Source: Figure 26.2-1 Emergency War Surgery; Fourth United States Revision; 2013 (page 379).

 

CLINICAL INDICATIONS:

Deep partial-thickness or full-thickness circumferential burns to arms or legs.

Circumferential, full thickness burns to the chest wall.

CONTRAINIDICATIONS: No contraindications

EQUIPMENT:

  1. Scalpel, an electrocautery device, or both
  2. Chlorhexidine prep
  3. Combat gauze and Kerlix
  4. Sterile towels

PROCEDURE:

1. Remove patient’s rings, watch, and other jewelry during the initial examination.

2. Prep sterile items/equipment.

3. Outline or identify landmarks.

4. Follow guidelines to make escharotomies bilaterally (medial and lateral) down to the subcutaneous tissue.

a. Preferred sites of escharotomy (dashed and solid lines). Particular care is needed to divide eschar over involved joint (solid lines). Care must be taken to avoid major nerves, vessels, and tendons.

b. The incision along the extremities should extend through the length of the eschar, over joints, and down to the subcutaneous fat, laterally and medially.

c. Chest incisions usually are made bilaterally along the anterior axillary lines and are connected by a transverse incision at the costal margin.

5. Repeat pulse exam in all extremities, if there is no return of circulation return to step 4.

6. Achieve hemostasis with combat gauze and dry Kerlix.

7. Skin color, sensation, capillary refill, and peripheral pulses are assessed and documented hourly.