Total body surface area

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Total body surface area (TBSA) is an assessment of injury to or disease of the skin, such as burns or psoriasis.

Human skin the outer covering of the human body

The human skin is the outer covering of the body and is the largest organ of the integumentary system. The skin has up to seven layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to most of the other mammals skin, and human skin is very similar to pig skin. Though nearly all human skin is covered with hair follicles, it can appear hairless. There are two general types of skin, hairy and glabrous skin (hairless). The adjective cutaneous literally means "of the skin".

Psoriasis Human disease

Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. These skin patches are typically red, dry, itchy, and scaly. On people with darker skin the patches may be purple in colour. Psoriasis varies in severity from small, localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

In adults, the Wallace rule of nines can be used to determine the total percentage of area burned for each major section of the body. [1]

Wallace rule of nines

The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate the total body surface area (BSA) affected by a burn. In addition to determining burn severity, the measurement of burn surface area is important for estimating patients' fluid requirements and determining hospital admission criteria.

In burn cases that involve partial body areas, or when dermatologists are evaluating the Psoriasis Area and Severity Index (PASI) score, the patient's palm can serve a reference point roughly equivalent to 1% of the body surface area.

Psoriasis Area and Severity Index (PASI) is the most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 to 72.

For children and infants, the Lund and Browder chart is used to assess the burned body surface area. Different percentages are used because the ratio of the combined surface area of the head and neck to the surface area of the limbs is typically larger in children than that of an adult. [2]

Lund and Browder chart

The Lund and Browder chart is a tool useful in the management of burns for estimating the total body surface area affected. It was created by Dr. Charles Lund, Senior Surgeon at Boston City Hospital, and Dr. Newton Browder, based on their experiences in treating over 300 burn victims injured at the Cocoanut Grove fire in Boston in 1942.

Ratio relationship between two numbers of the same kind

In mathematics, a ratio is a relationship between two numbers indicating how many times the first number contains the second. For example, if a bowl of fruit contains eight oranges and six lemons, then the ratio of oranges to lemons is eight to six. Similarly, the ratio of lemons to oranges is 6:8 and the ratio of oranges to the total amount of fruit is 8:14.

Typical values for common groups of humans follow. [3] (Due to rounding, values may not add to 100%.)

Adult
Anatomic structureSurface area
Anterior head 4.5%
Posterior head4.5%
Anterior torso 18%
Posterior torso18%
Anterior leg, each9%
Posterior leg, each9%
Anterior arm, each4.5%
Posterior arm, each4.5%
Genitalia/perineum 1%
Child
Anatomic structureSurface area
Anterior head9%
Posterior head9%
Anterior torso18%
Posterior torso18%
Anterior leg, each6.75%
Posterior leg, each6.75%
Anterior arm, each4.5%
Posterior arm, each4.5%
Genitalia/perineum1%
Adult, obese >80 kg
Anatomic structureSurface area
Head and neck 2%
Anterior torso25%
Posterior torso25%
Leg, each20%
Arm, each5%
Genitalia/perineum0%
Infant <10 kg
Anatomic structureSurface area
Head and neck20%
Anterior torso16%
Posterior torso16%
Leg, each16%
Arm, each8%
Genitalia/perineum1%

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Rule of nines may refer to:

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References

  1. Burn Percentage in Adults: Rule of Nines
  2. Types of Burns Archived 2008-02-02 at the Wayback Machine .
  3. O'Sullivan, Susan B., Schmitz, Thomas J. Physical Rehabilitation. 5th ed. F.A. Davis Company, Philadelphia, 2007. p. 1098, Fig 27.9.