Stevens-Johnson Sydrome (SJS) and Toxic Epidermal Necrolysis Syndrome  (TENS) represent a dermatologic emergency.^1,4  A decision was made at a large academic medical facility and regional burn center that the Wound, Ostomy, and Continence Nurses (WOCNs) would be the first line consultants on the topical treatment of massive tissue loss (MTL) syndromes.  A protocol was developed that is effective for preventing colonization and infection, promoting faster healing times and facilitating care by bedside nurses.
There is a dilemma in the area of wound care for a standardized treatment protocol for SJS/TENS.  The topical treatment of MTL is closely related to treatment of chemical and thermal burns. In both instances the skin, the first line of defense against infection, ² has been compromised. The epithelial sloughing predisposes patients to septicemia, ² the primary cause of mortality in these syndromes.  Silver dressings have been used as a bacterial agent to treat thermal type injuries since the last half of the 19^th century. ⁷   The purpose of this article is to present three case studies demonstrating a standardized treatment protocol for MTL that is effective and accessible throughout the facility.  Research that has compared treatments has proven that the nanocrystalline silver-coated dressings^*  are more effective in decreasing infections related to fungal and bacterial invasion, providing better patient comfort levels, decreasing time spent on dressing changes and decreasing overall cost of treatment. ⁶