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Escharotomy

Intervention

ICD-9-CM 86.09

An escharotomyis a surgical procedure used to treat full thickness (third-degree)

circumferentialburns.Since full thickness burns are characterized by tough, leatheryeschar,anescharotomy is used primarily to combatcompartment syndrome.Following a full thickness

burn, as the underlying tissues are rehydrated, they become constricted due to the eschar's loss ofelasticity, leading to impaired circulation distal to the wound.

An escharotomy is performed by making an incision through the eschar to expose the fatty tissuebelow. Due to the residual pressure, the incision will often widen substantially.

Contents

1 Overview 2 Indications 3 See also 4 References 5 External links

Overview

Full-thickness circumferential and near-circumferential skin burns result in the formation of atough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in

the burn-induced compartment syndrome. This is caused by the accumulation of extracellular

and extravascular fluid within confined anatomic spaces of the extremities or digits. Theexcessive fluid causes the intracompartmental pressures to increase, resulting in collapse of thecontained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary

closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that

which requires intervention to prevent tissue death.

The circumferential eschar over the torso can lead to significant compromise of chest wall

excursions and can hinder ventilation. Abdominal compartment syndrome with visceral

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hypoperfusion is associated with severe burns of the abdomen and torso. Similarly, airway

patency and venous return may be compromised by circumferential burns involving the neck.

Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous

envelope to become more compliant. Hence, the underlying tissues have an increased available

volume to expand into, preventing further tissue injury or functional compromise.

Indications

Indications for emergency escharotomy are the presence of a circumferential eschar with one of

the following:

Impending or established vascular compromise of the extremities or digits. Impending or established respiratory compromise due to circumferential torso burns.[3] Severely burned extremities should be elevated and range of motion exercises performed

every 15-30 minutes as tolerated by the patient. This can help to minimize tissue edema

and elevated tissue pressures.

Neurovascular integrity should similarly be monitored frequently and in a scheduled manner.

Capillary refilling time, Doppler signals, pulse oximetry, and sensation distal to the burned area

should be checked every hour.[4] Limb deep compartment pressures should be checked initially

to establish a baseline. Subsequently, any increase in capillary refill time, decrease in Dopplersignal, or change in sensation should lead to rechecking the compartment pressures.

Compartment pressures greater than 30 mm Hg should be treated by immediate decompression

via escharotomy and fasciotomy, if needed.[5, 6] A decision-making algorithm is shown in the

image below.[1]

See also

Journal of Burns and Wounds

References

1. Jump up ^"Medscape: Medscape Access".Emedicine.medscape.com. Retrieved 2012-01-26.

http://en.wikipedia.org/wiki/Escharotomy#cite_note-1http://en.wikipedia.org/wiki/Escharotomy#cite_note-1http://en.wikipedia.org/wiki/Escharotomy#cite_note-1http://en.wikipedia.org/wiki/Journal_of_Burns_and_Woundshttp://en.wikipedia.org/wiki/Journal_of_Burns_and_Woundshttp://en.wikipedia.org/wiki/Escharotomy#cite_ref-1http://emedicine.medscape.com/article/80583-overview#a03http://emedicine.medscape.com/article/80583-overview#a03http://emedicine.medscape.com/article/80583-overview#a03http://emedicine.medscape.com/article/80583-overview#a03http://en.wikipedia.org/wiki/Escharotomy#cite_ref-1http://en.wikipedia.org/wiki/Journal_of_Burns_and_Woundshttp://en.wikipedia.org/wiki/Escharotomy#cite_note-1