What the Heck! Burn Surgery Nerd Words

Your skin does two jobs you never think about until it’s gone: it keeps fluid in and it keeps infection out. 

So what happens when a major burn breaks that barrier and every decision has to be made fast, with the right words, the right math, and the right plan? We jump into a rapid-fire round of “What The Heck Is That?” with Dr. Tommy and pro comedian Tara Brown, turning burn surgery terms into clear, usable concepts you can actually remember. 

We start with TBSA (total body surface area) and the surprisingly simple tools clinicians use to estimate burn size, including the patient’s palm as a quick 1% reference. From there we get precise about what a third degree burn really means and why it’s about depth, not surface area. 

One of the most misunderstood words in wound care? Debridement. We tackle what it looks like when dead tissue has to come off before healing can begin. 

Then we dig into skin grafting vocabulary you’ve probably heard but never had decoded: autograft versus allograft versus xenograft, plus why temporary graft coverage can be essential while a burn evolves and donor sites recover. 

We connect the dots to burn fluid resuscitation and the Parkland formula, and we wrap with hydro surgery, a “water knife” approach that shows how technical burn care has become. 

If YOU like smart medicine with real-world explanations and a little humor, hit play, subscribe, share with a curious friend, and leave a review with the next medical term you want us to decode.

THANKS TO OUR GUESTS:

Dr Tommy: LinkedIn: tommytranmd IG @tommytranmd,  www.tommytranmd.com

Dr Tommy jumps out of plane for patient:

https://www.newschannel5.com/news/i-will-jump-for-you-burn-survivor-gets-his-doctor-to-go-skydiving

Tara Brown: IG/TT @tarabrowncomedy, X @TaraBrownComedy, FB/YT Tara Brown Comedy, www.tarabrowncomedy.com

Tara’s TEDx The Laughter Assignment:

https://youtu.be/Fjy2eQF7kcs?si=L5usforWt12v0V8B

Subscribe wherever you listen, share this with a friend and leave a review so more people can find honest conversations about weight loss, health, and a little comedy along the way.

This episode was produced by Angie Debelak with post-production editing by Ben Hill Sound.

Thanks for listening to Dr Ben and Friends.  Laughter is the best medicine...unless you're treating bowel or bladder incontinence.  See you next time!

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Transcript

Game Setup And First Term

Dr Ben and Tara Brown 0:10

All right, folks. Are you ready for the next segment called What the Heck Is That? This portion of the podcast, we will test your knowledge of medical terms, terms that Dr. Tommy uses every day. We want to uh have Dr. Tara Brown here who just kills uh Cavity Sam. Okay. Pronounce the words and tell us what you think they mean.

Tara Brown Comedy 0:34

Okay.

Dr Ben 0:35

Dr. Tommy will show you a word here.

Measuring Burn Size With TBSA

Tara Brown Comedy 0:38

Total body surface area. Okay.

Dr Ben 0:41

What do you think that is?

Tara Brown Comedy 0:42

I think that would mean when Dr. Tommy is evaluating how much of the body he needs to graft, maybe? He's looking at it in its totality to get the percentage of what he needs to do. I don't know. Right or wrong. What do you think about it? Dr.

Dr Ben 1:04

Tommy, when would you use total body surface area? That's actually really, really close. Very close.

Dr Tommy and Tara Brown 1:09

So total body surface area or TBSA is the uh total uh percentage um that is burnt, or total body surface area that is involved um in a patient, and we measure that based off of a patient's hand or uh total anatomic um area that is uh involved. So from the tip of your hand to the base of your palm, the patient's palm is one TBSA. Oh you can also utilize your patient's um head. So the anterior uh front head is uh about uh 3.5, the back head is 3.5, the anterior neck is one, the posterior neck is one, and you kind of divide the the body up for that. So let's say that if only um half of the neck, half of the anterior neck is involved, that's about 0.5% TBSA.

Tara Brown Comedy 2:15

Interesting. Can I tell you a fun fact about the hand? Yeah do you know that people in Michigan use the hand to tell you different parts of Michigan, right, Dr. Ben?

Dr Ben 2:23

I'm from Michigan. You have a map wherever you go.

Dr Ben and Tara Brown 2:25

Yep. It's the glove close to the mitten of the glove. The mitten.

