Page 226 - 2026 SMOG

ESCHAROTOMY
Description
Escharotomies are performed on deep partial-thickness (2nd degree) or full-thickness (3rd degree)
burns to alleviate restriction from damaged tissue. This procedure should only be done prior
to transport of the patient by a trained provider or for emergency in-flight treatment by trained
medical personnel. Medical Directors who sign the SMOG should only allow this procedure to be
conducted by individuals under their direction on an individual or case-by-case basis. Immediately
notify a burn center or receiving physician if escharotomies are performed prior to transport.
Clinical Indications
• Deep partial-thickness or full-thickness circumferential burns to arms or legs
˚ This may mimic compartment syndrome or act like a tourniquet, reducing arterial
circulation, resulting in ischemia or necrosis of the limb.
˚ Pulses will feel diminished on exam even after elevation.
• Circumferential, full-thickness burns to the chest wall
˚ This can result in restriction of chest wall expansion and decreased compliance, causing
difficulty in oxygenating and ventilating intubated patients.
˚ Clinical manifestations of chest wall restriction include rapid, shallow respirations; poor
chest wall excursion; and severe agitation.
Contraindications
• No contraindications
Equipment
1. Scalpel, an electrocautery device, or both
2. Chlorhexidine prep
3. Combat gauze and Kerlex
4. Sterile towels
Procedure
1. Remove the 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
the eschar over the 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.
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218 • PROCEDURES