King Saud University

College of Nursing

Escharotomy incisions
Hatem alsrour
Escharotomy
objectives
.What is meaning escharotomy #
.Know the indication of escharotomy #
.Know the contraindication of escharotomy #
Know the equipment and how patient #
.preparation
Know the procedure steps and the #
.complications
Escarotomy
Escarotomies are not commonly performed in the #
emergency department but may be necessary in
the critically burned patient before admission
or transfer.
# Needed when there is a full thickness burn involving the
extremities or chest.
# Eschar is tough and rigid tissue that forms as a result of
. thermal or chmical burns
 As edema forms in the injured extremity after the #
burn, the eschar restricts outward expansion
. the tissue

The outcome is increased interstitial pressure that rises to the #

. point that vascular flow is compromised

Incising the eschar allows return of flow and prevents #

. further ischemic injury
indication

To decrease elevated intrathoracic or tissue pressure in the

:presence of

circumferential full-thickness burns to the chest, which-1

.mechanically constrict and compromise respiration

circumferential or electrical burns to the extremities causing-2

loss of distal pulses, impaired capillary filling, paresthesias or
motor weakness, cyanosis of distal uninjured skin, or tense
.edema with rigid muscle compartments
loss of distal Doppler pulses indicates the need for -3
.escharotomy of the extremity

tissue pressure exceeding 30 mm Hg, which indicates a need -4

.for escharotomy or fasciotomy
CONTRAINDICATIONS AND CAUTIONS

Failure to perform emergency escharotomy may result in the -1

inability to ventilate lung parenchyma, loss of
. neuromuscular function, or ischemic tissue injury

This procedure may cause significant blood loss in the patient-2

. already predisposed to hypovolemic shock

These new open wounds further predispose the patient to-3

. infection and sepsis
 underlying tissues may be damaged if procedures are-4
. incorrectly performed

If compartmental pressures do not decrease after escharotomy,-5

.a fasciotomy must be performed in the operating room

Improper technique or locations of the incisions may damage-6

.nerves

Prophylactic antibiotics are strongly discouraged to prevent the-7

.development of resistant bacterial strains
EQUIPMENT

.Sterile gown, mask, and gloves for all team members *

.)Local anesthetic infiltration ) optional in deep, insensate burns *
.Doppler to assess pulses *
Sterile scalpel *
.Cautery, thrombin, and hemostats *
.Sterile dressing and bandages *
.Antimicrobial creams *
PATIENT PREPARATION

.Remove all constricting clothing and jewelry -1

Elevate the burned extremity slightly above the level of the -2

.heart

.Administer analgesics -3

.Administer tetanus prophylaxis as indicated -4

Place the patient in a supine anatomic position, unless -5

.contraindicated by other injuries or conditions
PROCEDURAL STEPS

.Drape below and around the surgical area -1

.Anesthetize with local anesthetic infiltration -2
:Incise indicated areas -3
a- Chest: * Along the anterior axillary aspects of the chest
.extending from the clavicle to the costal margin
Make a second incision transverse across the chest at the level *
.of the diaphragm
.Cut through the eschar but not into the subcutaneous tissue *
The incision should cause the eschar to gap, thus releasing *
.pressure
Chest Incisions
PROCEDURAL STEPS

b- Neck: Posteriorly and laterally to avoid major vessels in the

.neck
c- Upper extremities: Medial and lateral aspects of arms avoiding
.the radial nerve
d- hand: Doral aspect of the hands and along the palmar crease
.and medial and lateral aspects of the digits
e- Legs: Midmedial and midlateral incision; toes in a similar
.manner to the fingers
.Reassess respiratory function and distal circulatory status-4
Apply direct pressure, cautery, clamps, or thrombin to all -5
.bleeding areas
PROCEDURAL STEPS

Reassess hematocrit, and consider blood administration if -6

.necessary
.Apply dressings to reduce the potential for infection -7
keep the affected extremities elevated, and monitor distal -8
.pulses frequently
COMPLICATIONS

.Wound infection -1

.Sepsis -2

.Blood loss -3

.Nerve or vessel damage -4

Inadequate decompression may lead to tissue necrosis, -5

.myoglobinuria, renal failure, hyperkalemia, and acidosis
PATIENT TEACHING

This procedure will decrease the pain as it relieves the tissue -1

.pressure

Care will be taken to help these wounds heal with as little -2

.scarring as possible
Escharotomy
Escharotomy
Some things to
remember…
 Invasive Procedure…

 Pain Control

 Topical Antibiotics

 Dressings: keep the wounds clean & dry

Thank you