Escharotomy: Difference between revisions
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==Indications== | ==Indications<ref>Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015.</ref>== | ||
*Circumferential eschar with any of: | |||
**Restricted ventilation (torso) | |||
**Vascular compromise | |||
**[[Compartment syndrome]] (compartment pressure > 30 mmHg) | |||
==Contraindications== | ==Contraindications== | ||
*No absolute contraindications | *No absolute contraindications | ||
*Elevated | |||
*Skin infection | ==Considerations== | ||
* | *Irreversible ischemia of a gangrenous limb may render escharotomy futile | ||
*[[coagulopathy|Elevated INR]] | |||
**Give [[Vitamin K]] +/- [[FFP]] but do not delay procedure | |||
*[[Thrombocytopenia]] | |||
**Transfuse [[platelets]], but do not delay procedure | |||
*Skin infection | |||
**Not a contraindication | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Sterile prep equipment | |||
*Scalpel or electrocautery | |||
**Electrocautery preferred when available | |||
*Burn dressings | |||
*Topical antibiotics | |||
==Procedure== | ==Procedure== | ||
* | *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 | |||
==Specific Techniques== | |||
===Torso=== | ===Torso=== | ||
*Incise at | [[File:shield incision.JPG|thumbnail]] | ||
*Incise at anterior axillary line from level of 2nd rib to 12th rib bilaterally | |||
*Join | *Join incisions transversly with one incision slightly inferior to the clavicle and a second along the upper abdomen | ||
===Extremities=== | ===Extremities=== | ||
*Extensive escarotomies of the limbs should be carried to thenar | [[File:feet.JPG|thumbnail]] | ||
* | [[File:lower extremities.JPG|thumbnail]] | ||
* | [[File:upper extremity.JPG|thumbnail]] | ||
** | *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 | |||
==Complications== | ==Complications== | ||
*Actually have minimal bleeding due to full thickness burns | |||
==See Also== | ==See Also== | ||
| Line 33: | Line 60: | ||
==External Links== | ==External Links== | ||
https://www.youtube.com/watch?v=puU4aDuhc0g | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Trauma]] | |||
Latest revision as of 22:46, 22 February 2021
Indications[1]
- Circumferential eschar with any of:
- Restricted ventilation (torso)
- Vascular compromise
- Compartment syndrome (compartment pressure > 30 mmHg)
Contraindications
- No absolute contraindications
Considerations
- Irreversible ischemia of a gangrenous limb may render escharotomy futile
- Elevated INR
- Thrombocytopenia
- Transfuse platelets, but do not delay procedure
- Skin infection
- Not a contraindication
Equipment Needed
- Sterile prep equipment
- Scalpel or electrocautery
- Electrocautery preferred when available
- Burn dressings
- Topical antibiotics
Procedure
- 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
Specific Techniques
Torso
- 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
Extremities
- 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
Complications
- Actually have minimal bleeding due to full thickness burns
See Also
External Links
https://www.youtube.com/watch?v=puU4aDuhc0g
References
- ↑ Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015.