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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.
To estimate the body surface area of a burn, the rule of nines assigns BSA values to each major body part: [3] This allows the emergency medical provider to obtain a quick estimate of how much body surface area is burned. For example, if a patient's entire back (18%) and entire left leg (18%) are burned, about 36% of the patient's BSA is affected.
Total body surface area (TBSA) is an assessment of injury to or disease of the skin, such as burns or psoriasis. 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.
Burns that affect only the superficial skin layers are known as superficial or first-degree burns. [2] [11] They appear red without blisters, and pain typically lasts around three days. [2] [11] When the injury extends into some of the underlying skin layer, it is a partial-thickness or second-degree burn. [2]
The original Baux score was the addition of two factors, the first being the total body surface area affected by burning (usually estimated using the Wallace rule of nines, or calculated using a Lund and Browder chart) and the second being the age of the patient.
[1] [2] [3] The milliliter amount of fluid required for the first 24 hours – usually Lactated Ringer's – is four times the product of the body weight and the burn percentage (i.e. body surface area affected by burns). [4] The first half of the fluid is given within eight hours from the burn incident, and the remaining over the next 16 hours.
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Timing is important to wound healing. Critically, the timing of wound re-epithelialization can decide the outcome of the healing. [11] If the epithelization of tissue over a denuded area is slow, a scar will form over many weeks, or months; [12] [13] If the epithelization of a wounded area is fast, the healing will result in regeneration.