Escharotomy of the trunk following full-thickness burn injury; an evidenced-based study

Dr  David Goltsman, Prof Peter Maitz, A/Prof Peter Haertsch, A/Prof Peter Kennedy

1Burns Unit, Concord Repatriation General Hospital

Objective. To determine the most appropriate sites and rationale for escharotomy incisions following full-thickness burns to the trunk.

Methods.  High-speed infrared cameras and motion capture software were used to determine the regions of maximum expansion of the chest and abdomen during respiration among healthy male volunteers in both the erect and supine positions. Expansion was observed using markers in vertical and horizontal rows over the chest and abdomen and was calculated by examining the change in distance between the lines during both normal and maximum respiration. Results. There were significant differences in the expansion of the chest and abdomen in the erect and supine positions. In the supine position, the maximum expansion of the chest occurred with respiration both laterally and anteriorly, particularly at the lower end of the sternum. However, in the abdomen the greatest movement occurred in an anterior direction, maximal in the mid and upper abdomen.

Conclusions. The most appropriate sites for escharotomy of full-thickness burns to the trunk would involve an incision in both mid axillary lines throughout the full length of the eschar to allow forward expansion of both the chest and the abdomen.  When burns involve both abdomen and chest, a complete separation of the chest and abdominal eschar is essential. This is best achieved by a curved horizontal subcostal incision joining the axillary incisions and is necessary to permit anterior movement and expansion of both the chest and the abdomen.

David Goltsman completed his MBBS at Sydney University, and concurrently completed a PhD with the Concord Burns and Reconstructive Surgery Department. He is currently a General Surgery Registrar at the Prince of Wales Hospital, Sydney.

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