Name of the Procedure:

Escharotomy; Each Additional Incision (Separate from Primary Procedure)

Summary

An escharotomy is a surgical procedure that involves making an incision through the burned skin (eschar) to relieve underlying pressure and restore blood flow. When multiple incisions are required, each additional incision performed beyond the initial one is documented separately.

Purpose

The procedure addresses complications from severe burns, particularly circumferential burns that can constrict blood flow and breathing. The primary goal is to prevent or reduce tissue damage, improve circulation, and alleviate pressure caused by the eschar.

Indications

• Severe, circumferential burns that restrict blood flow or respiratory movement.
• Symptoms of compartment syndrome, including severe pain, numbness, tingling, and decreased pulse in the affected area.
• Evidence of impaired circulation, such as swelling, cool skin, or diminished pulses in the limbs.

Preparation

• Fasting may be required if general anesthesia is used.
• Adjustment of specific medications, particularly blood thinners.
• Pre-procedure diagnostic tests may include burn depth assessment and blood flow studies.

Procedure Description

1. The patient is positioned and prepped in a sterile environment.
2. Local anesthesia or general anesthesia is administered, depending on the extent of the burn and number of incisions.
3. The surgeon makes an incision through the thick, dead tissue (eschar) to release pressure and improve circulation.
4. Additional incisions are made as necessary, each documented separately to ensure comprehensive treatment.
5. The wounds are dressed, and bleeding control measures are applied as needed.

Duration

The duration varies but typically ranges from 30 to 60 minutes, depending on the number of incisions needed.

Setting

Performed in a hospital or surgical center, often in an operating room equipped for sterile procedures.

Personnel

• Surgeon specializing in burn care or trauma
• Anesthesiologist or nurse anesthetist
• Surgical nurses and possibly a burn specialist team

Risks and Complications

• Bleeding from the incision site
• Infection
• Damage to underlying tissues, nerves, or blood vessels
• Scarring or delayed wound healing
• Potential need for additional surgeries

Benefits

• Improved blood circulation and respiratory function
• Prevention of further tissue damage
• Relief from pain and pressure

Recovery

• Post-procedure observation for complications such as bleeding or infection
• Wound care instructions, including dressing changes and hygiene
• Pain management with prescribed medications
• Activity restrictions and guidance on physical rehabilitation
• Follow-up appointments for wound assessment and possible additional treatments

Alternatives

• Non-surgical interventions, such as loosening bandages, although these are often insufficient for severe burns.
• Fasciotomy, a more invasive procedure when deeper tissue pressure relief is needed.

Patient Experience

During the procedure, if under local anesthesia, the patient may feel pressure or slight discomfort at the incision site. After the escharotomy, there may be pain at the incision sites managed with pain relief medications. Patients can expect to feel an immediate reduction in pressure and improvement in limb function or breathing, with full recovery varying based on the extent of the burns and individual healing rates.