Escharotomy

With full thickness and deep partial thickness burns, the dermis can become very stiff. If this occurs circumferentially over the chest it can restrict chest wall movement and lead to mechanical respiratory failure. Equally if there are circumferential burns to the limbs this can cause limb ischaemia. In these cases an emergency escharotomy needs to be undertaken to release the rigid skin to allow: adequate ventilation (if the chest is involved) or circulation (in the limb).¹⁹

The process of the dermis stiffening takes time and the majority of patients requiring escharotomies often go to theatre for this at a later stage. However, knowledge of the procedure can be life and limb saving in the emergency setting.

Procedure:

• The limb should be kept in the anatomical position.
• The area is cleaned and incised along the anatomical lines (see figure 11) with a scalpel down to the fat
• The incision should not go down to the muscle or fascia
• For the limbs the incisions need to release both medial and lateral aspects
• For the chest the incision needs to release the whole breast plate
• Care must be taken to avoid the named important structures (see figure 11)

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