Extensive eschars of the trunk can impede ventilation due to reduced compliance. In adults, this generally requires circumferential burns. In children who largely ventilate through diaphragmatic excursion, burns of the anterior thorax and abdomen can be sufficient to compromise breathing; they do not need to be circumferential.
Clinical features indicative of respiratory compromise secondary to a trunk burn include tachypnoea, poor oxygen saturation, use of accessory muscles of respiration and exhaustion.
The lines of incision for an escharotomy of the trunk are bilaterally in the anterior axillary lines. In addition, further release may be required transversely slightly inferior to the clavicles and subcostally. These incisions should extend to join the anterior axillary incisions.
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