A literature review of the urgency of burn victim escharotomy and fasciotomy, and an algorithm for management during the COVID-19 pandemic

Abstract

Background. If a circumferential limb deep partial or full-thickness burn occurs, compartment syndrome can develop. Although several factors affect the outcome of patients who develop compartment syndrome, the most important salvage treatment is an early release of the compartment under pressure by a fasciotomy. However, COVID-19-related fear from doctors may cause some hesitancy to enter a hospital, and hesitancy to interact with patients. Objectives. To provide a literature review of the urgency of burn victim escharotomy and fasciotomy, and to provide a practical algorithm for use during the COVID-19 pandemic. Methods. We used a literature review to search the following key words as search phrases: compartment syndrome; burns; fasciotomy and escharotomy; COVID-19. We searched with the following search engines: Pubmed and Medline. We limited the articles searched to the period 2015 - 2020. We decided not to include abdominal compartment syndrome in the search, but rather to focus on limb compartment syndrome. Results. We included 8 of 14 screened articles, which were relevant to our search. We found no articles discussing the effect of the COVID-19 pandemic and compartment syndrome on burns. Most authors suggest early escharotomy and early fasciotomy. Conclusion. Based on the literature review, it is our recommendation to do a fasciotomy immediately once the diagnosis is made. From the onset of compartment syndrome until fasciotomy, there should be no more than 3 hours’ delay. In patients with circumferential burns that are deep or are converting to full-thickness, it is necessary to do escharotomies where necessary. Hourly monitoring of limbs with escharotomies is essential, and it is important to communicate this clearly to nursing staff. It is important in the environment of the fear related to the COVID-19 global pandemic that the urgency of escharotomy and fasciotomy is not delayed.