A case of peristomal skin ulceration

Ostomy surgery often encounters a variety of problems, but most stoma patients are troubled by the skin of the stoma. A little improper care will cause redness, itching, and ulceration. So what are these problems? What caused it, and how to deal with it? Today, I would like to share with you a case of skin ulceration around the stoma caused by feces stimulation. Here I will briefly introduce the cause and treatment method.

Case picture:

Case analysis:

1. The cutting size of the center hole of the chassis is improper. If it is too large, the skin will be exposed outside the chassis. Long-term stimulation by feces will cause redness and ulceration.

2. The method of removing the chassis is incorrect, causing slight damage to the skin around the stoma.

3. Incorrect product selection.

What is fecal dermatitis?

The erosion of the skin around the stoma due to frequent stimulation by feces or urine is called irritant dermatitis or fecal water dermatitis, mainly because the feces contain a large number of digestive enzymes, and if there are a lot of leakages, it will cause erythema within 1 hour, and epidermal ulcers within several hours. skin ulceration, pain.

What usually causes this to happen?

1. The position of the stoma is poor, the skin around the stoma is uneven or close to the wound, making it difficult to stick the stoma bag to the skin, leakage of feces and urine, and corrosion of the skin around the stoma.

2. The ileostomy does not form a proper protruding papilla, which makes it difficult for all feces or urine to be collected into the stoma bag, resulting in partial leakage and irritation of the skin.

3. Often do bending or squatting, the skin of the abdomen is wrinkled and separated from the ostomy bag, resulting in feces leakage.

4. New patients, who have not yet mastered the correct stoma sticking and replacement techniques, and improper selection of stoma care products can cause irritant dermatitis.

5. Depending on the leakage of the stoma chassis, the frequency of bag replacement should be determined. When the chassis turns white by more than half, replacement should be considered;

How to take care of this situation?

1. Use normal saline to clean the stoma and surrounding skin;

2. Spray Skin Protective Powder on the wound surface, then apply Skin Protective Spray, and repeat the application of powder and film three times if necessary;

3. If the skin around the stoma is uneven, use Skin Protective Paste to flatten the sunken skin and folds;

4. Choose an ostomy bag suitable for the shape of the stoma. If the skin around the stoma is flat or the stoma is lower than the surrounding skin, it is recommended to choose the stoma convex chassis and ostomy belt;

There are a few points to pay attention to in the daily care of a stoma:

Is the cutting size of the center hole of the chassis appropriate?

If the incision of the bottom of the stoma bag is too large, the skin around the stoma will lose the protection of the bottom shield, and the skin under the bottom will be exposed to contact with excrement. As a result, the skin will be damaged and prone to redness, swelling, and pain. Therefore, the size of the stoma must be measured correctly, and the chassis should be cut to a suitable size. The problem of excrement irritating the skin of the stoma will be resolved quickly.

1. Correct chassis cut:

① First use a ruler to measure the size of the stoma at the stoma

② Then draw the size on the chassis, which is 1-2mm larger than the actual stoma

③ Finally cut the chassis along the scale line, pay attention to keep the edge cutting smooth, so as not to damage the surrounding skin

2. Check whether the fastener is firm

When using a two-piece ostomy bag, it is necessary to ensure that the ostomy bag and the chassis are fastened in place and that no gaps are left, to avoid excrement soaking the chassis for a long time, which may cause skin ulceration, redness, and swelling.

3. Is the removal method appropriate?

Frequent sticking and removing of the ostomy bag, the adhesive is easy to damage the skin, so when removing it, be careful and slowly peel it off to avoid over-stimulating the skin vigorously. It is recommended to use a two-piece ostomy appliance, which can reduce the damage to the skin caused by removing the chassis.

4. Whether the selected product is correct

Choose a suitable stoma bag according to the shape of the stoma. If the skin of the stoma is flat or sunken, you can choose a stoma bag with a convex chassis, and use a belt to pressurize the skin around the stoma, so that the stoma outlet is higher than the skin surface, is conducive to a better collection of excrement, reducing the occurrence of leakage and skin damage. If the stoma protrudes from the skin around the stoma, you can choose an ostomy bag with a flat chassis.

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

At Longterm Medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia

Date: December 22, 2022