Fasciotomy

Optimal fluid resuscitation and prompt escharotomy usually mitigates the need for fasciotomy. Consider fasciotomy in the operating room (OR) if pulses remain undetectable after complete escharotomy.

Due to the frequency of extremity injuries seen among combat casualties, fasciotomies on burned extremities may be required for those with:

- delayed revascularization.
- hemorrhage requiring massive resuscitation.
- fractures, crush, or blast injuries.

Following escharotomy or fasciotomy, late bleeding may occur as circulation is restored. Examine the surgical site every few minutes for up to 30 minutes for signs of new bleeding, which is usually easily controlled with electrocautery.

Refer to Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds CPG for additional information. 23