A case of stoma skin and mucous membrane separation

Rectal cancer is one of the common tumor diseases in gastrointestinal surgery, with a high incidence rate, second only to gastric cancer and esophageal cancer. Surgical resection is also the main treatment method currently used in clinical practice, and its therapeutic effect is good. With the change in people's life and diet, there are more and more patients with rectal cancer combined with diabetes. The main problem is that the increase in blood sugar can hinder the healing of wounds, and incision infection and skin and mucous membrane ulcers around the stoma are prone to occur, which complicates the patient's condition. It is not conducive to its clinical recovery.

The following is a case to share, let's take a look at it with me.

Here's a challenge:

Chelsea is a retired engineer who is 64 years old this year. He had rectal cancer and diabetes mellitus. chelsea's daughter told me that she had a near-miss experience three years ago. One day three years ago, his father started without any obvious incentive. There was blood in the stool, accompanied by a small amount of fresh blood, and the number of defecation began to increase. The daughter decided to take him to the hospital for a colonoscopy examination. It was rectal cancer, and the pathology showed that it was poorly differentiated adenocarcinoma. Then underwent abdominal rectal cancer radical resection (Dixon) operation. On the 5th day after the operation, Chelsea began to have abdominal pain and yellow feces from the drainage tube. The doctor considered anastomotic leakage and performed emergency abdominal double cannula irrigation and drainage. On the 6th day, the abdominal cavity was Irrigation did not improve, and an emergency performed "exploratory laparotomy + terminal ileal loop ostomy + abdominal and pelvic irrigation and drainage", Chelsea developed septic shock after the second operation and was transferred to ICU with multiple organ failure. The Chelsea recovered gradually, the bowel function recovered, he could eat, and there was no abdominal tenderness and discomfort. The incision of Chelsea and the skin around the stoma had cracks and infection in the later stage. After that, the stoma specialist, with his help, formulated detailed nursing measures for Chelsea and provided related dressing changes, anti-infection, hypoglycemic, nutritional support, etc. After treatment and nursing, the Chelsea incision healed well, the stoma defecation was smooth, and the blood sugar was controlled smoothly.

Longterm Medical's Path to Wound Healing

Solution: Debridement and Dressing Healing

(1) Debridement period: The first step in wound care is effective debridement. In this case, the Chelsea incision is located in the middle of the abdomen, with full-thickness dehiscence, the peritoneum and intestinal tube below, and the yellow tissue at the base tightly adheres. while avoiding accidental injury to the bowel. Iodine cotton balls were used to disinfect the skin around the wound, surgical debridement was used to remove loose necrotic tissue and sutures on the wound surface, and then 0.9% saline solution cotton balls were used for cleaning. Considering a large amount of wound exudate, the Longterm Medical alginate dressing is packed after the first debridement and cleaning. It can absorb the exudate and form a gel to promote the autolytic debridement of the yellow tissue. It is stable and can effectively control infection. The outer layer is covered with Longterm Medical hydrocolloid, the abdomen is bandaged, and the dressing is changed once a day. The wound of the patient.

(2) Granulation growth phase: On the 14th day after wound treatment, the granulation tissue on the wound surface grew, and the exudate also decreased. Considering the local condition of the patient's wound, it is not suitable to perform a two-stage suture and continue to be treated with a dressing change. The size of the incision is 14 cm× 4 cm×2.5 cm, the base is 100% red tissue, the exudate is light red, the surrounding skin is normal, the wound has entered the granulation stage, the infection has been effectively controlled, the antibacterial dressing is stopped, the suture around the wound is removed, and the wound base is applied A little hydrogel dressing is then covered with alginate dressing to provide the best moist healing environment for the wound, thereby promoting the growth of granulation tissue and accelerating wound healing. The frequency of replacement is determined by the dressing's absorption and saturation of wound exudate and is replaced once every 2-3 days.

(3) Epithelial transition stage: On the 40th day, the granulation tissue grows close to the skin plane, and the skin around the wound edge migrates to the center of the wound. At this time, after the wound is disinfected, a hydrocolloid dressing is applied to the wound to promote epithelial migration, 5-7 Change once a day until the wound is completely covered by epithelium.

Wound dehiscence after abdominal surgery is one of the common postoperative complications. Wound dehiscence not only prolongs the length of hospital stay and increases the cost of hospitalization, but also causes great harm to the patient's body and mind. There are many factors of incision infection. Incision infection can also delay wound healing and easily cause systemic infection, which can even lead to death in severe cases. In this case, the patient has diabetes, the wound is dehiscent and has a severe infection, and it is not suitable for secondary suture. He can only achieve second-stage healing through dressing change. Therefore, how to provide comprehensive treatment and care, protect organs, and choose appropriate wound treatment methods To shorten the wound healing time and promote wound healing is the focus of the medical staff. The skin and mucous membrane separation of enterostomy usually occur within one week after the operation. The patient's skin and mucous membranes are not healed well, resulting in an open wound, and excrement is easy to leak out and accumulates here, which further affects wound healing and aggravates infection. In this case, the patient's stoma is located near the wound, the skin and mucous membranes are separated, it is difficult to paste the stoma bag, and the feces leak out and contaminate the wound. Therefore, how do choose a dressing reasonably and stick the ostomy bag firmly to promote wound healing, adjust the diet structure reasonably, and make the feces into strips The condition is difficult for nursing in this case.

For more information on Innomed® dressings, refer to the previous articles. If you have customized needs, you are welcome to contact us; we will serve you wholeheartedly.

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Editor: kiki Jia

Date: August 19, 2022