Indications for Performing Escarotomy in a Serious Burn

 

Pathophysiology - A circumferential burn in an extremity results in one or both of the following which can cut off the blood supply distally:

(1) significant soft tissue edema with limited expansion because of band-like escar

(2) compartment syndrome

 

Indications:

(1) circumferential or almost circumferential full thickness (third degree) burn of an extremity

(2) usually done within the first 24 to 48 hours after injury

(3) evidence of decreased or absent pulses distally, preferrably demonstrated by color Doppler ultrasonography

(4) dehydration ruled out as the cause of the decrease in perfusion

(5) elevated compartment pressure (Saffle et al use > 30 cm water; ABA > 40 cm water)

Extremity Involved	Preferred Site for Monitoring
upper	palmar arch in the hand
lower	posterior tibial artery

 

The incisions are made longitudinally, involving the lateral and/or aspects of the major joints and extend into the subcutaneous tissue.