Dr Gareth Crouch¹, Dr  Tim Wang¹, Dr  Bishoy Soliman¹, Dr Aruna Wijewardane¹, Dr  Jeon Cha¹

¹Royal North Shore Hospital, St Leonards, Australia

Abstract:

Introduction

Approximating a patient’s hand surface area to 1% total body surface area (TBSA) forms a mainstay of burn size estimation. Rhodes’ (2013) meta-analysis suggested this overestimated proportional hand area among women and the obese, though did not include data for patients with Body Mass Index (BMI) <18.5 or ≥40, or of African ethnicity.

Methods

Pubmed, Cochrane and Embase databases from inception to May 2022 were queried for English language articles using keywords “palm OR hand surface”, “size” and “surface area”. Included articles reported original data comparing hand surface area to TBSA. Reference lists were screened to identify additional studies.

Results

743 articles were retrieved, excluding duplicates. 23 remained after title and abstract screening, and full text review left 19 included articles.

Discussion

Children with BMIs in the 0.3 percentile had larger proportional hand areas compared to those of normal weight (0.97% vs 0.93% TBSA) (Cox et al., 2017). Increasing BMI correlated with smaller relative hand area, with this relationship preserved for BMIs ≥40 (Range: 0.70-0.83% TBSA) (Butz et al., 2015). Males had larger %TBSA hand areas than females across age groups, though sex differences disappeared for those with BMI ≥40 (Butz et al., 2015). Children of African ethnicity tended to proportionally larger hand areas than Caucasians (Cox et al., 2017). Children had greater percentage hand size than adults (Wendler & Irakoze 2022).

Conclusions

Nutrition inversely correlates with proportional hand size, even at BMI extremes. Sex differences are not apparent when BMI ≥40. African children have greater proportional hand areas.

References

Butz, DR, Collier, Z, O’Connor, A, Magdziak, M & Gottlieb, LJ 2015. Is palmar surface area a reliable tool to estimate burn surface areas in obese patients? J Burn Care Res, 36, 87-91.

Cox, S, Kriho, K, De Klerk, S, Van Dijk, M & Rode, H 2017. Total body and hand surface area: Measurements, calculations, and comparisons in ethnically diverse children in South Africa. Burns, 43, 1567-1574.

Rhodes, J, Clay, C & Phillips, M 2013. The surface area of the hand and the palm for estimating percentage of total body surface area: results of a meta-analysis. Br. J. Dermatol., 169, 76-84.

Wendler, CB & Irakoze, V 2022. Utility of palm and hand surface area in approximating burn extent in Burundian adults and children. Burns, 48, 456-458.

Biography:

Dr Crouch is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. He has a special interest in Burns and Reconstructive Surgery.