Dr Ben 2:29

That's right.

Dr Tommy and Tara Brown 2:29

Bet you didn't know that, Dr. Tommy. I knew that. I did not.

Dr Ben 2:33

Folks from Michigan have a map wherever they go. I'm from here. I'm from here.

Tara Brown Comedy 2:36

Yeah, okay.

Dr Tommy 2:36

That's cool.

Tara Brown Comedy 2:37

I just love telling that every time somebody puts up their hand. Okay. All right.

Dr Ben 2:41

And that's important for uh burn surgeons for fluid resuscitation, how much fluid they should get. All right,

What Makes A Third Degree Burn

Dr Ben 2:48

ready for number two, Dr.

Tara Brown Comedy 2:49

Third degree burn. Well, we learned about this a little bit earlier. That's one of the higher degree burns that you have. Does it cover, does it matter how much surface area it covers or the level of the burn? Like I think it's one of the ones it definitely won't heal itself, as we discuss with more surface level burns. And it's one of the ones where graft could be involved, but not necessarily.

Dr Tommy 3:16

Exactly. Okay. So you're right. Um, partially right. So a third degree burn or a full thickness burn is based off of depth, not of surface area. Right. And it goes down all the way to fat.

Tara Brown Comedy 3:32

Okay.

Dr Tommy and Tara Brown 3:33

So I still remember you saying that. Exactly. So when you see fat, you know that it's a full thickness burn or a third degree burn.

Tara Brown Comedy 3:41

Okay. Okay. All right.

Debridement And Removing Dead Tissue

Tara Brown Comedy 3:44

Debridement. Debride. As a single woman, I'm gonna say it means a woman who does not have a husband. Debride. Otherwise, let's say debridement. Otherwise, I have no clue what I'm saying.

Dr Ben 3:57

Maybe a widower has been debrided.

Tara Brown Comedy 3:59

You've been debrided. I've been debried. I've been devoid of a being a bride. Okay. So tell me what you got to say.

Dr Tommy 4:04

Debridment means a widower.

Tara Brown Comedy 4:08

I was close.

Dr Tommy 4:09

I'm kidding. Debriment means to remove dead tissue.

Tara Brown Comedy 4:13

Okay. Okay. Yes.

Dr Ben, Dr Tommy, and Tara Brown 4:15

So surgically exercise. Oh, okay. To either uh exactly. To either surgically or non-surgically remove dead tissue.

Tara Brown Comedy 4:25

Okay.

Dr Tommy 4:26

To, in order to heal a wound, the first step is to remove all dead tissue. Okay. So we do that with uh uh debridement.

Tara Brown Comedy 4:37

Here's a ridiculous question, maybe. Dead tissue, once you remove it, is there no more signs of life from that area? Like in the sense that will it re uh um generate? Or is it once it's dead, it's gone.

Dr Tommy and Tara Brown 4:55

You know what I'm saying? Let's say that you have a wound bed. Yeah, and on top of that wound bed is some non-viable tissue, right? You can remove it uh with a few ways. You can remove it with dressing changes, okay, with called wet-to-dry dressing changes. And so if the dressing goes on wet and it gets dry, when you remove that dressing change, the the stickiness of the dry dressing will essentially debreed that tissue off.

Dr Ben, Dr Tommy, and Tara Brown 5:23

Is there a degroomment? Degroomment. Should I be worried if my wife wants a degroomment? Hey, you should trademark that. Autograft.

Autograft Allograft Xenograft Basics

Dr Ben and Tara Brown 5:31

Signed up for a autograph.

Tara Brown Comedy 5:33

Autograft.

Dr Ben 5:34

Does that have something to do with a car?

Tara Brown Comedy 5:36

I know. Um autograft. Autograft. That's good. Okay, so I know the second part of this for grafting, obviously, but autograft. Hmm. Is it mean does it mean that you can look at this and know automatically that they're gonna need a graft? See what I did there, Dr. Tommy? Yeah.

Dr Tommy 5:56

Okay, what do you got? So auto means self, right? And then graft means to graft. So it's like skin graft. So in the context of uh burn surgery, it means to copy and paste your own skin.

Tara Brown Comedy 6:13

Okay.

Dr Ben, Dr Tommy, and Tara Brown 6:14

So it means taking skin from a donor site. Like the tuckus graph. Like the tuckets grant. To place it onto a wound.

