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AUTHORS:
Robert H. Demling, M.D.
Leslie DeSanti R.N., Dennis
P. Orgill, M.D. PhD.
Section
4
Impaired Distal Perfusion And
Need For Escharotomy
As
subeschar edema develops under the burn tissue,
pressure increases.
Problems
of Measuring Tissue Preasure
- occurs with circumvential deep burn
- edema increases tissue pressure decreasing venous return
- this accelerates further measured pressure impairing
arterial flow
- eschemia results
- escharotomy necessary
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Perfusion
to the distal extremity must be closely monitored.
Pain and color will be unreliable indicators of
perfusion in the presence of a burn to the area. A
warm extremity invariably indicates good flow during
this period, but a cool skin does not always indicate
that the problem is due to proximal burn constriction.
Hypovolemia may well be the problem.
Steps
for the prevention and treatment of impaired distal
perfusion:
- Remove constricting objects
- Immediate elevation of burned extremities
- Early escharotomies on circumferential third or
fourth degree burn
- Decreasing Doppler flow signal with adequate blood
pressure or tissue pressure more than
25
mmHg means escharotomy is needed
Escharotomy must extend completely through the burn
tissue
Hemostasis is obtained with pressure,
cautery, or
microcrystalline collage
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Unless
decreased blood flow is evident in the ED, the
escharotomy should be performed in the burn center if
transfer is expedited. In general, finger
escharotomies should be performed in a burn center
environment because of the associated potential
morbidity.
CIRCUMFERENTIAL DEEP BURN
Check blood flow to hand by Doppler. Anticipate an
increasing problem over time post burn as sub-eschar
edema evolves. Will need escharotomy
Standard
Incision Lines |
Escharotomy |
C ircunferential
Deep Burns
  
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