## Lund and Browder Chart: TBSA Distribution in Adults **Key Point:** The Lund and Browder chart is the gold standard for estimating total body surface area (TBSA) in burn patients, offering greater accuracy than the Rule of Nines, especially in children where body proportions differ significantly from adults. ### Adult TBSA Distribution (Lund and Browder) | Body Region | Percentage | |---|---| | **Head** | 7% | | **Neck** | 2% | | **Each arm (upper arm + forearm + hand)** | 9% | | **Trunk (anterior)** | 13% | | **Trunk (posterior)** | 13% | | **Each thigh** | 4% | | **Each leg (below knee)** | 3% | | **Each foot** | 3.5% | | **Genitalia** | 1% | **High-Yield:** In the Lund and Browder chart for adults, **each arm is assigned 9% TBSA** — identical to the Rule of Nines approximation for the arm. The key difference between the two methods lies in how they handle the **head and lower extremities**, particularly in children (where the head is proportionally larger and legs smaller). The Lund and Browder chart adjusts these regions by age, not the arms. **Common Misconception:** The claim that each arm = 11% in the Lund and Browder chart is incorrect. The 9% per arm figure is consistent across both the Rule of Nines and the Lund and Browder chart for adults (upper arm ~4%, forearm ~3%, hand ~2% = 9% total). **Clinical Pearl:** Accurate TBSA estimation is critical for fluid resuscitation using the Parkland formula: $$IV\ fluid\ (mL) = 4\ mL \times TBSA(\%) \times Weight(kg)$$ Half is given in the first 8 hours post-burn; the remainder over the next 16 hours. Underestimation leads to hypovolemic shock; overestimation causes pulmonary edema and compartment syndrome. **Reference:** Lund CC, Browder NC. The estimation of areas of burns. *Surg Gynecol Obstet.* 1944;79:352–358. Also cited in Bailey & Love's Short Practice of Surgery and standard forensic medicine texts (Reddy's *The Essentials of Forensic Medicine and Toxicology*).
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