Piccolo NS, Piccolo MS, Piccolo PD, Piccolo-Daher R, Piccolo ND, Piccolo MT, et al.
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemein.... Date of publication 2007 Jun 1;volume 39(3):161-7.
1. Handchir Mikrochir Plast Chir. 2007 Jun;39(3):161-7.
Escharotomies, fasciotomies and carpal tunnel release in burn patients--review of
the literature and presentation of an algorithm for surgical decision making.
Piccolo NS(1), Piccolo MS, Piccolo PD, Piccolo-Daher R, Piccolo ND, Piccolo MT.
Author information:
(1)Plastic Surgery, Pronto Socorro para Queimaduras, Goiânia, Brazil.
nelson-piccolo@hotmail.com
Escharotomies are usually performed in patients with circumferential third degree
burns of the extremities or anterior trunk. Fasciotomies are recommended for
patients who sustained high voltage (or associated crush) injuries, with entrance
or exit wounds in one or more extremities. Carpal tunnel release is practiced
routinely in some services for cases of electrical injury. We have reviewed the
literature which provides relatively little information as to when should these
procedures actually be performed and what would happen if they were not done. We
present a series of patients treated at our institution when an algorithm was
used for surgical decision making as to when (or not) to operate (perform an
escharotomy, a fasciotomy or a carpal tunnel release), based on clinical signs
and monitoring alternatives, using the oximeter and the Doppler flowmeter. 13 938
burn patients were treated at our institution during the year of 2005. Of these,
571, with an average of 22.3 % TBSA, were treated as inpatients. Of these, 58
(10.3 %) had circumferential or electrical burns of one or more extremities.
Patients were monitored hourly from admission and decision to operate was based
on clinical signs and in absent or below 90 % oximetry, regardless of Doppler
flow signs. 68 % were males, 6 (11.3 %) patients had immediate escharotomies,
while 4 (7.5 %) had immediate fasciotomies. 2 of these patients were operated
regardless of positive Doppler sign but no oximetry. All patients recovered
oximetry over 90 % immediately after the operations. 3 patients had negative
Doppler sign but oximetry > 90 % and were not operated. 3 patients had carpal
tunnel releases based on oximetry < 90 % and symptoms of compression of the
median nerve. Patients who were not operated fared well with no signs or symptoms
of impairment of circulation or nerve damage up to their 3 and 6 months
reevaluations.
DOI: 10.1055/s-2007-965322
PMID: 17602377 [Indexed for MEDLINE]
