CBM Surgical Interventions & Grafting 3 — Questions and Answers
Question 1: What is the primary purpose of performing an escharotomy in a circumferential burn?
- To harvest donor skin
- To relieve compartment syndrome and restore distal perfusion (Correct answer)
- To debride necrotic tissue
- To apply topical antimicrobials
Correct answer: To relieve compartment syndrome and restore distal perfusion
Escharotomy incises the inelastic eschar to relieve constriction, restoring blood flow to distal tissues and preventing compartment syndrome.
Question 2: Which donor site is most commonly used for split-thickness skin grafting in burn patients with burns to the trunk?
- Scalp
- Anterior thigh (Correct answer)
- Forearm
- Abdomen
Correct answer: Anterior thigh
The anterior thigh provides a large, accessible donor area with reliable healing and is the most commonly harvested site for STSGs.
Question 3: In burn surgery, fasciotomy differs from escharotomy in that fasciotomy:
- Is only done under general anesthesia
- Extends through the fascia to decompress muscle compartments (Correct answer)
- Is limited to the eschar layer
- Is used only for chemical burns
Correct answer: Extends through the fascia to decompress muscle compartments
Fasciotomy cuts through the deep fascia to release elevated compartment pressure within muscles, while escharotomy only incises the eschar.
Question 4: Graft 'take' failure most commonly results from which cause?
- Excessive oxygen supply
- Hematoma or seroma formation under the graft (Correct answer)
- Over-hydration of the patient
- Use of a meshed graft
Correct answer: Hematoma or seroma formation under the graft
Fluid collections beneath the graft prevent direct contact with the wound bed, blocking the neovascularization needed for graft survival.
Question 5: Dermal substitutes (e.g., Integra) are applied first in a two-stage procedure because they:
- Provide immediate permanent wound closure
- Establish a neodermis before a thin autograft is placed over it (Correct answer)
- Replace the need for autografting entirely
- Act as an antimicrobial barrier only
Correct answer: Establish a neodermis before a thin autograft is placed over it
Integra's collagen matrix vascularizes over 2–3 weeks, forming a dermal layer before a thin STSG is applied as the second stage.
Question 6: Which intraoperative measure is MOST important to minimize hypothermia during extensive burn excision and grafting?
- Keeping the OR temperature at 18°C (64°F)
- Warming IV fluids and maintaining OR ambient temperature above 28°C (82°F) (Correct answer)
- Using cold saline irrigation
- Limiting anesthesia time
Correct answer: Warming IV fluids and maintaining OR ambient temperature above 28°C (82°F)
Burn patients lose heat rapidly through open wounds; warm ambient temperatures and warmed fluids are essential to prevent intraoperative hypothermia.
Question 7: When planning staged burn excision for a patient with 60% TBSA burns, surgeons typically limit each operative session to excise no more than:
- 5% TBSA
- 10% TBSA or 2 hours
- 20–25% TBSA per session (Correct answer)
- The entire burn in one session
Correct answer: 20–25% TBSA per session
Limiting each session to approximately 20–25% TBSA or about 2 hours reduces blood loss and physiologic stress, improving patient safety.
CBM Surgical Interventions & Grafting 3
What is the primary purpose of performing an escharotomy in a circumferential burn?