Chapter 48 – Escharotomy in Burns




Abstract






  • Deep partial thickness and full thickness circumferential or near circumferential burns of the neck, chest, abdomen, or extremities can cause serious local or systemic complications and need surgical release of the burn eschar to relieve obstruction or high pressures and restore perfusion.

    • Circumferential burns of the neck can cause airway obstruction.
    • Circumferential burns of the chest can cause respiratory compromise with increased peak inspiratory pressures, hypoxia, and hypercapnia.
    • Circumferential burns of the abdomen can cause intra- abdominal hypertension and abdominal compartment syndrome.
    • Circumferential burns of the extremities can cause muscle compartment syndrome.

  • Deep partial or full thickness circumferential extremity burns require prophylactic escharotomy.
  • Near circumferential extremity burns require frequent neurovascular checks to assess for need of escharotomy. Worsening neurovascular exam or pressure measurement >30 mmHg should prompt urgent escharotomy of the affected extremity.
  • In severe burns requiring massive fluid resuscitation, abdominal or extremity compartment syndromes may develop independent of circumferential burns. It is important that these high-risk patients are monitored closely and decompressive laparotomy or extremity fasciotomies are performed timely in the appropriate cases.
  • Electrical burns or burns associated with crush injuries may require fasciotomies, in addition to escharotomies, to restore adequate perfusion.





Chapter 48 Escharotomy in Burns


Justin Gillenwater and Warren Garner



General Principles




  • Deep partial thickness and full thickness circumferential or near circumferential burns of the neck, chest, abdomen, or extremities can cause serious local or systemic complications and need surgical release of the burn eschar to relieve obstruction or high pressures and restore perfusion.




    • Circumferential burns of the neck can cause airway obstruction.



    • Circumferential burns of the chest can cause respiratory compromise with increased peak inspiratory pressures, hypoxia, and hypercapnia.



    • Circumferential burns of the abdomen can cause intra- abdominal hypertension and abdominal compartment syndrome.



    • Circumferential burns of the extremities can cause muscle compartment syndrome.




  • Deep partial or full thickness circumferential extremity burns require prophylactic escharotomy.



  • Near circumferential extremity burns require frequent neurovascular checks to assess for need of escharotomy. Worsening neurovascular exam or pressure measurement >30 mmHg should prompt urgent escharotomy of the affected extremity.



  • In severe burns requiring massive fluid resuscitation, abdominal or extremity compartment syndromes may develop independent of circumferential burns. It is important that these high-risk patients are monitored closely and decompressive laparotomy or extremity fasciotomies are performed timely in the appropriate cases.



  • Electrical burns or burns associated with crush injuries may require fasciotomies, in addition to escharotomies, to restore adequate perfusion.


Figure 48.1



(a) Circumferential full thickness bilateral leg burns requiring escharotomy.





(b) Circumferential full thickness right arm burns requiring escharotomy.



Equipment




  • Special equipment is not necessary to perform an escharotomy, and all supplies are widely available to all hospitals and operating rooms.



  • A warming blanket or heat lamps to prevent hypothermia.



Technique



General


Sep 4, 2020 | Posted by in EMERGENCY MEDICINE | Comments Off on Chapter 48 – Escharotomy in Burns
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