Why is an escharotomy performed?
An escharotomy is generally performed:
- To restore perfusion (blood supply)
- To relieve pressure (pressure greater than 30 mmHg)
- To correct lung function
It is most effective when performed before the onset of lactic acidosis.
What is escharotomy?
An escharotomy is an emergency medical procedure that involves the removal of the full-thickness burn (eschar) down to the subcutaneous fat to release it and prevent further complications. It restores blood flow and allows adequate ventilation. When the skin suffers an eschar, it loses its elasticity resulting in the compression of the underlying skin tissues due to the formation of edema beneath the eschar. The fluid from the cells shifts to the adjacent interstitial space, causing augmented tissue pressure. The inelasticity of the overlying burned skin can lead to increased tissue pressure, thus reducing blood flow to the legs. If the front part of the body is affected by eschar, it can compromise lung function, which is seen as an inability to ventilate and oxygenate. Escharotomy allows the underlying tissues to have an increased available volume to allow expansion and prevent further tissue damage.
When is escharotomy avoided?
There are generally no contraindications associated with escharotomy except for this one condition
- Gangrene in the leg that is close to the full-thickness eschar
How is escharotomy performed?
You are made to lie flat on the table. The physician then cleans the surgical site with the povidone-iodine solution. For escharotomy, the physician may either use a scalpel or electrocautery to make incisions through the entire thickness of the eschar until the subcutaneous fat is seen. There would be an immediate release of tissue pressure heard as a popping sensation. The doctor extends the incisions to the entire length of the eschar. Electrocautery prevents bleeding from the site. The effectiveness of escharotomy can be tested after its completion by checking the pressure in the blood vessels using a handheld Doppler and compartment pressure. Compartment pressure is a dangerous condition in which the pressure builds up in the tissue resulting in bleeding or swelling. Improvement in fluid flow and decrease in the compartmental pressure indicate that the procedure is effective. Persistent low Doppler signals or increased compartmental pressure indicates an insufficient release of tissue pressure, which may require further extension of escharotomy incision.
What are the complications of escharotomy?
Complications of escharotomy include
- Excessive blood loss
- Injury to the underlying healthy tissues
- Bacteremia (infection of the tissues)
- Infection of the open escharotomy wounds
The complications of escharotomy not performed on time include
- Muscle necrosis (cell death of the muscles around the eschar)
- Injury to the nerve
- Gangrene that may lead to amputation of the legs or toes
- Inadequate ventilation leading to compromised lung function
- Abdominal compartment syndrome (abdominal pressure is 5 to 7 mm Hg)
- Kidney failure
- Hyperkalemia (high blood potassium concentration)
- Metabolic acidosis (increase in plasma acidity)
Zollinger's Atlas of Surgical Operations
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