A 35-year-old woman with 40% TBSA flame burns develops circumferential full-thickness burns of both lower limbs. Six hours after admission her feet become cold, pale, and pulseless despite adequate resuscitation. The most appropriate immediate intervention is:

• A Fasciotomy of all four compartments of both legs
• B Application of elevation and warm compresses with limb repositioning
• C Increase in fluid rate by 50% and reassessment in one hour
• D Escharotomy through the burned skin along the lateral aspects of both limbs ✓

Explanation

A tight circumferential full-thickness eschar constricts the limb like a tourniquet as oedema accumulates beneath it, producing distal ischaemia. The treatment is escharotomy, longitudinal incisions through the eschar along the lateral and medial limb lines, extending onto the digits if needed. It is done at the bedside and requires little or no anaesthesia because the eschar itself is insensate. Fasciotomy is reserved for true deep compartment involvement such as electrical injury, and raising fluid rate worsens the swelling.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.