García-Ballesteros Daniel Iván, Rivera-Martínez Delia Del Carmen, García-Pérez Mauricio Manuel, Valdés-Flores Everardo, Castro-Govea Yanko, Chacón-Moreno Hernán Jesús
Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México.
J Emerg Med. 2023 Oct;65(4):e320-e327. doi: 10.1016/j.jemermed.2023.05.017. Epub 2023 Jun 7.
Currently, the Wallace Rule of Nines is the most widely used method to measure total body surface area (TBSA) in burned patients due to its practicality and speed in its application; however, it often provides inaccurate estimations in obese patients, affecting the fluid resuscitation process.
In this study, we aimed to modify and optimize the Rule of Nines' values for its application in these patients.
We compared the estimations of the TBSA established by the Wallace Rule of Nines against the measurements of the three-dimensional (3D) software Skanect - Meshmixer 3.5 in participants without different obesity grades. Based on our results, we generate an optimized guideline for the evaluation of TBSA in normal body mass index (BMI) and obese patients.
In our study, 32 participants were recruited with a mean age of 28.5 ± 3.3 years. In the general population, we observed a poor correlation between the Wallace Rule of Nines and the 3D method measures in all body regions (e.g., Anterior Trunk: 18.0 vs. 16.61 ± 2.11, p = 0.0008) except the anterior arm. Interestingly, these differences narrowed in the Trunk and Leg regions as the participants' BMI increased (e.g., Anterior Trunk in Obesity Grade II patients: 18.0 vs. 18.66 ± 1.69, p = 0.3089).
We found important differences in TBSA determination using the 3D Skanect-Meshmixer software compared with the Wallace Rule of Nines. Therefore, we generated a modified and optimized Wallace Rule of Nines estimations based on BMI. Future studies are needed to assess the safety and efficacy of this optimized table.
目前，华莱士九分法是烧伤患者中测量总体表面积（TBSA）最广泛使用的方法，因其实用性和应用速度快；然而，它在肥胖患者中常常提供不准确的估计，影响液体复苏过程。
在本研究中，我们旨在修改和优化九分法的值，以便在这些患者中应用。
我们将华莱士九分法确定的TBSA估计值与三维（3D）软件Skanect - Meshmixer 3.5在不同肥胖等级参与者中的测量值进行比较。根据我们的结果，我们生成了一个用于评估正常体重指数（BMI）和肥胖患者TBSA的优化指南。
在我们的研究中，招募了32名参与者，平均年龄为28.5±3.3岁。在一般人群中，我们观察到除上臂外，所有身体区域中华莱士九分法与3D方法测量值之间的相关性较差（例如，前躯干：18.0对16.61±2.11，p = 0.0008）。有趣的是，随着参与者BMI的增加，躯干和腿部区域的这些差异缩小（例如，II级肥胖患者的前躯干：18.0对18.66±1.69，p = 0.3089）。
我们发现使用3D Skanect - Meshmixer软件确定TBSA与华莱士九分法相比存在重要差异。因此，我们根据BMI生成了修改和优化后的华莱士九分法估计值。未来需要进行研究以评估此优化表格的安全性和有效性。
