Dehisced stomal surgery with contracted wound healing leads to plastic surgery reconstruction of an ileostomy

M.H., 52 y.o. male, with a history of Crohns, had ileostomy placed at age 17 with good results.  Peristomal hernia developed at age 51, necessitating hernia repair with same site stoma revision.   Incisions both medially and laterally of stoma dehisced, with a depth of six centimeters on the medial aspect.  The main goal was to “manage the wound first”.¹ 

Wound closure was accomplished with negative pressure therapy.  Contraction of tissues resulted in a retracted stoma, deep crease (medial peristomal), and several other divots across the abdomen.  Wafer wear time was often only hours.  Patient had allergic reactions to numerous common supplies.  Multiple products and systems were tried with minimal success.  Skin breakdown occurred often. 

Quality of life (QOL) was diminished greatly in all aspects, “…not only the physical or functional outcome but also…the emotional and social well-being…”.²  Plastic surgery was proposed.  The patient had multiple scars and creases, which fit within the requirement for abdominoplasty.³

Preservation of existing stoma was imperative due to lack of available bowel for new stoma.  The plastic surgeon opened the abdomen at the site of a previous incision and did not disrupt the peristomal skin. He released and removed scar tissue, reconfigured underlying adipose tissue and sutured layers together to build up indented area.  A section of abdominal tissue was removed with edges realigned, providing a flat surface across the abdomen.  A pouching system was placed, with wear time of three days. 

Stoma patients who have undergone abdominal reconstructions had “dramatic improvement in body image [and] would undergo the operation again”.³  Peristomal skin and tissue complications are significant factors in determining a patient’s QOL.  The availability of numerous products can often solve the issues.  However, for patients facing insurmountable problems, the expertise of a plastic surgeon willing to undertake a challenge, should be considered.