Burns · Excision and Grafting + Escharotomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Depth/extent + circumferential eschar? + severe?
   Depth/extent? Circumferential eschar with compression? Severe needing resuscitation?
   • Circumferential full-thickness eschar causing limb ischemia/chest restricting ventilation → Circumferential eschar compression → escharotomy
   • Large/severe burn (needs resuscitation, transfer to center) → Severe → Parkland resuscitation + transfer
   • Superficial/superficial-partial (self-healing) → Superficial-partial → dressings, heal
   • Deep partial/full-thickness → Deep partial/full-thickness → excision + grafting
2. [End] Circumferential eschar compression → escharotomy
   Circumferential full-thickness eschar causing limb ischemia/chest restricting ventilation → emergency escharotomy for decompression (fasciotomy if needed).
3. [End] Severe → Parkland resuscitation + transfer
   Large/severe → fluid resuscitation first (Parkland formula titrated to urine output), airway assessment (early intubation for inhalation injury), transfer to a burn center; staged excision and grafting once stable.
4. [End] Superficial-partial → dressings, heal
   Superficial/superficial-partial → conservative dressings (usually heal within 2 weeks), no grafting needed; analgesia, infection prevention, wound protection.
5. [End] Deep partial/full-thickness → excision + grafting
   Deep partial/full-thickness → early excision (tangential/full excision) + autologous split-thickness skin graft; if donor sites are insufficient, use allograft/skin substitutes for temporary cover then graft later.

Source guidelines & references

• Burn management (ABA/ABLS; early excision and grafting)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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