Silver hydrofiber dressings in the management of patients with toxic epidermal necrolysis: A case series
Background: Toxic epidermal necrolysis (TEN) is a rare autoimmune reaction with severe mucocutaneous involvement. The incidence of the disease is 1 to 3 per million people. Mortality from the condition is high. Contributory to the high mortality is poor wound management resulting in wound infection with subsequent septicaemia.
Patients and methods: This was a prospective study of patients suffering from TEN who were managed by the authors between January 2010 and December 2016 and whose wounds were treated with silver hydrofiber dressings (specifically Aquacel® Ag). The study was approved by the local ethics and research committee. Consent was sought from the patients or their next of kin. All patients with TEN seen by the authors were managed by surgical debridement of the wounds and the wounds dressed with Aquacel® Ag.
Results: A total of 12 patients with TEN of more than 70% body surface area had their wounds managed by serial surgical debridement and dressed with Aquacel® Ag. The male:female ratio was 3:1. The age range of patients was 22 to 43 years with a mean age of 29.5 years. All the wounds healed well in a time-frame of 28 days. No mortalities related to TEN were reported.
Conclusion: The absence of deaths in this series suggests that treatment with Aquacel® Ag silver hydrofiber dressings decreases mortality in patients with TEN. However, these findings need to be further validated by means of randomised controlled studies. Surgical debridement removed necrotic tissue decreasing the chances of wound colonisation. The hydrofiber silver dressing material removed the excess moisture in the wound preventing wound maceration and infection. Due to adequate moisture control the wounds healed rapidly through epithelialisation.
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