A Retrospective Analysis of Complications of Patients Requiring Single and Multiple Site Escharotomies

K Louly Nathan, M Nizamoglu, D Barnes, N El-Muttardi, P Dziewulski

Objectives 

Escharotomies are a mainstay of emergency burns care. Escharotomies of the neck and chest are performed to allow adequate ventilation and of the limbs to improve circulation in circumferential deep burns. This study aimed to review the outcomes and complications of escharotomy patients within the burns population. 

Method 

A retrospective review was conducted of all patients who required escharotomies seen at a regional burns centre in the United Kingdom over a 10 years period. All patients coded with escharotomy on the international burns database were included. Number of complications and mortality outcomes were recorded. 

Results 
95 patients were identified who required escharotomies ranging from 2-95% TBSA (mean 47.7%).  77.9% (74) were male and 22.1%(21) were female. A total of 231 complications were collated from 95 patients. Overall there was a 37.9% (36) mortality rate.  Of the 95 patients requiring escarotomies 18.9% (18) were done prior to admission to a burns unit, 12.6% (12) deemed adequate and 6.3% (6) requiring extension, 81% (77) were done on admission. Escharotomies performed pre-admission that were adequate had an average TBSA% of 52% , mortality of 33.3% (4) and an average complication rate per patient of 1.25. Escarotomies performed pre-admission requiring extension had an average TBSA% of 60.3%, mortality of 83.3% (5) and an average complication rate per patient of 4.33. Escarotomies performed on admission had an average TBSA% of 46.1%, mortality of 35.1% (27) and an average complication rate per patient of 2.4 

Conclusion:

The results show that better outcomes are achieved when adequate escharotomy is performed at the referring unit. Patients with inadequate escharotomies on arrival who needed extension or further Escharotomy had more complications and higher mortality.