Escharotomy
The medical term for making incisions in slough or eschar (dead tissue) is "escharotomy." 1
Definition and Purpose
Escharotomy is a surgical procedure involving longitudinal or horizontal incisions through inelastic eschar to decompress underlying tissue and restore circulation. 2, 3 The procedure is performed to:
- Release pressure in circumferential third-degree burns that constrict underlying compartments 1
- Restore blood flow to ischemic limbs and prevent tissue necrosis 3
- Improve respiratory mechanics when chest wall expansion is compromised 3
- Prevent compartment syndrome with its associated complications including acute limb ischemia, neurological disorders, and downstream necrosis 1
Clinical Context and Indications
The procedure differs fundamentally from simple debridement, which removes necrotic tissue but does not address the constricting pressure of intact eschar. 1, 4
Escharotomy should be performed within 48 hours of emergence of circulatory impairment or intra-abdominal hypertension in burn patients. 1 The only urgent immediate indication is compromised airway movement and/or ventilation. 1
Technical Considerations
- Incisions must extend through the full thickness of the eschar until tissue gapes sufficiently to release vascular pressure 3
- The procedure is performed under sterile conditions and bleeding must be controlled 3
- Multiple directional incisions may be preferable to only medial and lateral longitudinal cuts to avoid unnecessary scarring 4
Important Caveats
This procedure should only be performed at a Burns Centre due to significant complication risks including hemorrhage, infection, and increased morbidity from poorly executed escharotomies. 1 If immediate transfer is impossible, specialist advice must be obtained before attempting the procedure. 1
The term specifically applies to burn management and should not be confused with general debridement techniques used for other types of necrotic tissue or slough in non-burn wounds. 1