Autologous Skin Cell Suspension in Toxic Epidermal Necrolysis: A Case Series.

Toxic epidermal necrolysis is a dermatological process which has lacked both clear pathophysiological definition and efficacious medical treatment. This leads to metabolic dysfunction due to the inability to regulate fluid and electrolytes after the loss of skin. It is a deadly and costly disease which is associated with long lengths of stay and high mortality rates. The depth of toxic epidermal necrolysis mimics that of a partial thickness burn. There has been documentation of successful usage of autologous skin cell suspension in toxic epidermal necrolysis. This study expands upon our previous experience using autologous skin cell suspension in toxic epidermal necrolysis to a series of three. Dermatology is consulted for biopsy along with the burn surgery team for wound care, where a Score for Toxic Epidermal Necrolysis is performed for risk stratification. Aggressive operative debridement is performed in the operative suite and a healthy, uninvolved donor site is harvested and processed per standard protocol. Dressings are taken down at post-operative day four for evaluation. The average length of stay when compared to historical data in literature is a reduction by 48%. ICU days were reduced by 64%. Cost was reduced by 54%. There was no mortality in our population of three. Autologous skin cell suspension is both therapeutically and cost effective at treating toxic epidermal necrolysis. The question of type of dressing and decision to operate is mitigated by this intervention. As an efficacious intervention, it reduces hospital stay, reduces wound cares, speeds healing, and provides a cosmetically acceptable outcome.