outcome of the patient. An escharotomy is an emergency surgical procedure involving incising through areas of burnt skin to release the eschar and its constrictive effects, restore distal circulation, and allow adequate ventilation. Unlike fasciotomies, where incisions are made specifically to decompress tissue compartments, escharotomy incisions do not breach the deep fascial layer. Unfortunately, there is no objective measure to define the need for escharotomy and in most cases, an escharotomy is done on a prophylactic basis. Recently, escharotomy has been classified as a part of a wider group of decompressive therapies including fasciotomy, nerve release, and decompressive laparotomy.