What Is an Escharotomy?

An escharotomy is a surgical procedure to cut through layers of thickened dead tissue on a burn victim's body. This tissue, called eschar, can restrict circulation and may potentially lead to damage in the extremities. In a situation where a doctor believes a patient's circulation is compromised, it may be necessary to use an escharotomy to relieve pressure and restore circulation. The procedure ideally takes place in a burn unit and may involve specialists familiar with wound care needs for burn victims.

People with severe burns develop a thickened layer of eschar during the healing process. This material covers fragile internal structures and may need to be left in place while the patient heals, as removing it would effectively skin the patient. However, the thick layers of dead tissue also pose some risks. Fluid can build up underneath, causing painful swelling, and the combination of thick tissue and swelling may limit circulation. Furthermore, patients can develop contractures, where their muscles contract and do not release, because the thick tissue may limit freedom of movement.

Surgeons can determine if a patient needs an escharotomy with a careful examination. This may involve the use of doppler radar to check circulation, oxygen saturation tests on the blood, and gentle stretches to determine a patient's range of movement. The eschar itself is dead and has no nerve endings. Care providers can cut through it without anesthesia, but the patient may require sedation for comfort as the release of pressure can be painful.

In the escharotomy procedure, the care providers position the patient on a surgical table and provide a level of anesthesia or sedation appropriate to the case. Burn victims can experience intense pain when they are moved or handled, and general anesthesia may be necessary for comfort. It may also be necessary to secure the airway, as some patients have inhalation damage that can be a cause for concern. Once the patient is ready, the escharotomy surgeon can carefully cut through the eschar to expose the underlying tissues and relieve the pressure.

As the patient recovers from the burns, the eschar can slowly be removed. Burn patients may need skin grafts to replace missing or severely damaged skin, along with careful management of wound dressings to provide as much protection as possible to the living tissue underneath. Weeks or months in a burn unit may be required, followed by reconstructive plastic surgery to address the deep scarring and other injuries common in burn victims.