You can estimate the body surface area on an adult that has been burned by using multiples of 9.

An adult who has been burned, the percent of the body involved can be calculated as follows: Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% Each palm = 1% Groin = 1% Each leg = 18% total (front = 9%, back = 9%)

This article is about the 'rule of nines' in assessing burns of the skin.
Total body surface area (TBSA) is an assessment measure of burns of the skin. In adults, the "rule of nines" is used to determine the total percentage of area burned for each major section of the body.[1] In some cases, the burns may cover more than one body part, or may not fully cover such a part - in these cases, burns are measured by using the casualty's palm as a reference point for 1% of the body. For children and infants, the Lund-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]

Adults

Children

Anatomic structure Surface area Anatomic structure Surface area

Anterior head

4.5%

Anterior Head

8.5%

Posterior head

4.5%

Posterior Head

8.5%

Anterior torso

18%

Anterior torso

18%

Posterior torso

18%

Posterior torso

18%

Each Anterior leg

9%

Each Anterior leg

6.5%

Each Posterior leg

9%

Each Posterior leg

6.5%

Each Anterior arm

4.5%

Each Anterior arm

4.5%

Each Posterior arm 4.5%

Each Posterior arm 4.5%

Genitalia/perineum 1%

Genitalia/perineum

1%

[3]

[3]

Adults Obese & > 80 kg

Infants < 10 kg

Anatomic structure Surface area Anatomic structure

Surface area

Head and neck

2%

Head and neck

20%

Anterior torso

25%

Anterior torso

16%

Posterior torso

25%

Posterior torso

16%

Each leg

20%

Each leg

16%

Each arm

5%

Each arm

8%

Genitalia/perineum 0%

Genitalia/perineum

1% [but it does not add up to 100%]

INTRODUCTION A burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, cold, electricity, radiation, or caustic chemicals. Burns are acute wounds caused by an isolated, non-recurring insult and progress rapidly through an orderly series of healing steps [1]. The most common types of burns and their classification will be reviewed here. The clinical assessment, potential acute complications, and management of moderate and severe burns in adults and children, minor burns, and other related injuries are discussed elsewhere. (See "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children" and "Treatment of minor thermal burns" and "Smoke inhalation" and"Environmental electrical injuries".)

What are the classifications of burns? Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin's surface. first-degree (superficial) burns First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color. second-degree (partial thickness) burns Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful. third-degree (full thickness) burns Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed. An inhalation injury is a fourth type of burn injury. Inhalation injuries result from: direct inhalation of a hot air or flame source, which will damage the upper airways; inhalation of toxic chemicals, such as carbon monoxide, which can cause brain damage or even death; or injury from smoke inhalation. People suffering from inhalation injuries as a result of chemical or industrial accidents often frequently suffer from serious chemical burns.

Types of Burns There are three types of burns that can result from a variety of mechanisms. Types of burns include first, second and third degree burns. These burns may also be referred to as superficial, partial and full-thickness burns. Types of burns may also be classified according to the mechanism of burn injury. Superficial Burns These types of burns cause superficial erythema (redness) and swelling and may be quite painful. The skin will blanch upon pressure. These types of burns involve only the outermost layer of skin, or the epidermis. Treatment generally involves cooling the burn with running water or the application of cool cloths and application of an over-the-counter burn ointment or a soothing agent, such as aloe cream or gel. These types of burns heal quickly and do not result in scarring. A physician should be consulted if superficial burns are extensive, especially in children or the elderly.

Partial-Thickness Burns Partial-thickness burns affect both the epidermis and the dermis to varying degrees. Superficial partial-thickness burns do not involve the full thickness of the dermis, while deep partial-thickness burns may involve the dermis more extensively. Depending on how much of the dermis is affected, these types of burns may result in scarring and may require skin grafting to heal. It may be difficult to determine whether a burn affects the dermis superficially or more deeply; the difference lies partially in healing time, as superficial partial-thickness burns will heal more quickly,

often in less than 3 weeks. These types of burns will cause blisters. Blisters should never be punctured but should be left intact, as rupturing them may increase the risk of infection. These types of burns may cause permanent disfigurement. They may also be quite painful, as nerves are intact and undamaged. Full-Thickness Burns Full-thickness burns extend down into the hypodermis, or subcutaneous tissue. These types of burns may affect underlying bone, nerves, tendons and other structures. These burns in themselves are generally not painful; however, there may be surrounding areas of partial-thickness burns that are painful. Mechanism of Burn Injury Burns may be caused by several different mechanisms, each with their own complications: Scalds- these types of burns result when skin comes into contact with hot liquids (spilled liquids or food, hot bathwater) Contact burns- these burns result from contact of the skin with hot items, including flames Chemical burns- these burns result from contact of the skin with chemicals, or by ingestion of chemicals Electrical burns- these types of burns result when a person comes into contact with a source of electrical energy; includes burns caused by electrocution and lightning strike

Radiation burns- these types of burns result from contact with a source of radiation; may include overexposure i.e. sunburn