TOXIC EPIDERMAL NECROLYSIS - A REVIEW AND REPORT OF THE SUCCESSFUL USE OF BIOBRANE FOR EARLY WOUND COVERAGE

Toxic epidermal necrolysis (TEN), is an exfoliative dermatological dis order of unknown cause, A patient with TEN loses epidermis in sheet-li ke fashion, leaving extensive areas of denuded dermis that must be tre ated like a large, superficial, partial-thickness burn wound, Methods of coverage described in the English literature over the last decade i nclude the use of several dressings such as fresh-frozen or cryopreser ved cadaver allograft, porcine xenograft, and amnionic membrane. Succe ssful use of the biosynthetic dressing, Biobrane, has been described a fter burn injuries and Stevens-Johnson syndrome; however, its use in T ENS has not. We present three patients with TEN treated successfully i n our burn center over the past 12 months using Biobrane, The patients were men aged 20, 58, and 77 years, with 58% to 95% total body surfac e area slough, Diagnosis was confirmed by skin biopsy on admission, an d drug ingestion was implicated in each instance, Each patient was tho roughly debrided in the operating room shortly after admission, and de nuded areas were covered with Biobrane within 24 to 48 hours of admiss ion, Biobrane demonstrated greater than 90% adherence by 48 hours, and no wound sepsis occurred. Each patient demonstrated epithelialization within 9 days. Patients were ambulatory at 72 hours. Corticosteroids and prophylactic antibiotics were avoided, Enteral nutritional support and aggressive septic surveillance was routine. Hospital stay was bet ween 13 and 30 days without mortality, Early use of Biobrane in patien ts with TEN appears to provide a reasonable means of wound coverage.