P0705 / #733: SUCCESSFUL APPLICATION OF SYNTHETIC AND BIOLOGICAL SKIN SUBSTITUTE TO A CHILD WITH TOXIC EPIDERMAL NECROLYSIS

Abstract

Aims & Objectives: Report the successful application of synthetic and biological skin substitute to a child with toxic epidermal necrolysis Methods: Descriptive case report Results: A 2 years old female with a two days history of fever, reduced oral intake and loose stool, she was treated with multiple drugs (antibiotics, antiviral, acetaminophen, antihistamines, dexpanthenol, zinc acetate) with no improvement. Five days later, she developed progressing reddish rash with symmetrical exfoliation affecting face, scalp, neck, trunk, both upper limbs and both lower limbs. As the rash worsened, the child developed oral and lip ulcers, hemorrhagic lesions of the oral mucous membrane, purulent conjunctivitis. Her general condition deteriorated and she was therefore transferred to a Intensive Care and Pediatric Burn Unit. Intravenous fluid resuscitation was initiated with commencement of nasogastric feeding and adequate opioid analgesia. She received a single dose of intravenous immunoglobulin as well as a three day course of steroids. On day 2 the affected areas were debrided. A synthetic copolymer based on DL-lactide, Trimethylenecarbonate and e-caprolactone (Suprathel) was applied to the entire left arm, right arm, left leg, right leg, trunk circumferentially, then covered with paraffin gauze (Adaptic) and dry dressings. The face area was covered with an extracellular matrix graft (OASIS Wound Matrix) a porcine derived collagen scaffold. All areas were completely healed at 6 days, no longer required dressings. Discharged after 1 week with follow-up at outpatient consultation.Conclusions: In conclusion wound coverage using synthetic and biological skin substitute enables easier application, less exudation with fewer dressing changes, reduced pain and earlier re-epithelialization.