Background: As far as high technology is concerned, digital images of burn patients are widely used for wound documentation and specialist consultation. Wound area can be approximated from the photographs to aid further treatment for the patients. However, objective estimation of the wound areas in the digital images is still problematic.

Objective: To calculate sizes of burn wounds from digital images.

Materials and Methods: A computer application, Burn Percentage Calculation (BPC), was developed based on image segmentation algorithm called Grabcut. This image processing tool extracted an object of interest out of the background by using differences of pixel color and contrast in the image. The probabilistic models of being foreground and background were created to distinguish object pixels from the rest of the input image. The BPC application effectively extracted patient’s body parts and burn wounds from the background. By mapping to Lund and Browder chart in the application, the wound area in a unit of percent total body surface area (%TBSA) was obtained. To validate the application, 10 plastic surgery residents were assigned to assess burn wound areas from 5 digital photographs using BPC application compared to conventional Lund and Browder chart.

Results: Forty-one digital images of burn patients were processed by BPC application. The application clearly separated the burn wounds from the background, and calculated wound areas in a unit of %TBSA. Burn sizes calculated by BPC application were not significantly different from those using conventional Lund and Browder diagram.

Conclusion: Grabcut algorithm is a powerful image segmentation tool which can sufficiently extract burn wounds from a 2D photograph. Our study demonstrated that sizes of burn wounds in the photographs were accurately calculated using an image segmentation-aided computer application. The resulting burn areas can guide individualized treatment for burned patients.

Keywords: Burn wound area; Digital image; Grabcut algorithm; Image segmentation; TBSA