Statement of Clinical Problem

Patients with an ostomy may suffer from peristomal skin breakdown.

Description of Past Management

This study involved four patients who have experienced peristomal skin breakdown and /or ulceration. 

Patient #1- Used a pre-cut appliance that was too large for the size of the stoma, causing peristomal skin breakdown.

Patient#2 - Had constant leakage, despite using convexity products.

Patient #3 –Used an appliance that was too large, causing peristomal skin

breakdown.

Patient#4 - Developed a pressure ulcer around the stoma.

Current Clinical Approach

The first patient was placed in a flat moldable wafer* that provided a customized, secure fit. The second patient was placed in a convex moldable wafer† with the addition of a hydrocolloid skin barrier ring‡ to reduce leakage and provide an even peristomal skin surface.  The third patient was treated with an ostomy skin barrier powderµ and protective skin barrier wipe||.  The fourth patient was placed on a system¶ that did not cause pressure with the addition of a fiber gelling dressing# and a hydrocolloid dressing** to treat the ulcer.

Patient Outcomes

All four patients easily learned the new steps to their ostomy management.  The peristomal skin healed in all four cases. 

Conclusions

Today, there are a variety of techniques available to the clinician to either treat or decrease the frequency of peristomal skin breakdown.  All four patients in this study with peristomal skin breakdown and ulceration healed with the techniques described. All were pleased with the results.

*   SUR-FIT Natura® Moldable Stomahesive® or Durahesive® Skin Barrier

†   SUR-FIT Natura® Moldable Durahesive® Convex Skin Barrier with Flange

‡   Eakin Cohesive® Seals

µ   Stomahesive® Protective Powder

||   AllKare® Protective Barrier Wipe

¶   Esteem synergy® Two-Piece Ostomy System

#   AQUACEL® Hydrofiber® Wound Dressing

** DuoDERM® Extra Thin Dressing

SUR-FIT Natura, Durahesive, Stomahesive, AllKare, Esteem synergy, AQUACEL, Hydrofiber, and DuoDERM are registered trademarks of E. R. Squibb & Sons, L.L.C.

Eakin Cohesive is a registered trademark of T.G. Eakin Limited.

© 2007 E.R. Squibb & Sons, L.L.C.                                                     US-07-2027