Burn area using the rule of nines. Burns: area of ​​burns, determined by the palm rule. Classification of burns by area and degree of damage

1). Palm rule(method of I.I. Glumov) is used to assess minor burns: The area of ​​a person's palm = 1% of the area of ​​their body.

2). Rule of nines(Wallace method) is used for extensive burns: head and neck = 9% of the body area, arm = 9%, thigh = 9%, lower leg with foot = 9%; and back = 18%, chest and stomach - 18%.

3). Postnikov method: the surface of the burn is outlined on plastic film, after which the area is calculated on special graph paper.

4). Scheme G.D. Vilyavina is intended both for documentation and for calculating the area of ​​the burn and represents the contour of the front and back surfaces of the body, while burns of different depths are indicated in different colors (I degree - yellow, II - red, IIIA - blue stripes, IIIB - solid blue, IY – black).

A combination of methods is possible (for example, a combination of the rule of palm and the rule of nines).

The area of ​​a child's burn can be calculated using the table:

Currently often used formula for designating burns according to Yu.Yu.Dzhanelidze: the numerator of the fraction indicates the affected area as a percentage (with the percentage of deep burns in parentheses), and the denominator is the degree of burn. In addition, before the fraction indicate etiological factor, and after it - the affected areas.

Burn disease General disorders in the body are observed with extensive and deep burns and are called burn disease.

Burn disease in young and middle-aged people develops when a deep burn affects more than 15% of the body surface; in children and the elderly, it can also be observed with a smaller area of ​​deep burn, limited to 5-10% of the skin.

During a burn disease there are 4 stages:

1). Burn shock(first 3 days)

– occurs with deep burns covering an area of ​​15-20% of the body surface.

Two mechanisms play a role in its development:

Irritation large quantity nerve endings. This causes stimulation of the sympathetic nervous system, which leads to vasospasm, blood redistribution and a decrease in blood volume

During thermal injury, a large number of inflammatory mediators are released, which causes severe plasma loss, hemolysis, microcirculation disorder, water-salt balance and kidney function. Blood is deposited in the internal organs. Strong evaporation of water occurs through the burn surface.

BCC deficiency leads to hypoxia and the development of acidosis. As a result of a drop in blood pressure, urinary retention develops, which leads to the development of uremia.

Differences between burn shock and traumatic shock:

The period of excitation (erectile phase) is longer and more pronounced.

No blood loss.

Severe plasma loss.

• Blood pressure decreases somewhat later.

According to the clinical course, there are 3 degrees of burn shock:

Burn shockIdegrees(with a burn of 15-20% of the body surface) is characterized by agitation, mild tachycardia up to 100 per minute, and the development of oliguria is possible.

Burn shockIIdegrees(with damage to 20-60% of the body surface) is characterized by lethargy, tachycardia up to 120 per minute, a drop in blood pressure to 80 mm Hg, a decrease in diuresis up to anuria.

Burn shockIIIdegrees(with damage to more than 60% of the body surface) is characterized by an extremely serious condition: severe lethargy, thread-like pulse up to 140 per minute, blood pressure drops below 80 mm Hg, which leads to a decrease in blood supply to internal organs, acidosis, hypoxia and anuria. Characteristic development acute ulcers Gastrointestinal tract (Curling ulcers). Body temperature often drops to 36 o C and below.

2). Burn toxemia(3-15 days)

– characterized by intoxication (nausea, pale skin, tachycardia, heart failure, psychosis) associated with the accumulation of burn wound breakdown products in the blood:

Nonspecific toxins: histamine, serotonin, prostaglandins, hemolysis products.

Specific burn toxins: glycoproteins with antigen specificity, “burn” lipoproteins and toxic oligopeptides (“middle molecules”).

3). Burn septicotoxemia(layers on the stage of toxemia, starting from the 4-5th day)

– begins from the moment of rejection of the burn scab, because this creates conditions for the development of infectious complications - wound suppuration, pneumonia, phlegmon, etc. Patients with extensive burns may develop sepsis. The period of septicotoxemia usually lasts about 2 weeks (until the burn wound closes).

