Escharotomy

Indications

• Circumferential eschar with one of the following:
  • Circumferential torso - restricted ventilation
  • Circumferential extremities - vascular compromise
• Immediate escharotomy if compartment pressure > 30 mmHg
• Elevate limb and optimize fluid status

Contraindications

• Elevated IRN: not a contraindication. Give vitamin K, FFP as needed
• Skin infection: not a contraindication
• Thrombocytopenia: not a contraindication. Give platelets.

Procedure

• Baseline neurovascular exam with serial neurovasc checks with Dopplers and compartment pressures to assess for need to extend escharotomy and/or add fasciotomy

Torso

• Incise at ant axillary line from level of 2nd rib to 12th rib bilaterally, incising down to level of subcutaneous fat
• May have an immediate release manifested by popping sensatio
• Join these two incisions transversely

Extremities

• Extensive escarotomies of the limbs should be carried to thenar/hypothenar eminences for UEs, and great/little toe for LEs
• Limb escharotomies are close to superficial veins, so identify if possible
• Digital escharotomies should be performed by hand surgeon if at all possible
  • Restricted perfusion (focal)
  • Perform along midlateral portion of fingers/toes, extremities if no pulse by doppler

See Also

• Burns