Eschar Removal and Skin Closure Guidelines for Breast Procedures

Eschar Removal Techniques

• Surgical debridement is necessary to remove necrotic tissue and mechanically reduce the pathogen burden, particularly in burn injuries where accurate management with early excision of eschar substantially decreases the incidence of invasive wound infection 1
• Remove necrotic tissue completely in one piece rather than multiple fragments to allow proper assessment 2, 3, 4

Skin Closure Principles

• The American Cancer Society recommends using curvilinear skin incisions following Langer's lines as the standard approach for optimal cosmetic results 5
• Close all breast skin incisions with subcuticular technique to optimize cosmetic results and minimize visible scarring 2, 3, 4, 5, 7
• Preserve subcutaneous tissue with separate closure to improve cosmetic outcome and structural integrity 5, 7

Hemostasis Requirements

• Meticulous hemostasis is critically important to prevent hematoma formation, which produces changes difficult to interpret on physical examination and mammography 2, 3, 4, 7, 8
• Hematomas can be long-lasting and lead to unnecessary biopsies due to difficulty in evaluation 2, 3, 4

Tissue Management

• Allow the biopsy cavity to fill with serum rather than reapproximating breast tissue, as reapproximation that appears adequate supine often causes distortion when upright 5, 7
• Ensure adequate incision length to permit complete specimen removal in one piece 2, 3, 4

Common Pitfalls to Avoid

• Do not reapproximate breast tissue in a manner that creates tension on the incision, as this causes distortion when the patient is upright 5, 7
• Avoid removal of lesions in multiple fragments, which precludes margin assessment and size determination 6, 2, 3, 4
• Prevent hematoma formation through meticulous hemostasis, as hematomas complicate healing and may lead to infection 2, 3, 4, 7