It is advisable to divide the stage of septicotoxemia into 2 periods:

From the beginning of scab shedding to complete cleansing wounds. Patients have decreased appetite, high fever, tachycardia, anemia, toxic hepatitis and pyelonephritis may develop.

Granulating wound phase. This phase is characterized by the appearance of various infectious complications: pneumonia, acute gastrointestinal ulcers (usually in the duodenal bulb and the antrum of the stomach). Generalization of the infection is possible - burn sepsis (early - before cleansing the burn wound or late - after cleansing).

The skin consists of the following layers:

• epidermis ( outer part skin);
• dermis ( connective tissue part of the skin);
• hypodermis ( subcutaneous tissue).

Epidermis

The epidermis consists of the following layers:

• basal layer ( ensures the process of skin cell reproduction);
• stratum spinosum ( provides mechanical protection against damage);
• granular layer ( protects underlying layers from water penetration);
• shiny layer ( participates in the process of cell keratinization);
• stratum corneum ( protects the skin from the introduction of pathogenic microorganisms into it).

Dermis

The dermis consists of the following layers:

• papillary layer ( includes capillary loops and nerve endings);
• mesh layer ( contains blood vessels, muscles, sweat and sebaceous glands as well as hair follicles).

Hypodermis

When burns occur, the following damage occurs to the layers of the skin:

• superficial or complete damage to the epidermis ( first and second degrees);
• superficial or complete damage to the dermis ( third A and third B degrees);
• damage to all three layers of skin ( fourth degree).

It should also be noted that for burn injuries protective function skin is significantly reduced, which can lead to the penetration of microbes and the development of infectious inflammatory process.

The circulatory system of the skin is very well developed. Vessels passing through subcutaneous fat, reach the dermis, forming a deep skin-vascular network at the border. From this network circulatory and lymphatic vessels extend upward into the dermis, nourishing nerve endings, sweat and sebaceous glands, and hair follicles. A second superficial dermal-vascular network is formed between the papillary and reticular layers.

Burns cause disruption of microcirculation, which can lead to dehydration of the body due to massive movement of fluid from the intravascular space to the extravascular space. Also, due to tissue damage, fluid begins to leak from small vessels, which subsequently leads to the formation of edema. With extensive burn wounds ah destruction blood vessels may lead to the development of burn shock.

Causes of burns

• thermal effects;
• chemical exposure;
• electrical influence;
• radiation exposure.

Thermal impact

• Fire. When exposed to fire, the face and upper respiratory tract are most often affected. With burns to other parts of the body, difficulties arise in removing burnt clothing, which can cause the development of infectious process.
• Boiling water. IN in this case The burn area may be small, but quite deep.
• Steam. When exposed to steam, in most cases, shallow tissue damage occurs ( the upper respiratory tract is often affected).
• Hot items. When the skin is damaged by hot objects, clear boundaries of the object remain at the site of exposure. These burns are quite deep and are characterized by the second to fourth degrees of damage.

• influence temperature ( the higher the temperature, the stronger the damage);
• duration of exposure to skin ( how longer time contact, the more severe the degree of burn);
• thermal conductivity ( the higher it is, the stronger degree defeats);
• condition of the skin and health of the victim.

Chemical exposure

Burns due to chemical exposure may occur due to the influence of the following substances on the skin:

• Acids. The effect of acids on the surface of the skin causes shallow lesions. After exposure to the affected area in short term a burn crust forms, which prevents further penetration of acids deep into the skin.
• Caustic alkalis. Due to the influence of caustic alkali on the surface of the skin, it is deeply damaged.
• Salts of some heavy metals ( e.g. silver nitrate, zinc chloride). Skin damage by these substances in most cases causes superficial burns.

Electrical impact

Electrical injuries are divided into:

• low voltage;
• high voltage;
• supervoltaic.

Radiation exposure

• Ultraviolet radiation. Ultraviolet skin lesions predominantly occur in summer period. The burns in this case are shallow, but are characterized by a large area of ​​damage. When exposed to ultraviolet light, superficial burns of the first or second degree often occur.
• Ionizing radiation. This impact leads to damage not only to the skin, but also to nearby organs and tissues. Burns in such a case characterized by a shallow form of damage.
• Infrared radiation. May cause damage to the eyes, mainly the retina and cornea, as well as the skin. The degree of damage in this case will depend on the intensity of the radiation, as well as on the duration of exposure.

