Escharotomy

Indications

Circumferential eschar with any of:
- Restricted ventilation (torso)
- Vascular compromise
- Compartment syndrome (compartment pressure > 30 mmHg)

Document neuro-vascular status
- Consider Doppler ultrasound and compartment pressure if there is suspected need for an extension of the escharotomy or simultaneous fasciotomy
Incise eschar with scalpel or electrocautery, extending at least 1 cm into normal, unburned skin
Depth of incision controversial
- Most recommend incision into subcutaneous fat
Apply burn dressing
- Silver sulfadiazine or antibiotic ointment with petroleum gauze
Note that local anaesthetic is usually unnecessary as full thickness burns are insensate

Incise at anterior axillary line from level of 2nd rib to 12th rib bilaterally
Join incisions transversly with one incision slightly inferior to the clavicle and a second along the upper abdomen

Extensive escarotomies of the limbs should be carried to thenar and hypothenar eminences for upper extremities, and great and little toes for lower extremities
Identify superficial veins and avoid if possible
If possible, digital escharotomy should be performed by a hand surgeon
- If plastic surgery expertise is not immediately available, incise along the mid-lateral portion of fingers and toes
Avoid the posterior to medial malleoli of the ankle due to superficial neurovascular structures
Avoid flexor surfaces of elbows, wrists, and knees
- Escharotomy must still be performed over joints, as these are susceptible areas of high tension

Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015.

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