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Updated: May 27, 2026

A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis
Published on: March 14, 2025
Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis
Manuel Florian Struck1, Till Illert, Thomas Schmidt
1Department of Plastic and Hand Surgery, Burn Trauma Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112 Halle/Saale, Germany. manuelstruck@web.de
Introduction:
Secondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require less fluid.
Patients And Methods:
We reviewed our registry of adult patients presenting with TEN in our 8-bed BICU over the course of 11 years and identified and analyzed patients treated for ACS and decompressive laparotomy (DL).
Results:
From a total of 29 patients with bioptic confirmed TEN, 5 underwent DL due to ACS with a mean age of 57 years, mean percentage of total body surface area (TBSA) affected of 54±25%, complete epidermolysis of 28±24% TBSA, a mean severity of illness score (SCORTEN) of 3.8±0.8, and a mean intra-abdominal pressure before DL of 33±7 mmHg. Mortality was 100% in patients with ACS versus 33% without ACS.
Conclusion:
An ACS that requires DL worsens the already critical condition of a TEN patient considerably. TEN-related impaired intestinal functionality and increasing intestinal edema due to systemic capillary leakage warrant early initiation of intra-abdominal pressure monitoring to identify patients at high risk of ACS.
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