Degrees of burns

• I degree;
• II degree;
• III-A and III-B degree;
• IV degree.

The depth of burn damage depends on the following factors:

• nature of the thermal agent;
• temperature of the active agent;
• duration of exposure;
• the degree of heating of the deep layers of the skin.

• Superficial burns. These include first, second and third-degree burns. These lesions are characterized by the fact that they are able to heal fully on their own, without surgery, that is, without scar formation.
• Deep burns. These include third-B and fourth-degree burns, which are not capable of full independent healing ( leaves a rough scar).

Symptoms of burns

• faces ( in most cases leads to eye damage);
• scalp;
• upper respiratory tract (pain, loss of voice, shortness of breath, and cough with Not big amount sputum or streaked with soot);
• upper and lower extremities ( with burns in the joint area there is a risk of limb dysfunction);
• torso;
• crotch ( can lead to dysfunction of the excretory organs).

Burn degree	Symptoms	Photo
I degree	With this degree of burn, redness, swelling and pain are observed. The skin at the site of the lesion is bright pink, sensitive to touch and slightly protrudes above the healthy area of ​​skin. Due to the fact that with this degree of burn only superficial damage to the epithelium occurs, after a few days the skin, drying out and wrinkled, forms only a slight pigmentation, which goes away on its own after some time ( on average three to four days).
II degree	With a second degree burn, just like with the first, there is hyperemia, swelling, and burning pain at the site of the injury. However, in this case, due to the detachment of the epidermis, small and relaxed blisters appear on the surface of the skin, filled with light yellow, clear liquid. If the blisters break, reddish erosion is observed in their place. Healing of this kind of burns occurs independently on the tenth to twelfth day without the formation of scars.
III-A degree	With burns of this degree, the epidermis and part of the dermis are damaged ( hair follicles, greasy and sweat glands are saved). Tissue necrosis is noted, and also, due to pronounced vascular changes, swelling spreads throughout the entire thickness of the skin. At third-A degree a dry light brown or soft white-gray burn crust is formed. Tactile pain sensitivity skin is preserved or reduced. Blisters form on the affected surface of the skin, the size of which varies from two centimeters and above, with a dense wall, filled with a thick yellow jelly-like liquid. Epithelization of the skin lasts on average four to six weeks, but if an inflammatory process occurs, healing can last for three months.
III-B degree	In third-degree burns, necrosis affects the entire thickness of the epidermis and dermis with partial capture of subcutaneous fat. At this degree, the formation of blisters filled with hemorrhagic fluid is observed ( streaked with blood). The resulting burn crust is dry or wet, yellow, gray or dark brown. There is a sharp decrease or absence pain. Self-healing of wounds at this stage does not occur.
IV degree	Fourth degree burns affect not only all layers of the skin, but also muscles, fascia and tendons down to the bones. A dark brown or black burn crust forms on the affected surface, through which the venous network is visible. Due to the destruction of nerve endings, there is no pain at this stage. At this stage, severe intoxication is noted, and there is also high risk development of purulent complications.

Burns are divided into extensive ( damage to 10 - 15% of the skin or more) and not extensive. With extensive and deep burns with superficial skin lesions of more than 15–25% and more than 10% with deep lesions, burn disease may occur.

Burn disease is a group clinical symptoms for thermal damage to the skin, as well as nearby tissues. Occurs with massive tissue destruction with the release of large amounts of biologically active substances.

The severity and course of burn disease depends on the following factors:

• age of the victim;
• location of the burn;
• degree of burn;
• affected area.

• burn shock;
• burn toxemia;
• burn septicotoxemia ( burn infection);
• convalescence ( recovery).

Burn shock

Degrees of burn shock

Burn toxemia

For intoxication syndrome The following signs are characteristic:

• increase in body temperature ( up to 38 – 41 degrees for deep lesions);
• nausea;
• thirst.

