The Management of Acute Abdominal Wounds with AN Encroaching Colostomy in AN Outpatient Setting

Case Study Abstract Clinical Problem:  Patients with open abdominal wounds that have ostomy stomas either within the margins of the wound or in very close proximity are a challenge for clinicians to manage. 
Description of Past Management:  In the past, these wounds were managed by changing the dressing every day or sometimes even several times a day. 
Current Clinical Approach:  Patient with a complex abdominal wound with a stoma within the wound margins presented to the clinic on 5/19/08.  At that time, the wound measured 17 cm x 18 cm x 3.1 cm.   The tissue was beefy red and granular, and there were no signs of wound infection present.  Initially, the wound was covered with a negative pressure wound therapy product to fill in the base of the deeper areas of the wound bed.  The superficial areas were covered with bacteriostatic foam impregnated with Methylene Blue and Crystal Violet. To the partially inverted stoma a deep convex ostomy appliance was used.

Patient Outcomes: By 7/28/08 the wound had become superficial. The wound measured 5.3 x 4.8 cm x 0 cm.  At that time, negative pressure was discontinued and the foam was continued. The wound was rimmed with stoma paste.  The foam and paste was covered with transparent film and changed 2 times per week.  Again, a deep convex ostomy appliance was applied to the ostomy and an ostomy belt was initiated.  By 9/15/08 the wound had epithelial tissue and the peristomal area was intact.  The patient was able to switch to a hydrocolloid to the wound and apply a convex 2-piece appliance over the stoma and change them every 5 days.    CONCLUSION:  Managing complex abdominal wounds with encroaching stomas is possible.  Continual monitoring of the wound and objectively choosing options to manage the drainage, keep infection at bay, and decrease costs improves patient outcomes and satisfaction.