Collagen sheet dressings for cutaneous lesions of toxic epidermal necrolysis
31 December 2019 (online)
Toxic epidermal necrolysis (TEN) is associated with a significant mortality of 30–50% and long-term sequelae. Treatment includes early admission to a burn unit, where management with precise fluid, electrolyte, protein, and energy supplementation, moderate mechanical ventilation, and expert wound care can be provided. Specific treatment with immunosuppressive drugs or immunoglobulins did not show an improved outcome in most studies and remains controversial. We have treated the cutaneous lesions of seven patients of TEN with collagen sheet dressings and have found a significant reduction in morbidity. The sheets are a one-time dressing, easy to apply and they reduce fluid loss, prevent infection, reduce pain, avoid repeated dressings and gradually peal off as the underlying lesions heal.
- 1 Park SN, Lee HJ, Lee KH, Suh H. Biological characterization of EDC-crosslinked collagen-hyaluronic acid matrix in dermal tissue restoration. Biomaterials 2003;24:1631-41.
- 2 Lazovic G, Colic M, Grubor M, Jovanovic M. The application of collagen sheet in open wound healing. Ann Burns Fire Disasters 2005;18:151-6.
- 3 Horch RE, Stark GB. Comparison of the effect of a collagen dressing and polyurethane dressing on healing of split thickness skin graft donor sites. Scand J Plast Reconst Surg Hand Surg 1998;32:407-13.
- 4 Veves A, Sheehan P, Pham HT. A randomized, controlled trial of promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. Arch Surg. 2002;137:822-7.
- 5 Nataraj C, Ritter G, Dumas S, Helfer FD, Brunelle J, Sander TW. Extra cellular wound matrices: Novel stabilization and sterilization method for collagen-based biologic wound dressings. Wounds 2007;19:148-56.
- 6 Nagata H, Ueki H, Moriguchi T. Fibronectin: Localization in normal human skin, granulation tissue, hypertrophic scar, mature scar, progressive systemic sclerotic skin, and other fibrosing dermatoses. Arch Dermatol 1985;121:995-9.
- 7 Motta G, Ratto GB, De Barbieri A, Corte G, Zardi L, Sacco A, et al. Can heterologous collagen enhance the granulation tissue growth? An experimental study. Ital J Surg Sci 1983;13:101-8.
- 8 Chung J, Wang XQ, Lindberg FP, Frazier WA. Thrombospondin-1 acts via IAP/CD47 to synergize with collagen in alpha2beta1-mediated platelet activation. Blood 1999;94:642-8.
- 9 Ramakrishnan KM, Jayaraman V. Management of partial-thickness burn wounds by amniotic membrane: A cost effective treatment in developing countries. Burns 1997;23:S33-6.
- 10 Hadjiiski O, Anatassov N. Amniotic membranes for temporary burn coverage. Ann Burns Fire Disasters 1996;9:88-92.
- 11 Gruss JS, Jirsch DW. Human amniotic membrane: A versatile wound dressing. Can Med Assoc J 1978;118:1237-46.
- 12 Ghalambor AA, Mohammad HP, Khodadadi A. The amniotic membrane: A suitable biological dressing to prevent infection in thermal burns. Med J Islamic Acad Sci 2000;13:115-8.
- 13 Mohammadi1 AA, Riazi1 H, Hasheminasab MJ, Sabet B, Mohammadi MK, Abbasi S, et al. Amniotic membrane dressing v/s conventional topical antibiotic dressing in hospitalized burn patients. Iranian Red Crescent Med J 2009;11:66-70.