A patient received flame burns of both hands. On the dorsal and palmar surface of the hands there are blisters filled with serous fluid. The wrist joint region is hyperemic. The forearms were not injured. What is the provisional diagnosis?

Answer options

1. IIIa degree flame burn of the hands, 4% of body surface area
2. IIb degree flame burn of the hands, 2% of body surface area
3. III degree flame burn of the hands, 4% of body surface area
4. II degree flame burn of the hands, 4% of body surface area
5. II degree flame burn of the hands, 2% of body surface area

Explanation

Burn size needs to be formally assessed in a controlled environment. This allows the area to be exposed and any soot or debris washed off. Care should be taken not to cause hypothermia during this stage. In the case of smaller burns or patches of burn, the best measurement is to cut a piece of clean paper the size of the patient’s whole hand (digits and palm), which represents 1 % TBSA and match this to the area. Another accurate way of measuring the size of burns is to draw the burn on a Lund and Browder chart, which maps out the percentage TBSA of sections of our anatomy. It also considers different proportional body surface area in children according to age. The ‘rule of nines’, which states that each upper limb is 9 % TBSA, each lower limb 18 %, the torso 18 % each side, and the head and neck 9 %, can be used as a rough guide to TBSA outside the hospital environment. Bailey & Love’s short practice of surgery. – 27th edition. – P. 621.