A 40-year-old man sustains circumferential full thickness burns to both upper limbs 8 hours after injury. He now has progressive difficulty in maintaining hand perfusion despite adequate fluid resuscitation, with cool digits and absent capillary refill. The most appropriate intervention is:

• A Increase fluid rate by 50 percent
• B Escharotomy along the medial and lateral aspects of the limbs ✓
• C Fasciotomy of both forearms through the flexor compartment
• D Application of silver sulfadiazine and limb elevation

Explanation

An inelastic full thickness eschar constricts the underlying tissues as oedema accumulates, causing vascular compromise of the limb. Escharotomy, longitudinal incision through the burned skin along the medial and lateral aspects down to bleeding fat, releases this constriction and restores flow. Fasciotomy is reserved for deeper muscle compartment involvement such as high voltage electrical injury where compartment pressure itself is elevated.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.