Name of the Procedure:

Escharotomy; initial incision

Common Names: Escharotomy, Escharotomy incision
Technical/Medical Terms: Escharotomy, Eschar incision

Summary

An escharotomy is a surgical procedure where deep cuts are made through dead and burned skin to relieve pressure, restore blood flow, and improve breathing. This procedure is often necessary in cases of severe burns, where the skin has become tough and rigid, restricting circulation and hindering respiration.

Purpose

Condition Addressed: Severe third-degree burns, circumferential burns, compartment syndrome
Goals: To alleviate pressure, prevent tissue necrosis, restore blood flow, and improve respiratory function

Indications

Symptoms/Conditions:

• Severe burns leading to tight, inelastic skin (eschar)
• Restricted blood flow and compromised circulation
• Signs of compartment syndrome or respiratory distress due to chest or limb constriction

Patient Criteria:

• Individuals with severe third-degree or full-thickness burns, especially those encircling a limb or torso

Preparation

Pre-Procedure Instructions:

• Patients are often already in critical care; specific preparations depend on the situation
• Ensure the burn area and adjacent skin is clean to minimize infection

Diagnostic Tests/Assessments:

• Physical examination to assess the severity and extent of burns
• Monitoring of vital signs and blood flow
• Imaging studies (if available) to understand the extent of tissue damage

Procedure Description

Step-by-Step:

1. Anesthesia: Local or general anesthesia is administered based on patient needs and burn severity.
2. Sterilization: The affected area is sterilized.
3. Incision: A scalpel is used to make precise cuts through the dead skin (eschar) down to healthy tissue, avoiding veins, tendons, and nerves.
4. Extension: Incisions are extended as needed to fully relieve pressure.
5. Assessment: Additional incisions may be made if initial cuts do not sufficiently relieve pressure.

Tools: Scalpel, antiseptic solutions, monitoring equipment
Anesthesia/Sedation: Local or general anesthesia, depending on the size and location of the burns

Duration

Typically 45 minutes to 1 hour, depending on the extent of the burns and the number of incisions needed

Setting

Usually performed in a hospital setting, specifically in an operating room or a burn unit

Personnel

• Primary: Surgeons specializing in burns or trauma
• Support: Nurses, anesthesiologists, and possibly respiratory therapists

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Pain

Rare Risks:

• Damage to underlying tissues (nerves, veins)
• Worsening compartment syndrome
• Delayed healing

Management: Close monitoring for infection, immediate care for any signs of complications, follow-up treatments

Benefits

Expected Benefits: Relief of pressure, restoration of blood flow, improved breathing, prevention of further tissue damage
Realization Timeline: Immediate to within a few hours post-procedure

Recovery

Post-Procedure Care:

• Wound care and dressing changes
• Pain management with medications
• Monitoring for signs of infection or complications

Recovery Time: Several weeks to months, depending on the severity and complications

Restrictions/Follow-Up: Avoid strenuous activities, regular follow-up with a burn specialist, physical therapy as needed

Alternatives

Other Treatment Options:

• Fasciotomy (for severe cases of compartment syndrome)
• Advanced wound care techniques
• Hyperbaric oxygen therapy

Pros and Cons:

• Pros of Alternatives: Less invasive options may suffice for minor burns or injuries
• Cons of Alternatives: May not provide immediate pressure relief, higher risk of further damage if escharotomy is delayed

Patient Experience

During Procedure:

• Under anesthesia, should not feel pain but may experience pressure or mild discomfort

After Procedure:

• Post-operative pain managed with medication
• Possible swelling and restricted movement initially
• Gradual improvement in symptoms as healing progresses

Pain Management/Comfort Measures:

• Pain relievers, anti-inflammatory medications, careful monitoring, and regular wound dressing changes to enhance comfort.