II. Indications
- Conditions
- Circumferential Extremity Full thickness burn (Third Degree Burn)
- Compartment Syndrome
- Findings
- Absent pulses and doppler pulses
- Compartment Pressure >40 mmHg (consider if >25 mmHg)
- Decreased limb Oxygen Saturation, while other limbs have normal Oxygen Saturation
- Abrupt limb neurologic symptoms
III. Pathophysiology
- Eschar is hard and inflexible and may result in a Tourniquet effect with tissue ischemia and necrosis
- Compartment Syndrome secondary to Burn Injury may also result in irreversible neurovascular injury
IV. Complications
- Neurovascular Injury
- Tissue Hemorrhage
-
Wound Infection
- Careful wound management after Escharotomy is important
- Failed decompression with continued decreased tissue perfusion
- Fasciotomy may be required
- May require Limb Amputation
- Large scars
- Often require surgical reconstruction (e.g. skin grafting) later
V. Precautions
- Typically performed by burn center, Trauma surgery or general surgery
- However in resource limited areas, emergency providers may be tasked with Escharotomy
- Early intervention is associated with best outcome to prevent tissue ischemia, necrosis and amputation
- Escharotomy site selection is critical to prevent neurovascular injury to major structures
- Depth of incision (to subcutaneous fat) must be adequate to ensure tissue decompression
- Length of incision should extend from unburnt skin to unburnt skin (or superficial burn regions)
- Persistently high tissue pressures and decreased perfusion may require additional Escharotomy (e.g. opposite side of limb)
- Avoid Escharotomy of digits unless recommended by expert opinion
VI. Technique
- Consult with burn center or surgery as needed
- Plan Escharotomy incision to avoid major structures
- Clean and prepare incision site
- Antiseptic (e.g. Hibiclens)
- Local or Regional Anesthesia
- Incision
- Incision is longitudinal from proximal to distal extremity, on one side of the circumferential burn
- Start incision 1 cm outside of affected area
- Incise down to subcutaneous fat
- Continue incision to distal point of the affected area (1 cm into the uninvolved or superficially injured skin)
- If distal arm is affected, incision should extend to hypothenar or thenar eminence
- If distal leg is affected, incision should extend to fifth toe or great toe base
- Reassessment
- Incision on the opposite side of extremity is indicated for persistently decreased tissue perfusion in distal limb
- Ensure adequate depth of incision (down to subcutaneous fat)
-
Wound care
- Wound bandaging
VII. Resources
- Escharotomy (Stat Pearls)
- Escharotomy (Wiki EM)
- Escharotomy with Video (VicBurns)
- Escharotomy with Video (UW)
VIII. References
- Warrington (2020) Crit Dec Emerg Med 34(4):12-3
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| ICD10 | 30017-00 |
| SnomedCT | 70177008 |
| CPT | 16035, 16036, 1003562 |
| Italian | Escarotomia |
| Japanese | 焼痂切開, ｼｮｳｶｾｯｶｲ |
| Czech | Protětí příškvaru |
| English | ESCHAROTOMY FIRST INCISION, INCISION OF BURN SCAB INITI, escharotomies, escharotomy, Incision of burn scab initi, Escharotomy; initial incision, Escharotomy, initial incision, Escharotomy, Escharotomy (procedure) |
| Hungarian | Hegkimetszés |
| Spanish | Escarotomia; incision inicial, escarotomía (procedimiento), escarotomía, Escarotomía |
| French | Escarrotomie |
| Portuguese | Escarotomia |
| Dutch | escharotomie |
| German | Schorfoeffnung |
Ontology: Escharotomy of burnt skin (C0411707)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 240992000 |
| English | Escharotomy of burnt skin, Escharotomy of burnt skin (procedure) |
| Spanish | escarectomía de piel quemada (procedimiento), escarectomía de piel quemada |
