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Injuries Due to Burns and Cold
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Escharotomies are needed only if there is circulatory or ventilatory compromise, which does not usually occur until several hours after the injury, as the oedema increases—this means that it is a procedure rarely necessary outside of a specialist burns unit. It is also rarely necessary for a non-specialist doctor to carry out escharotomy but, if it is, it should not be undertaken without prior discussion with the eventual receiving burns centre. Sufficient anatomical knowledge to site the escharotomy incisions avoiding superficially located nerves, such as the ulnar nerve, is essential (Figure 27.6). Escharotomy involves incisions into unburnt tissues and bleeding may be heavy. Electrocautery must be available. Appropriately equipped and resourced burns centres may proceed directly to total early burn excision, thereby eliminating the need for separate escharotomy.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
The patient has circumferential burns on his upper limbs. What would you do?There should be rapid assessment of the hands to confirm adequate perfusion and sensibility. If there is concern, the patient will require an urgent escharotomy: In the upper limbs, this is done by performing two parallel incisions on the radial and ulnar borders of the forearm and arm, through the burnt skin, into the unburnt subcutaneous fat. Care must be taken especially near the elbow and wrist, not to injure the radial or ulnar neurovascular structures.This procedure should ideally be performed in the operating theatre, but if it needs to be done in the ED, an electrocautery unit (bipolar diathermy is normally sufficient) and appropriate dressings should be readied prior to starting the procedure. It should be performed under sterile conditions.
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Consider the need for escharotomy in the following: Circumferential, leathery, full-thickness burns that may cause distal ischaemia in limbs or digits by restricting blood flow, and respiratory compromise by constricting chest wall movements.Ask the surgical or burns unit team to perform relieving incisions through the burn area.
Enzymatic debridement: past, present, and future
Published in Acta Chirurgica Belgica, 2022
Ignace De Decker, Liesl De Graeve, Henk Hoeksema, Stan Monstrey, Jozef Verbelen, Petra De Coninck, Els Vanlerberghe, Karel E. Y. Claes
Surgical escharotomy for BICS may sometimes be delayed because of logistical shortcomings or even avoided due to its invasiveness, especially by inexperienced surgeons on the other hand it is sometimes performed although not necessary. A safe, non-surgical debriding tool that offers early burn eschar removal on admission, releases (or prevents) BICS with increased preservation of native dermis and/or subcutaneous tissue over the intricate tendinous and vascular structures may provide a minimally invasive modality. It has been proven that already 30 min after employing enzymatic debridement, the compartment pressure decreases below 30 mmHg [86]. This reduction will stand even after removing the product. Fischer et al. reported on the use of NexoBrid® for preventing the need for and morbidity of operative escharotomy [37].
Ecthyma gangrenosum of the eyelid in an immunocompromised patient
Published in Orbit, 2021
Natalie A. Homer, Aliza Epstein, Paul M. Hoesly
Ecthyma gangrenosum is a rare complication of pseudomonas bacteremia, primarily affecting immunocompromised patients, but may also be found in children and immunocompetent adults. Lesions may affect the face in 6% of cases, and initially appear as painless red macules and progress to induration, bullae and eventual gangrenous ulceration. Herein we report the fifth case to affect the periorbital area. Management includes surgical debridement and escharotomy, followed by systemic antibiotic therapy. The wound may be allowed to heal by granulation or be managed with delayed reconstruction following bacterial eradication. Ecthyma gangrenosum should be considered in cases of periorbital necrosis, particularly in immunocompromised patients and those with pseudomonal sepsis.
Enzymatic debridement of hands with deep burns: a single center experience in the treatment of 52 hands
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Mehran Dadras, Johannes M. Wagner, Christoph Wallner, Alexander Sogorski, Maxi Sacher, Kamran Harati, Marcus Lehnhardt, Björn Behr
The first 20 hands were treated 2014–2016 with 13 of them being deep partial thickness burn depth. Of these, 10 (69.2%) received operative intervention with skin transplantation after a median of 3 days post debridement. Of the 25 hands with deep partial thickness burns treated 2017–2019, only four (16%) received operative intervention after a median of 14 days post debridement. Overall, 21 out of 24 hands (87.5%) treated 2014–2016 but only 11 out of 28 hands (39.3%) treated 2017–2019 received surgery (p = .001). No escharotomy was needed in any of the treated hands.