Limbs

A full-thickness, circumferential burn of any limb can cause circulatory compromise. This occurs because increasing oedema in an unyielding compartment sequentially impairs venous and then arterial flow.

The clinical features and investigation of impaired perfusion are detailed in the submenu.

Escharotomies in the limbs are performed in the mid-lateral lines. They should be performed before pulses become impalpable. Care must be taken at certain areas where structures lie superfically:

• upper limb:
  • ulnar nerve at elbow posterior to medial epicondyle; incision should pass anterior to this
  • ulnar nerve at wrist
  • radial nerve in dorsal and distal part of arm
  • cephalic vein on radial side of wrist
• lower limb:
  • common peroneal nerve at level of fibular head
  • short saphenous vein and sural nerve along lateral aspect of ankle
  • long saphenous vein, posterior tibial vessels and saphenous nerve on medial aspect of ankle; incision should pass posterior to the medial malleolus