Facial burns. 3. How to estimate the total burned surface area (%TBSA) and the degree of burns? Total body surface area (TBSA) is an assessment measure of skin burns. As shown in Figure 1, in adults the “”rule of nines”" is used to determine the

total percentage of the burned area for each major section of the body [6, 7].However, this rule cannot be used in pediatric burns. The Lund-Browder chart is one of the most accurate methods to estimate not only the size of the burn area but also the burn degree in each part. The use of this chart has shown an easy access and fast readability in the clinical practice as well as its use in pediatric burns [7]. It is available in many centres and also available online. Note that an internet address has been added at the end of this article to make it accessible for education purposes. Accurate estimation must be performed in order to estimate the amount click here of intravenous fluids, referral indications to the burn unit and indication of surgery as well as the estimation of prognosis. Figure 1 Rule of nines: This figure shows the different parts of

the body that equal 9% of the body surface area (i.e. complete upper thigh = 9%, complete lower thigh = 9%, complete leg = 18%). The degree of burns is calculated to estimate the prognosis as well as the type of treatment and consequently the type of surgery that should be conducted. Burns are classified to: First degree burns: typical redness CH5424802 and pain of the affected skin. Minor epithelial damage occurs without formation of blisters. Typically occurs with sunburns. HSP90 Superficial second degree burns: complete epithelial damage and only papillary dermal damage occurs. This degree leaves no neurovascular damage. Thus, it causes pain, bleeds and presents with blisters. Epithelial repair occurs within 14 days. It mostly leaves no scars after healing. Sometimes discoloration

stays. Deep second degree burns: complete epithelial damage and damage of the reticular dermis present. It results in neurovascular damage. Thus, it generally presents without bleeding or sensation and appears white in colour. Blisters can also be present but are bigger than in superficial second degree burns. Healing can occur but takes longer than 14 days and results in scars. Third degree burns: involving the epidermis, dermis and subcutaneous tissue. The skin appears leathery consisting of thrombotic vessels (Figure 2). Figure 2 Third degree burns (Note the thrombotic vessels formation). Forth degree burns (debatable): it is a third degree burn with involvement of the underlying fascia, muscles and even bones. Superficial burn injury (First degree). Superficial partial-thickness burns (Superficial second degree). Deep partial-thickness burns (Deep second degree). Full-thickness burns (Third degree). Fourth degree burns (debatable classification as some references do not support this degree [1]). 4.