Definition & Overview
Full thickness burns, also called third-degree burns, are life-threatening conditions. In fact, studies in the United States revealed that 69% of patients with third-degree burns covering 70% of their body died because of their injuries.
However, even with such a high rate of mortality, it is still possible to survive the condition. Studies showed that a patient has a higher chance of surviving if the right treatment is provided within the first 24 hours following the injury.
The type of treatment a burn patient requires will depend on the severity of the injury and the percentage of the body that has been affected. Patients with severe burns that cover a high percentage of their body may likely require an emergency burn treatment procedure called an escharotomy.
The danger of a third-degree burn on the torso, limbs, and digits is that burnt skin turns into a leathery substance called eschar. Both the dermis and epidermis layers are also destroyed. In some cases, tissue underneath the skin layers may also be damaged.
As a result, fluids from damaged capillaries and vessels have no way of leaving the body. Instead, the fluids are trapped underneath the layer of eschar resulting in an oedema.
An escharotomy prevents this situation from progressing. The procedure involves incising canals or pathways along a specific route to enable the skin to expand.
Escharotomies need to be performed as early as possible in a sterile environment. This can be at a mobile trauma centre, inside the emergency department of a hospital, or in an operating room.
However, statistics show that the majority of escharotomies are not performed in the emergency department. Instead, the patient is first transferred to a burn unit.
Who Should Undergo & Expected Results
Escharotomy is only performed on patients with a full-thickness burn that affects the neck, chest, and extremities.
Although it could be a life-saving procedure, successful results are not guaranteed. Aside from burnt skin, other factors may also contribute to the patient’s death, such as smoke inhalation and other injuries sustained.
Moreover, the possibility remains that any affected limbs may need to be amputated due to severe infections or loss of tissue, muscles, and/or bone.
How Does the Procedure Work?
The first step in treating severely burnt patients is to remove any materials from their body. These include pieces of clothing or jewellery. A doctor or emergency health services provider will then assess the patient’s condition. If needed, an emergency escharotomy may be performed.
If not, the patient may be transferred to a hospital’s emergency department. As mentioned earlier, many emergency departments do not perform escharotomies. Instead, they transfer the patient to a tertiary burn centre for further treatment.
Once in the hospital’s operating room, the patient may be given sedatives to help him/her relax. At this point, the patient will not have any sensation in the skin, but sedatives or anaesthetics are still provided. The surgeon will then mark the areas for incision, which may include the chest, neck, and any affected limbs. Using a scalpel or a cutting diathermy (cutting device that uses heat produced by electricity), the surgeon will create an incision along the marked lines. The depth of the incision is around 1cm or through the epidermis and dermis layers of skin.
The surgeon will take care not to cut through nerves and vessels directly underneath the skin. These include the ulnar nerve, peroneal nerve, saphenous nerve, and long saphenous vein. After the procedure, the patient will receive further treatment before the wounds are covered with skin grafts.
Possible Risks and Complications
An escharotomy is performed to increase the chances of the patient surviving third-degree burns. However, there are risks involved. There is also a possibility that complications may develop.
The success of an escharotomy relies heavily on the skills of the surgeon. But even under the hands of a highly skilled surgeon, there is still a risk of excessive bleeding, infection, and unintentional damage to nerves and vessels underneath the skin.
There is also a possibility that a portion of a limb may be damaged beyond repair and will need to be amputated. Amputations may result in gangrene or infections that could lead to septic shock.
Open wounds created in an escharotomy are also prone to infections. As such, the wounds are treated in the same manner as burn wounds.
Moreover, the patient may be subjected to psychological distress not only from the event but also from the actual procedure, which involves creating long incisions on the body and limbs.
Skin grafting may be able to reduce the appearance of such incisions, but will not totally cover them. Amputations could also add to the mental anguish that a patient may go through during and after the recovery process.
After the procedure, physical therapy is highly recommended so patients can regain their movement. More importantly, they will also have to undergo psychological therapy to recover from the mental trauma brought forth by the accident and escharotomy procedure.
Neelu Pal MD, E. Schraga Md,; “Emergency Escharotomy”; http://emedicine.medscape.com/article/80583-overview?pa=EdjOalOzftWMHoo2CD4X0%2FKjQ1ZjI2%2FrF8DFKS%2BDYSjj3Z6Qv53zdvXkhsoLL%2BgELETtYfFORRSsy9UTYatHiLOwhd8Mdk7tVO%2FdkscsGC4%3D#a9
Alabama Department of Public Health; “Responding to Victims with Burn Injuries in Disaster Events”; http://www.adph.org/ALPHTN/assets/072109handouts.pdf C. Nickson; “Releasing the Roman Breastplate”; http://lifeinthefastlane.com/trauma-tribulation-005/