Escharotomy - Revision history

Elcatracho: /* Indications */

2021-02-22T22:46:22Z

Indications

← Revisión anterior		Revisión del 22:46 22 feb 2021
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	==Indications==		==Indications<ref>Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015.</ref>==
	*Circumferential eschar with any of:		*Circumferential eschar with any of:
	**Restricted ventilation (torso)		**Restricted ventilation (torso)

Elcatracho: /* References */

2021-02-22T22:45:35Z

References

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	==References==		==References==
	*Peck, Michael. Arizona Burn Center. Escharotomy Procedures for Burn Patients. May 26, 2015.
	<references/>		<references/>

	[[Category:Procedures]]		[[Category:Procedures]]
	[[Category:Trauma]]		[[Category:Trauma]]

ClaireLewis at 16:04, 9 October 2019

2019-10-09T16:04:58Z

← Revisión anterior		Revisión del 16:04 9 oct 2019
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	**Restricted ventilation (torso)		**Restricted ventilation (torso)
	**Vascular compromise		**Vascular compromise
	**Compartment syndrome (compartment pressure > 30 mmHg)		**[[Compartment syndrome]] (compartment pressure > 30 mmHg)

	==Contraindications==		==Contraindications==
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	==Considerations==		==Considerations==
	*Irreversible ischemia of a gangrenous limb may render escharotomy futile		*Irreversible ischemia of a gangrenous limb may render escharotomy futile
	*Elevated INR		*[[coagulopathy\|Elevated INR]]
	**Give Vitamin K +/- FFP but do not delay procedure		**Give [[Vitamin K]] +/- [[FFP]] but do not delay procedure
	*Thrombocytopenia		*[[Thrombocytopenia]]
	**Transfuse platelets, but do not delay procedure		**Transfuse [[platelets]], but do not delay procedure
	*Skin infection		*Skin infection
	**Not a contraindication		**Not a contraindication
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	[[Category:Procedures]]		[[Category:Procedures]]
			[[Category:Trauma]]

SLuckettG: /* Procedure */

2019-05-11T23:26:37Z

Procedure

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	==Procedure==		==Procedure==
	*~~Baseline neurovascular exam with serial neurovasc checks with Dopplers~~ and compartment ~~pressures to assess~~ for ~~need to extend~~ escharotomy ~~and/~~or ~~add~~ fasciotomy		*Document neuro-vascular status
	*Depth of incision controversial~~, may require as little as dermal release to complete~~ subcutaneous ~~release to fasciotomy~~		**Consider Doppler ultrasound and compartment pressure if there is suspected need for an extension of the escharotomy or simultaneous fasciotomy
	*Apply ~~silver~~ sulfadiazine ~~dressings~~ or ~~antibiotics~~ with petroleum gauze ~~after escharotomy~~		*Incise eschar with scalpel or electrocautery, extending at least 1 cm into normal, unburned skin
	*~~Local anesthesia in areas of~~ full thickness burns ~~may not be necessary~~		*Depth of incision controversial
			**Most recommend incision into subcutaneous fat
			*Apply burn dressing
			**Silver sulfadiazine or antibiotic ointment with petroleum gauze
			*Note that local anaesthetic is usually unnecessary as full thickness burns are insensate

			==Specific Techniques==

	===Torso===		===Torso===
	[[File:shield incision.JPG\|thumbnail]]		[[File:shield incision.JPG\|thumbnail]]
	*Incise at ~~ant~~ axillary line from level of 2nd rib to 12th rib bilaterally~~, incising down to level of subcutaneous fat~~		*Incise at anterior axillary line from level of 2nd rib to 12th rib bilaterally
	*May have an immediate release manifested by popping sensation		*Join incisions transversly with one incision slightly inferior to the clavicle and a second along the upper abdomen
	*Join ~~these two~~ incisions ~~transversely~~