Tara Brown Comedy 6:25

Okay.

Dr Tommy 6:26

And so if I change, let me see. If I there's all right. So if I say allograft, what do you think that would mean?

Dr Ben, Dr Tommy, and Tara Brown 6:36

Allo graft? A-L-L-O? Uh that you're getting it from a cadaver? Dr. Brown. Dr. Brown. Yes, yes. Yes.

Dr Tommy 6:50

Now, let me ask you another question. If I said xenograft, xenograph, okay.

Tara Brown Comedy 6:57

So auto is the self-graft, allo is a cadaver graph, xenograft. Um Xeno, Xeno, Xeno. Ah, golly, I want to get it right. I want to get it right.

Dr Tommy 7:11

Um so let me help let me help you a little bit. So auto is from a human that is from yourself.

Tara Brown Comedy 7:18

Yes.

Dr Tommy and Tara Brown 7:19

Allo is from a human that is not yourself. Okay. So Xeno is from an animal?

Dr Ben 7:28

Dr.

Dr Ben, Dr Tommy, and Tara Brown 7:28

Brown, Dr. Brown. Parkland formula. What does that mean? The Parkland formula. Is this a method of some sort? Like the I don't. Parkland formula. Parkland formula. I don't know. Is this a type of graft?

Dr Tommy 7:50

I don't know. Sure. We never talked about the Parkland formula. So I don't expect you to know it. Okay. So

Parkland Formula For Fluid Resuscitation

Dr Tommy 7:57

we we talked about the function of the skin, right? So we know that the skin keeps things in, yes, right, and it keeps things out. So we talked about uh keeping things out like bacteria and infection, right? But the skin keeps things in like fluid. So fluid seeps out.

Tara Brown Comedy 8:17

Okay. Right.

Dr Tommy 8:18

There's a uh there's a threshold at about 20% TBSA where it causes a shift and it becomes so much that you need uh resuscitation.

Tara Brown Comedy 8:36

Oh wow.

Dr Tommy 8:37

Okay. And so Dr. Parkland um created this formula back in the 1960s. Okay. And it is a formula that helps resuscitate patients within 24 hours of their initial injuries.

Tara Brown Comedy 8:53

Can I

Why Temporary Grafts Matter

Tara Brown Comedy 8:54

go back to xenograph for a second?

Dr Ben, Dr Tommy, and Tara Brown 8:56

There is no xenograft. No, but what's you think about it? Okay, we're talking about xenograph. Okay, yes.

Tara Brown Comedy 9:01

So for an animal, to get a graph of an animal, what would be the preferred animal that you would use?

Dr Tommy 9:08

So there's there's so there's so many. The market is saturated right now. And there used to be pig, there's right now, there's fish. There's Atlantic. Really?

Tara Brown Comedy 9:22

I would think fish had thin skin, no?

Dr Tommy 9:24

If you look at like xenograph right now, there's like Atlantic cod, there's sheep stomach, there's there's so many.

Dr Tommy and Tara Brown 9:32

Um is that common? Do is that kind of more last resort, or is there a reason that a person would do xenograph versus uh uh auto, not autograph, allographed?

Dr Tommy 9:44

That's that's a good question. So the goal is to get an autograph. Okay, is to get yourself covered with your own skin.

Tara Brown Comedy 9:54

Your own skin.

Dr Tommy 9:56

Because your body only accepts two sources of skin. Do you know which ones they are? I would imagine your own. Exactly. And the cadaver?

Dr Tommy and Tara Brown 10:09

An identical twin. Oh, is that right? Wow. So if I'm an only child, I'm kind of messed up. I'm screwed.

Tara Brown Comedy 10:15

Okay.

Dr Tommy 10:16

Yeah, your your your parents, your parents screwed up. Yeah, they messed up down. I I joke. I knew I needed another family. So the reason why the market for allograft and xenograft is so prevalent is because you don't know if that wound bed is ready for grafting. Okay. So if the wound is so deep and you excise, how do I know that that wound bed is ready? If you cook a steak and you want it at 131 degrees internal temperature, do you cook it to 131 internal degrees temperature?

Tara Brown Comedy 10:55

Because there's residual heat at the end.

