Management of Complex Wounds

The WOCN Team at Strong Memorial Hospital has been challenged with the management of patients with complex medical issues including multiple fistulae and abdominal wounds.  Despite using a variety of ostomy appliances and accessories from various companies, containing the effluent continued to elude our staff and severely impacted the quality of life for these patients.  The inability to contain the odor and prevent the unpredictable soiling of clothing and bed linens caused some patients to become reclusive even after discharge from the hospital.  A new product, liquid silicone filler, has the potential to provide a better, more reliable seal for the appliances used to manage this drainage.  The instructions from the manufacturer included application onto clean dry skin (no skin preparation products can be used) and applying the product at least 1 cm in width and 0.5 cm in depth onto skin, into folds, creases, crevices, etc.  The silicone needs to bond with the skin AND the fecal containment products, requiring the clinician to work rapidly and accurately to allow the product to set into place.  A “cure” time of at least 10 minutes is necessary for the silicone to bond to the skin. This filler can provide a longer, more reliable wear time for the appliances.  It was impressive to see the adherence and lack of “gaps” between skin and appliance when patients changed position.  Wear time can increase as clinician and patient discover the areas of leakage and use the silicone to seal these regions.