A 30-year-old woman with 55% TBSA flame burns has full thickness circumferential burns of both lower limbs. Twelve hours later her toes are cool, capillary refill is absent, and Doppler signals in the dorsalis pedis and posterior tibial arteries are no longer detectable despite adequate resuscitation. The most appropriate procedure is:

• A Fasciotomy of all four compartments of both legs
• B Escharotomy along the medial and lateral aspects of both limbs ✓
• C Elevation of limbs and continuation of fluid resuscitation
• D Early tangential excision and grafting of the burned areas

Explanation

Loss of pulses in a circumferential full thickness burn means the rigid inelastic eschar is constricting the limb like a tourniquet. Escharotomy, longitudinal incisions through the eschar along the medial and lateral aspects of the limb made at the bedside without anaesthesia because the eschar is insensate, restores distal perfusion. Fasciotomy is needed only when muscle compartments themselves are involved, as in electrical or deep crush burns. Excision and grafting address the wound later, not acute vascular compromise.

Reference: Total Burn Care (Herndon), 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.