A 40-year-old woman with 35% TBSA full thickness circumferential burns of both lower limbs develops cool toes with absent capillary refill 6 hours after admission despite adequate resuscitation. Which statement about the required procedure is correct?

• A It requires general anaesthesia because the incision passes through dermis
• B It converts a full thickness burn into a partial thickness burn to allow healing
• C It should be delayed until eschar separation occurs spontaneously
• D It is performed along the medial and lateral aspects of the limb through the eschar ✓

Explanation

Circumferential full thickness eschar acts as a tourniquet as oedema accumulates beneath it, compromising distal circulation. Escharotomy involves longitudinal incisions through the inelastic eschar along the mid medial and mid lateral lines of the limb, extending into bleeding subcutaneous fat until flow returns. Because the eschar is insensate, the procedure needs little or no anaesthesia, making option A wrong. It does not change burn depth or promote healing; it is purely a decompressive procedure and must not wait for spontaneous separation.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.