Escharotomy: Difference between revisions
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==Procedure== | ==Procedure== | ||
*Baseline neurovascular exam with serial neurovasc checks with Dopplers and compartment pressures to assess for need to extend escharotomy and/or add fasciotomy | *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=== | ===Torso=== | ||
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**Restricted perfusion (focal) | **Restricted perfusion (focal) | ||
**Perform along midlateral portion of fingers/toes, extremities if no pulse by doppler | **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]] | [[File:feet.JPG|thumbnail]][[File:lower extremities.JPG|thumbnail]][[File:shield incision.JPG|thumbnail]][[File:upper extremity.JPG|thumbnail]] | ||
Revision as of 22:22, 16 December 2015
Indications
Escharotomy Burn 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
- 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
