Push the Petal to the Periwound: An Innovative Use of Hydrocolloid Skin Barrier

Introduction: Pouching of large wounds and fistulae presents numerous challenges for the WOC nurse secondary to effluent, wound size and abdominal contour^{. (1)} Varying sizes of wound fistula pouches, skin barrier paste, strip paste, moldable rings, and hydrocolloid skin barriers are used to protect the skin and contain potentially caustic effluent. Using combinations of these products and various pouching systems can be costly.

Clinical Problem: Periwound/perifistular skin can become irritated from undermining of effluent and/or hydration of the pouch seal. The use of negative pressure wound therapy (NPWT) to segregate a wound from a fistula can cause the surrounding skin to depress, resulting in an uneven periwound surface making it difficult to obtain a secure pouch seal.

Clinical Approach: The “petaling” technique, involves using hydrocolloid skin barriers cut into petal shapes of varying sizes and lengths. ⁽²⁾  The petal size is determined by the contour and depth of perifistular defect that needs to be filled. Each petal overlaps the previous one, protecting surrounding skin and establishing a flat pouching surface. The petals move with the patient creating a more flexible seal.  Petals are placed close to the wound border to protect periwound skin. Petals are then lightly caulked along the edge or seam with tube paste. The pouch opening is cut slightly larger than the wound/fistula border to create a sloped aperture, promoting better effluent drainage to minimize pooling and undermining.

Outcome: Pouching large wounds or fistulae with the “petaling” technique provides improved perifistular skin protection, lengthened wear time with an enhanced flexible seal resistant to buckling and undermining. This technique is easy for colleagues and family to learn and repeat. The hydrocolloid skin barrier sheets are inexpensive in comparison with other products. This technique can be used on mushroom shaped stomas, drain sites, and other challenging pouching situations.