Escharotomy in burns.

Abstract

UNLABELLED: The need for escharotomies is relatively common in the treatment of burn injuries. The need arises because the tight eschar may interfere with the circulation to a limb causing demarcation and loss of the limb or in the case of the chest, may cause interference with respiration such that the expansion in the lungs is interfered with causing atelectasis and pneumonia. In the neck the oedema in the tissue may cause obstruction to the trachea. Indications for escharotomy rest on clinical grounds with tension in the limb under the burn and the state of circulation to the periphery being important. Added to this is the use of Doppler ultrasound, clinical presence of peripheral pulses and at times compartmental pressure measurements. The aim of the escharotomy is to release the pressure over the involved deeper tissues and to restore their circulation. TECHNIQUE: Under sterile conditions make incisions through the eschar until the tissue gapes such as to release the pressure particularly on the vascular supply. These should avoid flexion increases and be designed to release pressure in all compartments if necessary. In the case of electrical burns this may need to be combined with a fasciotomy for diagnostic and therapeutic purposes. Bleeding must be controlled and the escharotomy is then treated as a burn injury being packed with Silvazine cream. Elevation of the limbs is important also to help limit the oedema.