Wang Cecily F., Hughes Patrick G.
Straub Benioff Medical Center, University of Hawaii John A. Burns School of Medicine, OptimumAir Hawaii
Florida Atlantic University
Circumferential full-thickness burns affecting the extremities, chest, or abdomen can result in a rigid, nondistensible eschar that poses a significant risk for neurovascular and respiratory compromise. During the first 48 hours after injury, substantial fluid shifts occur from increased capillary permeability and fluid resuscitation, leading to progressive interstitial edema. When this edema develops beneath a rigid eschar, the rising compartment pressures can impair perfusion, leading to ischemia, tissue necrosis, infection, or potential limb loss. Involvement of the chest or abdominal wall can similarly compromise ventilatory mechanics and hemodynamic stability by restricting normal expansion. Escharotomy is a critical surgical intervention that decompresses affected compartments by incising the burned eschar, thereby restoring distal circulation and enabling proper ventilation. Unlike a fasciotomy, an escharotomy does not breach the deep fascial layer and is aimed specifically at relieving the constrictive effects of eschar formation. Clinical judgment is essential because there is no universally accepted objective measure to guide the timing of escharotomy. Intervention is often performed prophylactically at the earliest sign of vascular or respiratory compromise to prevent irreversible damage. Prompt surgical decision-making, guided by evolving clinical indicators and interprofessional assessments, remains central to achieving optimal outcomes for patients with severe circumferential full-thickness burns.
四肢环形三度烧伤会导致形成不可扩张的皮革样焦痂。在烧伤后的最初48小时内，由于毛细血管通透性增加以及液体复苏导致的液体转移，大量液体在间质和细胞内积聚。环形焦痂的非顺应性最终会导致骨筋膜室压力升高，并可能发展为骨筋膜室内组织缺血，继而出现组织坏死、感染或挛缩。同样的情况也可能发生在胸部和腹部，大面积的全层烧伤会妨碍胸部和腹部的充分扩张，导致呼吸和血流动力学障碍。早期进行焦痂切开术的外科干预可以预防这些有害后果，改善患者的预后。焦痂切开术是一种紧急外科手术，通过切开烧伤皮肤区域以松解焦痂及其压迫作用，恢复远端循环，并保证充分的通气。与筋膜切开术不同，筋膜切开术是专门为减压组织间隙而进行切口，焦痂切开术的切口不穿透深筋膜层。不幸的是，目前尚无客观指标来确定是否需要进行焦痂切开术，在大多数情况下，焦痂切开术是预防性进行的。最近，焦痂切开术已被归类为包括筋膜切开术、神经松解术和减压剖腹术在内的更广泛的减压治疗方法的一部分。
