A 35-year-old man sustains burns to his entire right upper limb (front and back), the front of his right lower limb, and his perineum. Using the Rule of Nines (Modified Wallace Rule), the total body surface area (TBSA) burn is:
- A 18%
- B 19% ✓
- C 22.5%
- D 27%
Correct answer: B. 19%
Explanation
Using the Rule of Nines: Entire right upper limb = 9%; Front of right lower limb = 4.5% (lower limb total = 18%, so front = 9%); Perineum = 1%. Total = 9 + 9 + 1 = 19%. Each lower limb is 18% total (9% anterior, 9% posterior). Each upper limb is 9% total. Head/neck = 9%, anterior trunk = 18%, posterior trunk = 18%, perineum/genitalia = 1%. Common errors include using 18% for the lower limb when only the front is involved. Perineal burns are specifically counted at 1% and are significant for their complications (contamination, urethral catheterization required).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.