View source for Escharotomy

==Indications==
{{Escharotomy burn indications}}

==Contraindications==
*No absolute contraindications; irreversible gangrenous limb may be futile
*Elevated IRN: not a contraindication. Give vitamin K, FFP as needed
*Skin infection: not a contraindication
*Thrombocytopenia: not a contraindication. Give platelets.

==Equipment Needed==

==Procedure==
*Baseline neurovascular exam with serial neurovasc checks with Dopplers and compartment pressures to assess for need to extend escharotomy and/or add fasciotomy
*Apply silver sulfadiazine dressings or antibiotics with petroleum gauze after escharotomy

===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
*Ankles - avoid posterior to medial malleolus due to neurovasculature
*Hands and feet - incise along dorsal interossei muscles; pay close attention to DP in feet
*Joints
**Avoid flexor surfaces of elbows, wrists and knees as shown in attached pictures
**However, it is important to release over joints due to high tension at these sites

[[File:feet.JPG|thumbnail]][[File:lower extremities.JPG|thumbnail]][[File:shield incision.JPG|thumbnail]][[File:upper extremity.JPG|thumbnail]]

==Complications==

==See Also==
*[[Burns]]

==External Links==

==Sources==

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[[Category:Procedures]]