Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1646-1653
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1646
Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: A case report
Dong-Dong Xue, Ling Zhou, Yong Yang, Si-Yuan Ma
Dong-Dong Xue, Ling Zhou, Yong Yang, Si-Yuan Ma, Southwest Hospital, Institute of Burn Research, Chongqing 400038, China
Author contributions: Xue DD, Zhou L and Yang Y contributed to the treatment, literature search and study design; Xue DD contributed to study conception and manuscript writing; Ma SY contributed to the treatment, study design and manuscript revision; all authors have read and approved the final manuscript.
Supported by: The State Key Laboratory of Trauma, Burns and Combined Injury, No. SKLJYJF18; and the First Affiliated Hospital, Army Medical University, No. SWH2019QNLC-04.
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Dr. Ma reports grants from The State Key Laboratory of Trauma, Burns and Combined Injury, and grants from the First Affiliated Hospital, Army Medical University, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Yuan Ma, PhD, Attending Doctor, Southwest Hospital, Institute of Burn Research, No. 30 Gaotanyan Street, Shapingba District, Chongqing 400038, China. siyuan82@tmmu.edu.cn
Received: August 4, 2020
Peer-review started: August 4, 2020
First decision: November 8, 2020
Revised: November 26, 2020
Accepted: December 10, 2020
Article in press: December 10, 2020
Published online: March 6, 2021
Abstract
BACKGROUND

Toxic epidermal necrolysis (TEN) is often associated with skin wounds affecting large areas. Healing of this type of wound is difficult because of pressure, infection and other factors. It can increase the length of hospital stay and result in wound sepsis and even death.

CASE SUMMARY

A 49-year-old woman developed a skin lesion covering 80% of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back; she developed life-threatening wound sepsis and septic shock. Methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue, deep venous catheter and blood samples. Imipenem cilastatin sodium, tigecycline and teicoplanin were used for anti-infection therapy. Finally, the patient was transferred to the burn department because of severe wound sepsis. In the burn intensive care unit, pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results. After three operations within 2 wk, the wound healed and sepsis resolved.

CONCLUSION

TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis. Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients, and it leaves no scar at the donor site.

Keywords: Toxic epidermal necrolysis, Wound sepsis, Autologous skin grafting, Scalp, Burn, Case report

Core Tip: Toxic epidermal necrolysis is often associated with large skin wound areas. Healing the wound is difficult because of pressure, infection and other factors. Autologous scalp skin grafting may be a good option to promote rapid wound healing and reduce the risk of wound sepsis.