Care of skin and mucous membrane separation around the stoma

Enterostomy surgery is one of the common surgeries in surgery, and it has been increasing in recent years . For patients with stoma, various stoma complications will affect the quality of life to varying degrees. Mucocutaneous separation is also one of the most common complications of stoma. Early stoma complications occur within 2 to 3 weeks after operation, with an incidence rate of 4.0% to 24.0% , which will prolong the hospital stay of patients, increase treatment costs, and bring pain and anxiety to patients . The following is a compilation of some introductions about the treatment of stoma skin and mucous membrane separation and stoma care suggestions. Let's take a look with me.

What is peristomal mucocutaneous separation?

Intestinal mucosal separation refers to the poor healing of the tissue at the suture of the intestinal stoma, which separates the intestinal mucosa and the suture of the abdominal wall skin at the intestinal stoma, leaving an open wound at the separation, which belongs to post-enterostomy surgery. One of the early complications of the disease, mostly occurs 1 to 3 weeks after surgery.

What is the reason?

1. Iodoform gauze and sutures were removed too early or too late, inappropriate cutting of the stoma chassis, improper stoma care operation, etc.

2. The sutures of the intestinal stoma mucosa are not firmly fixed and fall off: mainly because the absorbable gut suture that sutures the intestinal stoma mucosa and skin is relatively smooth, the knot is not firm or the sutures are broken, causing the sutures to fall off.

3. The structure of the stoma is poor, the position is not good, the skin around the stoma is uneven, and when the stoma product is pasted, the skin is stretched excessively and the suture tension is too large.

4. Patients with poor nutritional status, low immunity, preoperative radiation and chemotherapy, use of steroids and other drugs, suffering from metabolic diseases, inflammatory bowel disease, etc.

5. The oily skin around the stoma is polluted by the contents of the intestine, which in turn contaminates the wound around the stoma, causing the separation of the skin and mucous membranes.

Clinical manifestations:

Separation of the suture between the mucous membrane of the enterostomy and the skin of the abdominal wall

Nursing measures:

First observe the degree of separation of the skin and mucous membrane of the stoma, evaluate the position and type of the stoma, the size of the root of the stoma, the shape of the stoma, whether the abdominal wall skin is flat, elastic, dry, etc. Whether there is imitation gauze; whether there is a support rod and whether the support rod is loose, displaced, or compresses the mucosa and skin; the height of the mucosa at the lowest point of the excretory opening; the color of the intestinal mucosa; the color, volume, shape, and smell of the excrement . For unilateral shallow separation (separation depth less than 0.5 cm) , hydrocolloid dressing can be used; for unilateral deep separation (separation depth greater than 0.5 cm), Alginate Dressing Rope can be used.

operate:

Clean the stoma skin first, wipe the mucous membrane separation with normal saline, dry it, and use Hydrocolloid Dressing Ultra-thin or Alginate Dressing Rope to fill it first and then use Hydrocolloid Dressing Ultra-thin to fix it according to the degree of separation . Then attach an enterostomy bag to avoid fecal contamination. If there is leakage, the ostomy bag and dressing should be replaced in time. Hydrocolloid Dressing Ultra-thin can be cut and used according to the amount of use, and this dressing can speed up the healing of the wound, providing the wound with a slightly acidic airtight space that is conducive to wound healing. It has self-adhesive characteristics and is very convenient to use. Alginate Dressing Rope is a natural dressing made of calcium alginate fibers, which has good water absorption, and after absorbing exudate, it expands and acts as a gel. The gel helps create a moist environment for wound healing and allows for complete peeling.

How to properly care and prevent?

1. Strengthen nutrition and pay attention to a balanced diet, provide the necessary nutrition for postoperative body repair , avoid eating food that is prone to diarrhea and abdominal distension, which will cause intestinal contents to leak to the chassis, and reduce the chance of wound contamination .

2. Routinely use abdominal belt after operation to reduce the tension around the abdominal incision and stoma.

3. When replacing the ostomy bag, pay attention to observe the condition of the ostomy, whether the intestinal tube is attached to the skin normally, and find out whether there is separation of the skin and mucous membrane of the ostomy in time.

4. Keep the part of the stoma clean, discharge the excrement in the pouch in time, and avoid impregnating the junction of skin and mucous membranes; store the stoma supplies in a cool and ventilated place, and pay attention to their expiration date; replace with new stoma supplies to prevent allergic and other adverse reactions , do a patch test if necessary, and always keep the ostomy supplies clean.

For more information on Innomed® alginate dressing rope, 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: December 20, 2022