Burn septicotoxemia

The following symptoms are characteristic of burn septicotoxemia:

• weakness;
• increased body temperature;
• chills;
• irritability;
• yellowness of the skin and sclera ( with liver damage);
• increase in heart rate ( tachycardia).

Convalescence

Determination of burn area

Highlight following methods determining the burn area:

• rule of nines;
• palm rule;
• Postnikov's method.

Rule of nines

Rule of nines	Photo
head and neck 9%
upper limbs (each hand) at 9%
anterior surface of the body18% (chest and abdomen 9% each)
posterior surface of the body18% (top part back and lower back 9% each)
lower limbs ( each leg) at 18% (thigh 9%, lower leg and foot 9%)
Crotch 1%

Palm rule

Postnikov method

First aid for burns

• eliminating the source of the active factor;
• cooling burned areas;
• application of an aseptic dressing;
• anesthesia;
• calling an ambulance.

Eliminating the source of the active factor

Cooling burned areas

Note: For third and fourth degree burns, this first aid measure is not performed.

Applying an aseptic dressing

Dry and clean scarves, towels, and sheets can be used as an aseptic dressing. An aseptic dressing must be applied to the burn wound without pretreatment. If fingers or toes are affected, additional fabric must be placed between them to prevent the skin parts from sticking together. To do this, you can use a bandage or a clean handkerchief, which must be wetted before application. cool water and then squeeze.

Anesthesia

Calling an ambulance

• for third and fourth degree burns;
• in the event that the second degree burn in area exceeds the size of the victim’s palm;
• for first degree burns, when the affected area is more than ten percent of the body surface ( for example, the entire abdominal area or the entire upper limb);
• when such parts of the body as the face, neck, joint areas, hands, feet, or perineum are affected;
• if nausea or vomiting occurs after a burn;
• when after a burn there is a long ( more than 12 hours) increased body temperature;
• if the condition worsens on the second day after the burn ( increased pain or more pronounced redness);
• with numbness in the affected area.

Treatment of burns

• conservative;
• operational.

• affected area;
• depth of lesion;
• localization of the lesion;
• the cause of the burn;
• development of burn disease in the victim;
• age of the victim.

Conservative treatment

Conservative treatment of burns includes:

• closed method;
• open method.

• applied bandages prevent infection of the burn wound;
• the bandage protects the damaged surface from damage;
• used medicines kill germs and also promote fast healing burn wound.

• changing the bandage provokes painful sensations;
• dissolution of necrotic tissue under the bandage leads to increased intoxication.

Open way
This treatment method is characterized by the use of special equipment ( e.g. ultraviolet irradiation, air purifier, bacterial filters), which is only available in specialized departments burn hospitals.

The open method of treatment is aimed at accelerating the formation of a dry burn crust, since a soft and moist scab is a favorable environment for the proliferation of microbes. In this case, two to three times a day, various antiseptic solutions (for example, brilliant green ( brilliant green) 1%, potassium permanganate ( potassium permanganate) 5% ), after which the burn wound remains open. In the room where the victim is located, the air is continuously cleaned of bacteria. These actions contribute to the formation of a dry scab within one to two days.

In most cases, burns of the face, neck and perineum are treated using this method.

There are the following advantages of the open method of treatment:

• promotes rapid education dry scab;
• allows you to observe the dynamics of tissue healing.

• loss of moisture and plasma from the burn wound;
• high cost of the treatment method used.

Surgical treatment

• necrotomy;
• necrectomy;
• staged necrectomy;
• limb amputation;
• skin transplantation.

Necrectomy
Necrectomy is performed for third-degree burns in order to remove non-viable tissue in deep and limited lesions. This type The operation allows you to thoroughly clean the burn wound and prevent suppurative processes, which subsequently promotes rapid tissue healing.

Staged necrectomy
This surgical intervention is performed with deep and extensive lesions skin. However, staged necrectomy is a more gentle method of intervention, since the removal of non-viable tissue is carried out in several stages.

Limb amputation
Amputation of a limb is performed in case of severe burns, when treatment with other methods has not brought positive results or the development of necrosis and irreversible tissue changes with the need for subsequent amputation has occurred.