	===Extremities===		===Extremities===
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	[[File:lower extremities.JPG\|thumbnail]]		[[File:lower extremities.JPG\|thumbnail]]
	[[File:upper extremity.JPG\|thumbnail]]		[[File:upper extremity.JPG\|thumbnail]]
	*Extensive escarotomies of the limbs should be carried to thenar/hypothenar eminences for ~~UEs~~, and great/little ~~toe~~ for ~~LEs~~		*Extensive escarotomies of the limbs should be carried to thenar and hypothenar eminences for upper extremities, and great and little toes for lower extremities
	*~~Limb escharotomies are close to~~ superficial veins~~, so identify~~ if possible		*Identify superficial veins and avoid if possible
	*~~Digital escharotomies~~ should be performed by hand surgeon ~~if at all possible~~		*If possible, digital escharotomy should be performed by a hand surgeon
	**~~Restricted perfusion (focal)~~		**If plastic surgery expertise is not immediately available, incise along the mid-lateral portion of fingers and toes
	**Perform along ~~midlateral~~ portion of fingers/toes~~, extremities if no pulse by Doppler~~		*Avoid the posterior to medial malleoli of the ankle due to superficial neurovascular structures
	*~~Ankles - avoid~~ posterior to medial ~~malleolus~~ due to ~~neurovasculature~~		*Avoid flexor surfaces of elbows, wrists, and knees
	*Hands and feet - incise along dorsal interossei muscles; pay close attention to DP in feet		**Escharotomy must still be performed over joints, as these are susceptible areas of high tension
	*Joints
	**Avoid flexor surfaces of elbows, wrists and knees ~~as shown in attached pictures~~
	**~~However, it is important to release~~ over joints ~~due to~~ high tension ~~at these sites~~

	==Complications==		==Complications==

SLuckettG: /* Equipment Needed */

2019-05-11T23:19:25Z

Equipment Needed

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	==Equipment Needed==		==Equipment Needed==
	*Sterile prep equipment		*Sterile prep equipment
	*Scalpel ~~in austere~~ or ~~ED environment without~~ electrocautery		*Scalpel or electrocautery
	*Burn dressings ~~and topical~~ antibiotics		**Electrocautery preferred when available
			*Burn dressings
			*Topical antibiotics

	==Procedure==		==Procedure==

SLuckettG: /* Contraindications */

2019-05-11T23:18:39Z

Contraindications

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	==Contraindications==		==Contraindications==
	*No absolute contraindications~~; irreversible~~ gangrenous limb may be futile		*No absolute contraindications
	*Elevated ~~IRN: not a contraindication.~~ Give ~~vitamin~~ K, ~~FFP as needed~~
	*Skin infection~~: not a contraindication~~		==Considerations==
	*~~Thrombocytopenia: not~~ a contraindication~~. Give platelets.~~		*Irreversible ischemia of a gangrenous limb may render escharotomy futile
			*Elevated INR
			**Give Vitamin K +/- FFP but do not delay procedure
			*Thrombocytopenia
			**Transfuse platelets, but do not delay procedure
			*Skin infection
			**Not a contraindication

	==Equipment Needed==		==Equipment Needed==

SLuckettG: /* Indications */

2019-05-11T23:16:35Z

Indications

← Revisión anterior		Revisión del 23:16 11 may 2019
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	==Indications==		==Indications==
			*Circumferential eschar with any of:
			**Restricted ventilation (torso)
			**Vascular compromise
			**Compartment syndrome (compartment pressure > 30 mmHg)

	==Contraindications==		==Contraindications==

SLuckettG: /* Indications */

2019-05-11T23:15:27Z

Indications

← Revisión anterior		Revisión del 23:15 11 may 2019
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	==Indications==		==Indications==
	~~{{Escharotomy burn indications}}~~

	==Contraindications==		==Contraindications==

Kxl328: /* Torso */

2018-10-31T02:50:31Z

Torso

← Revisión anterior		Revisión del 02:50 31 oct 2018
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	[[File:shield incision.JPG\|thumbnail]]		[[File:shield incision.JPG\|thumbnail]]
	*Incise at ant axillary line from level of 2nd rib to 12th rib bilaterally, incising down to level of subcutaneous fat		*Incise at ant axillary line from level of 2nd rib to 12th rib bilaterally, incising down to level of subcutaneous fat
	*May have an immediate release manifested by popping ~~sensatio~~		*May have an immediate release manifested by popping sensation
	*Join these two incisions transversely		*Join these two incisions transversely

Kxl328: /* Procedure */

2018-10-31T02:50:00Z

Procedure

← Revisión anterior		Revisión del 02:50 31 oct 2018
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	*Depth of incision controversial, may require as little as dermal release to complete subcutaneous release to fasciotomy		*Depth of incision controversial, may require as little as dermal release to complete subcutaneous release to fasciotomy
	*Apply silver sulfadiazine dressings or antibiotics with petroleum gauze after escharotomy		*Apply silver sulfadiazine dressings or antibiotics with petroleum gauze after escharotomy
			*Local anesthesia in areas of full thickness burns may not be necessary

	===Torso===		===Torso===