Accurate debridement of toxic epidermal necrolysis using Versajet ®

Abstract

Toxic epidermal necrolysis (TEN) is a rare immune-mediated disease process exclusively affecting the epidermis. The disease characterised by extensive epidermal destruction still maintains a high mortality. Managing these patients in a specialised Burns service has been shown to improve survival [1]. The mechanism of TEN is not fully understood, however it has been demonstrated that extensive apoptosis of keratinocytes is responsible for epidermal destruction [2]. The trigger, often a severe drug reaction, is thought to be due to a cytotoxic lymphocyte-mediated immune response [3]. High levels of cytokines and activated T-lymphocytes are found in the blister fluid under necrotic epidermis and may play a role in disease propagation [4]. The Versajet system is a relatively new technology based on an old principle of the Venturi effect. High velocity saline forced through a narrow operating window creates a localised vacuum, which holds and cuts the underlying tissue while aspirating debris. We report our recent experience of the use of the Versajet system for effective and precise debridement in six patients with TEN syndrome.