Skin coverage with Biobrane* biomaterial for the treatment of patients with toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that may i nvolve a large body surface area and mucosal surfaces, The microscopic chan ges that occur with this condition are similar to those that occur with sup erficial dermal burns, such as dermal detachment from the underlying dermis . Complications of TEN are related to the loss of the the epithelial skin b arrier and include pain, fluid and electrolyte loss, and an increased risk of sepsis. The treatment of a patient with TEN is best accomplished in a bu rn unit, where expert treatment of these complications can be provided. Med ical treatment includes the administration of immunosuppressive therapy and the discontinuation of any previous corticosteroid treatment. Surgical man agement includes the debridement of necrotic areas. In this article, the su rgical management of 8 consecutive patients with TEN who were admitted to t he intensive care burn unit at the Hospital Universitario de Getafe in Madr id, Spain, from 1996 to 1998 is described. These patients were treated with extensive early debridement of necrotic skin areas followed by wound cover age with Biobrane (Dow B. Hickam, Inc, Sugarland, Tex), a temporary semisyn thetic skin substitute. Skin coverage with this material decreases pain and fluid loss, and it possibly facilitates epithelization and decreases the r isk of sepsis, without adverse side effects. This semisynthetic material me ets some standards of an ideal skin substitute: it is easy to use, provides several beneficial physiologic effects, and improves patients' comfort. In the 8 cases of patients with TEN that were studied, the use of Biobrane sk in substitute for the coverage of massive areas of detached skin was found to be an important aspect of treatment.