A 50-year-old woman with 55% TBSA full-thickness circumferential burns of both lower limbs develops progressive coolness, mottling and absent Doppler signals in the feet 6 hours after admission, despite adequate resuscitation volumes. The correct immediate intervention is:

• A Fasciotomy of both calves in theatre under general anaesthesia
• B Immediate excision and grafting of the burned areas
• C Increase fluid infusion rate by 50% and reassess in 2 hours
• D Escharotomy through the burnt skin along the mid-lateral lines at the bedside ✓

Explanation

Circumferential full-thickness burns form a rigid inelastic eschar that constricts the limb as oedema accumulates, threatening distal perfusion. Loss of Doppler signals mandates escharotomy, performed with longitudinal mid-lateral incisions through the insensitive eschar down to bleeding dermis, usually at the bedside without anaesthesia because the dead burnt tissue is insensate. Fasciotomy is needed only if muscle compartments remain tight after escharotomy. Escalating fluids risks fluid creep and abdominal compartment syndrome rather than restoring flow.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.