Evaluation of an Extracellular Matrix Dressing on a Complex Peristomal Ulcer

Background: Peristomal ulcers can be extremely difficult to heal due to the potential of contamination from feces or urine. Pouch adherence is a problem due to poor stoma sitting, flush stoma, peristomal hernia or other mechanical difficulties. However, when pouch adherence is not a problem and peristomal ulcers are still not healing, the process can be even more challenging to the care provider and the patient.

Case: The case being presented is of a 69 year old male with history of ulcerative colitis with an ileostomy since 1969. He has had a large, circumferencial peristomal ulcer open since January 2012. He has had previous ulcers that have healed using cyanoacrylate to heal the wounds and also for wound prevention. The patient denies any concerns with pouch leakage or poor pouch adherence when using a foam dressing underneath his pouching appliance. He came into the wound center for assistance when the wound became worse and no longer responded to preventative treatment. While under the direction of different wound care physicians (ie: plastic surgeon and dermatologist), the patient was prescribed oral antiviral, oral prednisone, and topical steriod treatments, but unfortunately the wound did not respond to these treatments. The wound area has also been biopsied and was shown inconclusive for peristomal pyoderma. In the outpatient ostomy clinic, more advanced wound therapy was explored. The use of an extracellular matrix dressing was implemented after obtaining patient's permission. The patient began weekly visits to the outpatient clinic for application of an extracellular matrix dressing. During this time, changes were made to secondary dressing and pouch application to accomodate new dressing treatment modalities.

Conclusion: The patient's peristomal wound shows ongoing improvement in wound size, pain, and appearance during treatment using an extracellular matrix.