A 40-year-old woman with 35% TBSA full thickness circumferential burns of both lower limbs developed 6 hours ago now complains of increasing tightness and pain in the legs. Distal pulses are still palpable but the toes are becoming dusky. The most appropriate intervention is:
- A Elevation of both limbs and observation with hourly pulse checks
- B Fasciotomy of all four compartments of both legs
- C Escharotomy of the burned limbs ✓
- D Immediate increase in fluid resuscitation rate
Correct answer: C. Escharotomy of the burned limbs
Explanation
Circumferential full thickness burns form a rigid, non-distensible eschar that constricts the limb as oedema accumulates, causing vascular compromise. Palpable pulses are a late sign, so waiting for their loss delays decompression. Escharotomy, a longitudinal incision through the burnt skin only, relieves constriction. Fasciotomy is reserved when muscle compartments themselves are involved, as in electrical or crush injury.
Reference: Sabiston Textbook of Surgery, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.