Editing Burns (section)

=== '''Escharotomies''' ===

** Required when compromised circulation may be present due to the combination of unyielding eschar and generalised oedema (initially venous, then arterial)
*** Assess as for compartment syndrome
*** Generally don't do prophylactic escharotomy at a peripheral site if transfer is planned same day, because the problem usually arises after 12 hours of resuscitation causing third-spacing
*** Required more often with circumferential burns, but can be needed with non-circumferential too
** Can also occur on trunk, with restriction of ventilation
** Perform at bedside or OT by incising the lateral and medial aspects of the extremity, completely through the eschar, with a scalpel or diathermy. Must incise the entire constricting eschar longitudinally.
*** Stop once healthy fat is seen and the tissue springs about 1cm apart - don't need to go down to fascia
** For upper limb, carry incision down onto thenar/hypothenar eminences, and sometimes even fingers. 
** Reperfusion injury can occur afterwards
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