Indications

Poor circulation and ischemia rarely occur immediately after burn injury. It is therefore important to reassess tissue perfusion frequently.

Ensure that there is no systemic cause of distal hypoperfusion, such as hypoxia, decreased cardiac output, hypovolemia or peripheral arterial constriction.

The timing of escharotomy is based on the clinical presentation. An escharotomy may be indicated in the following instances:

Limbs: When a circumferential or near-circumferential eschar of the extremities compromises the underlying tissues or the circulation distal to it.

Neck/Trunk: When a circumferential or near-circumferential eschar of the head, neck or trunk compromises aeration and breathing. Beware that near-circumferential burns in children, including those not extending to the posterior chest, may still reduce ventilation as breathing is principally diaphragmatic.

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Abdomen: When a circumferential or near-circumferential eschar of the abdomen is associated with evidence of intra-abdominal hypertension (IAH), or signs of ACS. Breathing may also be compromised.

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