Dr Tommy 10:58

You have to pull it out at 125. Right. Right. And you let it sit for 10 minutes and you rest it. It's the same thing for a burn.

Tara Brown Comedy 11:06

Got it. Okay.

Dr Tommy 11:07

But there's still residual damage that goes on days after the initial injury.

Tara Brown Comedy 11:13

Okay.

Dr Tommy 11:14

And so you need to make sure that the zone of stasis will either improve or continue to die. So you don't know where it's going to go. And so that's where the allograft market is there for. That's why the uh allograft market is there for. The other reason why it's there is what if the patient has such a large uh surf surface area of burns and you need something to cover and wait for the donor sites to heal. So that let's say that you have a 70% TPSA, right? And you've used that uh donor skin and you've grafted, let's say 40%. Two, three weeks later, that donor now re-heals. You're gonna take it again and then cover an additional 40%.

Tara Brown Comedy 12:04

Would you put uh would you put more you would put more skin on top of it, or would you take off what you had and then put these the uh graft on that you initially wanted to have on it? Does that make sense?

Dr Tommy 12:16

Yes, so it's it's kind of like um it's like a yard, right? You you only have so many seeds of grass, right? And you um you you thinly uh cut the the grass and then you you sow it and you place it here and you kind of like put little areas and that area kind of grows. You wait for the donor to regrow and you take more and then you're okay. You're you're you're placing it, and then over time, you're you have to you have to cover that bare area with something because that's gonna cause fluid loss or what or whatnot.

Dr Ben, Dr Tommy, and Tara Brown 12:56

So you're good because you've you've kind of put more on top of it. Exactly. I got you with analogy. Okay. What you got? You got another one there. Okay. Yeah.

Dr Ben 13:04

Will a fish skin make me a faster swimmer if I were to go fish alograft.

Dr Ben and Dr Tommy 13:11

Uh I I'm going to defer because uh could be an elective procedure.

Tara Brown Comedy 13:20

Uh-oh. What happened? Let me see.

Dr Tommy 13:22

I signed an NDA with uh with a uh I'm kidding. Oh okay.

Dr Ben, Dr Tommy, and Tara Brown 13:28

I was like, uh uh, the IOC is gonna test people's skin. Is that fish skin or your real skin?

Tara Brown Comedy 13:33

Um hydro surgery. Hydro.

Hydro Surgery With A Water Knife

Tara Brown Comedy 13:37

I feel like there's some sort of water involved. I feel like there's water involved with this surgery.

Dr Tommy 13:47

Exactly.

Tara Brown Comedy 13:48

That's all I feel. Yeah.

Dr Tommy 13:50

Yeah. That's exactly right. Okay. It's it's it's water surgery. It's water surgery.

Tara Brown Comedy 14:02

Is that right?

Dr Tommy and Tara Brown 14:02

Yeah. And what how though? So it's it's a water knife.

Tara Brown Comedy 14:08

Okay.

Dr Tommy 14:09

Yeah.

Tara Brown Comedy 14:09

So if you I would like to say to the public schools of Brooklyn, New York, I pay attention to things like hydro water. I paid attention.

Dr Tommy and Tara Brown 14:18

If you've ever seen water cut through granite, I don't think I have, but okay. You can you can imagine water cutting through skin. But imagine if that water was redirected as a knife. And so if you imagine this pencil and the water comes out, comes in through here, and then come out through the handle, so it's only exposed through the tip, like this, through the handle tip. And so you can then use it as a blade, and then you can essentially sharply dissect and control the um the plane of the water and it dissects. Yeah.

Tara Brown Comedy 15:07

Okay. I would also like to say that I'm a Pisces, so things would water.

Dr Ben 15:11

There you go.

Tara Brown Comedy 15:11

I'm gonna get that.

Dr Ben 15:12

I love it. I love it.

Quick Wrap And Super Sleuth Badge

Dr Ben 15:14

All right, thank you. Thank you. That was fantastic.

Tara Brown Comedy 15:17

Thank you for the education. I love it.

Dr Ben 15:18

Games are a blast. Great job, both of you. Stellar work. All right, you're an official Dr. Ben and Friends Super Sleuth. We're always curious about words. Great job, both of you. Great job, listener.

Speaker 1 15:36

Dr. Ben and Friend.