Escharotomy is surgery to treat third-degree burns. The procedure involves making an incision (cut) into the thick, leathery tissue to relieve pressure. You may need an escharotomy if the tissue affects your blood flow or your ability to breathe. It may take months for an escharotomy to heal.
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An escharotomy (eh-sk-RAH-tuh-mee) is emergency surgery. You may have this surgery if you have a third-degree burn that damages your skin and you develop thick tissue (eschar). The thick tissue can be life-threatening if it affects how your blood flows or your ability to breathe. "Decompressive incision" is another name for escharotomy.
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Third-degree burns can cause swelling from fluid buildup in your tissues. The burn also turns healthy skin into thick tissue that looks like leather. The swelling and thick tissue squeeze blood vessels in the area where you're burned. Your blood carries oxygen to your tissues. When blood can’t reach your tissues, they start to die (necrosis).
Thick tissue from a burn wrapping around your chest puts pressure on your chest wall. The pressure may feel like you’re wearing a very tight bandage that makes it hard for you to take a breath.
An escharotomy cuts through the thick tissue. This reduces pressure on your blood vessels or chest wall. Healthcare providers may also use an enzyme solution to remove thick tissue. This is an enzymatic escharotomy.
Your surgeon will explain the procedure and how it'll help you. Your burn care team will manage any preparation that you’ll need. For example, you may receive general anesthesia before your surgery. Your team will make sure you don’t eat or drink anything for several hours before the procedure.
You may receive general anesthesia, pain medication or sedation through an IV. Your plastic surgeon or trauma surgeon will:
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Your surgeon may use an enzyme solution to remove the thick tissue. This treatment doesn't hurt. Your surgeon may do it if a burn slows — but doesn't block — blood flow.
To perform an enzymatic escharotomy, your surgeon will:
Your surgeon will check your blood flow and ability to breathe. To check blood flow, they may perform:
If you have eschar around your chest wall, your provider will check to see if your breathing has improved after surgery. For example, if you needed mechanical ventilation before surgery, your provider will check that you don’t need as much — or any — breathing support.
Escharotomies treat life-threatening issues that a third-degree burn can cause. The procedure prevents tissue death (necrosis).
This surgery is usually successful — meaning it restores your blood flow or improves your breathing — if you have surgery before lack of blood flow causes muscle to die. But you may need more than one procedure.
It’s important to remember that an escharotomy treats only one complication that a severe burn causes. Your body still needs to recover from the burn.
Surgery to remove thick tissue may cause complications, like:
The surgery may leave a thick raised (hypertrophic) scar. You may need scar revision treatment to make the scar less noticeable.
An escharotomy incision (cut) may take weeks or months to heal. Healing may depend on factors like other surgeries for a third-degree burn. Your situation may be different from what others experience, so don’t hesitate to ask your surgeon what you can expect.
Your healthcare team will keep an eye on the escharotomy surgery site. They’ll watch for and treat surgery site infections if they develop.
The difference is how surgeons treat a buildup of pressure in your body. In an escharotomy, your surgeon cuts through thick tissue (eschar) but doesn’t cut into your fascia. Fascia is a type of connective tissue that wraps around and supports every structure in your body. A fasciotomy is treatment for compartment syndrome.
No, it’s not. A skin graft is surgery to replace damaged or missing skin. You may have a skin graft after you have an escharotomy.
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Recovering from a third-degree burn is a long journey. An escharotomy may be a necessary early step. It doesn’t heal burns. But it can prevent burns from doing more damage to your tissues. And the procedure can help you get started on your recovery.
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Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.
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