The Anatomy of Grayson's Ligament and Cleland's Ligament: The Basis of Digit Escharotomy for Circumferential Full Thickness Burns of the Fingers.

Abstract

Escharotomies are incisions placed in burned, devitalized tissue to relieve tension caused by contraction and fluid shifts. In circumferential burns of the extremities and torso, escharotomy can be limb and lifesaving. Escharotomy of the fingers for salvage following full thickness burns is inadequately described in the literature of burn surgery. Salisbury et al described a series of escharotomies for finger salvage, but the anatomic basis for their report is not widely recognized and their strategy is not a standard of burn care. Release of the compartment defined by Grayson's ligament and Cleland's ligament is the anatomic basis for finger escharotomy. This space, well-known to replantation surgeons, contains the digital artery and the digital nerve on each side of each digit. Understanding the anatomy of this compartment gives the surgeon a defined target for release of compression threatening arterial occlusion in circumferential full thickness burns of fingers. The present study provides an illustrative overview of digital escharotomy, discusses its pros and cons, and describes appropriate patient selection.