Toxic Epidermal Necrolysis: Meeting the Complex Needs of an Exfoliative Skin Disorder Using a Simple Single Dressing Approach

Purpose:  To demonstrate the efficacy and ease of using a soft silicone silver foam transfer dressing to manage the widespread necrosis and massive tissue loss affecting > 30% of epidermal skin surface as seen with Toxic Epidermal Necrolysis. (TEN)

Goals:  TEN practice guidelines for topical care were primarily established for use in burn care centers with the focus on two primary goals: 1)  The protection of denuded skin surfaces and  2) The prevention and treatment of infection.  Two additional goals were identified based upon factors that presented as obstacles while providing care to our patient with TEN:  3)  Minimizing and managing pain and  4) The management of small to large volume exudate.  Two secondary goals were identified stemming from a lack of appropriate product availability in our existing formulary and a shortage of nursing resources due to time restraint:  5) To develop a cost effective treatment plan by utilizing an all-in-one product with the capability of achieving the 4 primary goals and 6) To develop a POC that addresses time management that is reflected in ease of use, a decrease in the frequency of dressing changes, with an increase in the duration of therapy.

Method:  This patient had > 40% total body surface area affected.   Attention was focused on the back, torso, neck, shoulders and the scrotum where the original sloughing of epidermal skin began with the simple act of turning.   Dressings were removed for debridement every 2 days and re-applied based on clinical indications and existing dressing appearance.  Average duration of a single dressing was 5-7 days.

Results:  The soft silicone silver foam transfer dressing allowed us to achieve all primary and secondary goals outside the burn care center setting.  Staff feedback reported an increase in confidence in managing the complex needs of patients with massive tissue loss.