THE ADEQUACY OF LIMB ESCHAROTOMIES-FASCIOTOMIES AFTER REFERRAL TO A MAJOR BURN CENTER

To determine the frequency of inadequate decompression and its complic ations, the medical records of 108 pediatric burn patients requiring e scharotomies or fasciotomies were reviewed. Of 108 patients, 100 (93%) had escharotomies or fasciotomies performed at an outlying facility b efore transfer. Of these 100 patients, 44 (117 limbs) were inadequatel y decompressed and required further decompression after admission to o ur facility. Initial mean compartment pressures were 50.3 +/- 1.3 mm H g, which were reduced to 16.3 +/- 0.5 mm Hg after decompression. Pulse s were present in 74% of limbs requiring decompression. Twenty limbs r equired decompression despite noncircumferential burns. Complications of inadequate or delayed decompression included foot drop in 20 patien ts (35 limbs) and muscle necrosis in 13 patients (23 limbs). Four pati ents (seven limbs) required amputations because of progressive muscle necrosis and infection. Complications of the procedure itself were lim ited to bleeding in three patients. In conclusion, compartment pressur es should be followed in patients with significant burns since pressur es may increase over time and pulses are not predictive of ischemia. F ailure to decompress extremities with elevated pressures leads to sign ificant but preventable complications.