Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.
Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.
Gastrointestinal involvement is a rare complication of toxic epidermal necrolysis syndrome (TENS) that results in sloughing of the intestinal epithelium. Prior case reports have noted the potential susceptibility of the entire gastrointestinal tract, from oropharynx and esophagus to sigmoid colon and rectum. Given its infrequency, the effect of gastrointestinal involvement on the treatment and prognosis of TENS is poorly understood. Here, the authors report a case of gastrointestinal symptoms in a patient diagnosed with toxic epidermal necrolysis, likely representing gastrointestinal involvement. In addition, the authors describe the histopathologic and endoscopic characteristics of the involved mucosa, clinical course, and present a review of the literature of this rare but potentially impactful complication of TENS.
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