These surgical methods allow:

• clean the burn wound;
• reduce intoxication;
• reduce the risk of complications;
• reduce the duration of treatment;
• improve the healing process of damaged tissues.

Skin transplantation
Skin grafting is performed to close burn wounds large sizes. In most cases, autoplasty is performed, that is, the patient’s own skin is transplanted from other parts of the body.

Currently, the most widely used methods for closing burn wounds are:

• Plastic surgery with local tissues. This method is used for deep burn lesions. small sizes. In this case, the affected area is borrowed from neighboring healthy tissues.
• Free skin grafting. It is one of the most common methods of skin transplantation. This method consists in using a special tool ( dermatome) in the victim from a healthy area of ​​the body ( e.g. thigh, buttock, stomach) the necessary flap of skin is excised, which is subsequently applied to the affected area.

Physiotherapy

• inhibition of microbial activity;
• stimulation of blood flow in the affected area;
• acceleration of the regeneration process ( recovery) damaged area of ​​skin;
• prevention of the formation of post-burn scars;
• stimulation protective forces body ( immunity).

Prevention of burns

Preventing sunburn

• Direct contact with the sun should be avoided between ten and sixteen hours.
• On particularly hot days, it is preferable to wear dark clothes, as they protect the skin from the sun better than white clothes.
• Before going outside, it is recommended to apply open areas skin sunscreens.
• During your appointment sunbathing The use of sunscreen is a mandatory procedure that must be repeated after each swim.
• Since sunscreens have various factors protection, they must be selected for a specific skin phototype.

• Scandinavian ( first phototype);
• light-skinned European ( second phototype);
• dark-skinned Central European ( third phototype);
• Mediterranean ( fourth phototype);
• Indonesian or Middle Eastern ( fifth phototype);
• African American ( sixth phototype).

Prevention of household burns

To avoid burns at home, the following recommendations must be followed:

• Do not use electrical appliances with damaged insulation.
• When unplugging an electrical appliance from the outlet, do not pull the cord; you must hold it directly at the base of the plug.
• If you are not a professional electrician, you should not repair electrical appliances and wiring yourself.
• Do not use electrical appliances in damp areas.
• Children should not be left unattended.
• It is necessary to ensure that there are no hot objects within the reach of children ( for example, hot food or liquid, socket, turned on iron, etc.).
• Those items that can cause burns ( for example, matches, hot objects, chemicals and others), should be kept away from children.
• It is necessary to carry out educational activities with older children regarding their safety.
• You should stop smoking in bed, as this is one of the common reasons fires.
• It is recommended to install fire alarms throughout the house or at least in those areas where the likelihood of a fire is higher ( for example, in a kitchen, a room with a fireplace).
• It is recommended to have a fire extinguisher in the house.

According to the rule of nine, in borrowed common nouns the sound [i] of the source language between one of the nine consonants (hence the name) - d, t, h, s, c, g, w, h, r- and a letter meaning a consonant sound, except th, is conveyed in pronunciation by the Ukrainian sound [ɪ], and in writing by the letter And(sound close to Russian s[ɨ], but not coinciding with it). After the remaining consonants, the sound [i] is conveyed by the sound [i] and written with the letter і .

Example: whitefish cash, ding amo, re bench press, diz spruce, winter for.

Before vowels and th, and also at the end of a word the rule of nine does not apply and the sound and letter are used i: do ptria, stan this, hell zhіo, kol_b pi, So sі (But: So sis T).

In general, the rule of nine does not apply to proper names, so a proper name, becoming a common noun, changes its vowel: Diesel, But diesel.

There are a number of exceptions to the rule of nine associated with individual geographical names, surnames, ancient borrowings and borrowings from eastern languages. The status of a number of exceptions is controversial and is interpreted differently in different manuals.

The rule of nine was formulated in 1913 by the authors of Grammar Ukrainian language"S. J. Smal-Stotsky and F. Gartner, modeled on a similar rule of Polish spelling.

