In critical care, the percentage of burned body surface area is a crucial parameter to ensure adequate fluid resuscitation. However, overestimates of the burn extent are common, leading to fluid overload and “resuscitation morbidity.” A traditionally used method for estimating patchy burn surface area is the “rule of palms,” which relies on the original “Lund Browder chart.” In its simplest form, this states that the palmar surface area of the patient’s hand amounts to around 1% of the total body surface area. In this study, we aimed to prove that the palmar surface area of the hand (including fingers) is less than 1% of the body surface area in an Indian population with normal body mass index using an observational study design with 150 men and 150 women at a tertiary care center. Therefore, by extension, the rule of palms should be modified to minimise resuscitation morbidity. The average surface area of the palm (including digits) was found to be 0.79 in healthy Indian men and 0.77 in healthy Indian women, with a combined average of 0.78 (rounded off to 0.80). The findings of this study show that the palmar surface area is 0.8% of the total body surface area in an Indian population with a normal body mass index. The rule of palm may be modified as follows: Total burn surface area = 0.8 × number of palms (in case of patchy burns).
