An escharotomy is best carried out under controlled conditions. Usually, this means in the operating theatre.
The procedure should be explained to a conscious patient and local anaesthetic should be administered. The latter is necessary as occasionally burnt tissue is not fully anaesthetic and incisions must be extended into normal tissue.
Intravenous access should be assured and cross-matched blood should be available as bleeding is often extensive. Incisions can be made with either a scalpel or preferably diathermy haemostasis. To supplement diathermy, artery forceps and ties are often required.
The lines of incision must be carefully planned. If necessary, a drawing of the favoured lines of incision can be faxed from the local burns unit. These should be marked on the body part in advance with marker pen.
The procedure should be carried out under sterile conditions. The eschar should be incised along its full length and depth. Successful release is often heralded by obvious bleeding or 'pouting through' of deeper fat. Palpation of the length of the incision often reveals areas of residual constriction.
For limbs, if perfusion is not restored despite seemingly adequate release, suspect hypovolaemia. Deep burns into fascia and muscle may require fasciotomy.
Dressings should be light and, where relevant, permit visualisation of the distal part of an extremity. They should not be constrictive.
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