escharotomy

Escharotomy is a surgical procedure performed to relieve the constriction caused by burn eschar in circumferential full-thickness burns. By cutting through the burned tissue, the procedure releases pressure on underlying vessels and soft tissues, restoring distal blood flow and improving chest wall expansion when the chest is involved.

Indications include circumferential full-thickness burns of the limbs or trunk with signs of compromised perfusion, such as cool, mottled skin, diminished or absent distal pulses, or rising tissue pressures. In thoracic burns, escharotomy may be needed to alleviate restricted chest wall movement and improve ventilation.

During an escharotomy, a skin incision is made through the eschar along the length of the involved limb or across the chest wall to release constriction. The incision traverses the burned skin and subcutaneous tissue but generally does not penetrate underlying muscle unless fasciotomy is also required. The goal is to relieve pressure rather than to remove dead tissue. In some cases, sequential incisions are performed on both sides of a limb or circumferentially around the chest.

Aftercare involves wound care with dressing changes and assessment of perfusion; skin grafting may be needed later to close extensive wounds. If perfusion remains poor after escharotomy, a fasciotomy may be required to decompress deeper muscle compartments. Risks include bleeding, infection, nerve or vessel injury, and, in chest procedures, pneumothorax or respiratory complications.