Toxic epidermal necrolysis:: Use of Biobrane® for skin coverage reduces pain, improves mobilisation and decreases infection in elderly patients

Introduction: Toxic epidermal necrolysis is a rare disease with high mortality due to generalised infection, sepsis or lung involvement, and requires discontinuation of all potentially triggering medications and intensive care in a specialised burn centre. Apart from wound care with antiseptics, wound coverage may be achieved with a skin substitute; treatments are compared with regard to infection, protein loss, re-epithelialisation and mortality. Patients and methods: Of 14 people with toxic epidermal necrolysis affecting >30% body surface area, eight received daily dressing changes using Lavasept (R) and six received wound coverage with Biobrane (R). Demographic data, SCORTEN score, mortality, visual-analog pain scale, mobilisation, time to re-epithelialisation, serum protein, albumin, C-reactive protein and leukocytes, and body temperature were evaluated in all cases. Results: Mean age of patients was 68.0 +/- 14.8 years, mean body surface area affected was 66.4%, median SCORTEN score was three and overall mortality was 36%. In the Biobrane (R) compared with the Lavasept (R) (control) group, mean pain was significantly reduced (2.9 versus 5.5 on the scale, p < 0.05), mobilisation was significantly earlier (walking at 3 days versus 7 days, p = 0.003), re-epithelialisation was complete in 12.5 days versus 16 days, and at 9 days there was reduced decrease of serum proteins and significantly lower levels of C-reactive protein and white cells (p < 0.05). Conclusion: Early wound coverage with synthetic skin substitute such as Biobrane (R) is beneficial compared with conservative antiseptic wound treatment, but mortality rate is not significantly different. (c) 2007 Elsevier Ltd and ISBI. All rights reserved.