Mnemonic rule

To remember the “rule of nine” there are a number of mnemonic phrases, all words of which begin with the corresponding 9 letters. One of these phrases is “Roar and stogne the wide Dnieper, chovni with the gypsies to your wife”(“The wide Dnieper roars and groans, it drives boats with gypsies”; the first five words are the beginning of Taras Shevchenko’s ballad “Causal”).

The mnemonic phrase “Children with” is also widely known. (“Where will you eat this bowl of fat?”), containing only the corresponding consonants.

Notes

Literature

• Olena Guzar. Spelling standard of Ukrainian language: history and reality. News of Lviv. university. Series philol. 2004. VIP. 34. Part II. P.501-506
• The rule of “nine” in the context of Slovenian and non-Slovenian parallels of Ukrainian language / Maxim Olegovich Vakulenko // Comparative research of Slovenian language and literature: Memoirs of academician Leonid Bulakhovsky: Zb. Sci. Ave. - VIP. 10. - K.: Vidavn.-polygraph. center "Kyiv University", 2009. - 479 p. - pp. 21-27.

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A burn is an injury caused by close contact skin with hot objects or active chemicals. Determining the burn area is the necessary methodology to determine the degree of injury and prescribe further treatment.

The entire surface area of ​​human skin is 21,000 square centimeters. In medicine, many methods are used to determine the exact area of ​​burns. After establishing the location of the damaged areas, a clear picture becomes clear clinical picture, it is determined what degree of burn was received and what is the depth of damage to internal tissues.

Classification

The degrees of burns are divided according to the severity of the injuries received:

• The first one is affected upper layer skin, with slight redness;
• Second, blisters with clear liquid appear on the epidermis;
• Third, the injury affects the internal muscle tissue and fibers;
• Fourth, the damage affects the bones, the skin, muscles and ligaments become charred.

Third- and fourth-degree burns are dangerous to human life; it is necessary to immediately seek help from highly qualified specialists.

Damage area installation concept

As written above, various methods are used to determine the location of burns. medical methods, namely:

• Rule of nine for burns - the procedure quickly determines the degree of damage without the use of additional devices. The disadvantage of this tactic is that the resulting calculations are not accurate. The technique is based on visual division of the body into zones, each area equals nine percent (neck and head, surface of the limbs), the rear and front of the body 36%. The remaining interest falls on groin area. The area of ​​burns in children is not calculated using this method, since the child has smaller body proportions.

• According to the Rule of the Palm, the method was discovered in 1953 by military medicine doctor Glumov. The location of the burned areas is determined in direct proportion to the patient's hand. The area of ​​the palm is approximately 1% of the entire surface of the human body.

• Postnikov's technique - in given time no longer practiced. The essence of the process was to apply gauze bandages to the diseased areas and treat them contrast agent(dye). Next, the gauze was removed and a millimeter transparent tracing paper was applied to the clear outline, on which further calculations were made.

• Vilyavin’s scheme - in a drawing depicting a reduced copy of a person’s torso, the affected area is painted over; depending on the nature of the injury, the areas were marked in different colors. With this technique, the extent and depth of lesions can be easily monitored.

• Dolinin’s method - burnt areas are marked on a special rubber form with an imprint of the silhouette of the body, divided into one hundred equal sections (51 on the front surface and 49 on the rear). All that remains is to add up the resulting numbers and determine the areas of the burn surface.

• To determine the area of ​​the burn in children, the Land and Browder tactics are used. In infants under one year of age, the general location of the neck and head is 21 percent, the rear and frontal parts of the body are 18%, the hip region is 4.5%, the lower extremity girdle is 9%, and the genital area is 1%.

• Calculation according to Ariev - the affected areas are painted over on a special diagram. As treatment progresses, the drawing can be adjusted and supplemented. The main disadvantage of the technique is that it is impossible to indicate the lateral surfaces of the body on the diagram; for this, another profile sketch is made.

Precautionary measures

Carefully follow safety precautions when working with electrical heating devices and chemical reagents. Store detergents away from children and out of their reach.

If you do get a burn, you need to rinse the affected area with plenty of running water and treat the wound. antiseptics and apply a sterile bandage. In case of severe pain, it is recommended to take painkillers to avoid shock.

