The morbidity associated with paediatric burn wound escharotomies

Abstract

Introduction An escharotomy is an effective surgical procedure for the rapid decompression of a constricting and unyielding eschar, to permit restoration of blood flow. However, an escharotomy is also a full‐thickness incision, which adds additional scarring to the burn injury area. The cosmetic and functional morbidity of escharotomy scarring in children is poorly characterised. Methods Children who required a burn wound escharotomy at the Queensland Children's Hospital (QCH) between May 2011 and May 2020 were included. Demographics of these children were described. In addition, the number of operations for revision of escharotomy scars was recorded as an indicator of functional or cosmetic concern. Results A total of 19 patients required an escharotomy after a burn injury. Children with 1% to 96% TBSA burns required an escharotomy, with a median of 28% (IQR 10–39%) TBSA. Two patients (81% and 96% TBSA) died. Seventy‐one percent (12/17) of survivors had operative revisions of their escharotomy scars. The median time from burn to first scar intervention was 35 weeks (IQR 19–70 weeks). Conclusion There is substantial morbidity associated with escharotomies in children. Further investigation of the current methods of decompression after burn injury, and the long‐term morbidity of escharotomy, is required.

Variables Influencing the Differential Host Response to Burns in Pediatric and Adult Patients

“…Escharotomies are, by necessity, full thickness injuries, but subsequent operative debridement in children may not require excision to subcutaneous fat, leading to an uneven appearance with differential healing. This process is also occurring in the setting of continued limb growth in pediatric patients (89). As scar formation in children with burns has been strongly linked to social anxiety and negative self-image, it is important to be deliberate with the decision to perform an escharotomy, with care taken to minimize the number of incisions needed to effectively decompress the affected compartment (89).…”

“…This process is also occurring in the setting of continued limb growth in pediatric patients (89). As scar formation in children with burns has been strongly linked to social anxiety and negative self-image, it is important to be deliberate with the decision to perform an escharotomy, with care taken to minimize the number of incisions needed to effectively decompress the affected compartment (89). Alternative methods include enzymatic debridement that is gaining popularity in the United States but is actively undergoing clinical trials and will not be covered in this review.…”

“…Surgical release of eschar can lead to improvements in circulation and prevention of development of compartment syndrome. Escharotomies involve longitudinal incisions on lateral and medial aspects of extremities and digits, with a slightly more varied pattern across the thorax (89). Crossing joint spaces in the extremities allows for adequate decompression.…”