Timely request for medical care eliminates the risk of complications.

Conclusion

The general condition of the patient depends on the nature of the injuries received and where they occurred. In case of a burn, permanent scars may remain on the face, perineum, and hands. In particular severe cases Severe lesions lead to loss of ability to work and disability. Burns that affect 40-50% of the body lead to irreversible, life-threatening consequences.

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A burn is a violation of the integrity of the skin or mucous membranes as a result of exposure to thermal, chemical, and electrical irritants. According to the international disease code T20-T32. For diagnosis and treatment, it is necessary to determine the depth and area of ​​damage. For this purpose, the rule of nines is used for burns.

The degree of burn is the depth of the wound, which is determined visually and is related to the amount of skin damage. The human body is presented in the form of 3 layers: epidermis, dermis, hypodermis.

• epidermis is the top layer of skin that protects the human body from harmful influence environment;
• dermis - an intermediate layer between the epidermis and hypodermis, represented by connective tissue;
• the hypodermis is represented by fatty tissue, in which it is located connective tissue, blood vessels.

Each grade in the table represents damage to a specific layer (or layers) of skin.

In the absence of infection, they heal in up to 2 weeks. Treatment deep wounds carried out by transplanting skin-fat grafts.

Injuries larger than 60% of the body are fatal, and for people over 60 years old - over 40%.

The area of ​​burns is determined using the rule of nines, the palm, the Postnikov method, the Dolinin, Vilyavin, Land-Browder methods (the latter are not currently used).

Rule of nines

The rules of nine for burns were first studied in the 1950s by researcher Wallace. The technique involves dividing the body into sections, each corresponding to 9%.

Wallace's rule gives an approximate percentage ratio and is not difficult to use. Trauma treatment is effective for early stages, the size of the lesion should be quickly determined. Knowledge of the principle of nines in an emergency situation will allow you to navigate and provide first aid.

Palm rule

The method was first studied in the 50s of the twentieth century by researcher I. Glumov. The palm rule for burns is based on the belief that a person's hand accounts for 1% of the damage.

The given palm rule is used for adults. For children, the percentage depends on age.

So, at 1 year of age, a child’s palm occupies 9% of the body, the leg – 14%, the front surface of the body (chest, abdomen) – 36%, the head and neck – 18%. For children 5 years old, the proportion is already different: arm – 9%, leg – 16%, front torso (chest, abdomen) – 36%, head and neck – 14%.

Postinkov method

A gauze bandage is applied to the burned area of ​​the body and a sketch of the injury is made. Next, the drawing is transferred to graph paper, in this way the size of the lesion is determined. The technique is accurate, rarely used due to the complexity and duration of the procedure; graph paper is not always at hand.

To determine the severity of the wound in children under one year old, the Land-Browder method is used. It is based on the principle of the following ratio: head, neck - 21%, front, back surface of the body - 16%, lower limb– 14%, genitals – 1%.

Efficiency and accuracy of determination using these methods

For large lesions, the method of nines is used, and if a person is only slightly burned, it is faster to find out the percentage of damage using the palm method.

The listed methods for determining the burn area do not provide exact result, the size of body parts is different for each person. So, there are asthenic, normosthenic, hypersthenic body types. The limbs also have different lengths. Throughout life, a person gains weight, due to which the algorithm for calculating the size of each area of ​​the body changes.

The depth and size of the wound is determined further treatment. To find out the degree of complexity of a burn injury, you should calculate the Frank index - one of the integral indicators.

The sum of the indices thus obtained constitutes the injury level. For one of the types of illness with thermal injury - degree 1, the sum of points is 30-70. For burn shock of 2nd degree - 71-130 points. A score over 130 points means that the shock is in a severe stage.

In children and people over 60 years of age, it develops at lower values.

To predict the outcome of an injury, doctors use the “rule of hundreds.” The area of ​​the lesion should be added to the patient's age. The closer the resulting value is to 100, the greater the likelihood of death.

The patient's condition does not always depend on the size and depth of the burn. Even minor injuries are dangerous for babies. Small but deep injuries to the face, genitals, and hands can lead to loss of ability to work and disability.