Improving Quality of Life: An Interdisciplinary Collaboration to Develop a Customized Convex Ostomy Flange

Background: Ostomy appliances incorporating convexity features are available on the market; however, the depth, profile, and flexibility of the convex systems and supplies used to customize the convexity are limited. Using an ostomy belt along with a convex appliance often enhances the success of the skin barrier in prevention of leakage. The ostomy belt must serve to secure the appliance against the peristomal skin with appropriate tension applied during movement and position changes of the patient.

Case description: This case involves a 64-year-old male patient with a long-standing permanent ileostomy following a gunshot wound which affected the muscular structure of the abdominal wall with minimal alternatives for ostomy site location.  The patient had experienced the spiraling phenomenon of appliance leakage with skin damage causing repeating multiple ostomy application regimens per day, increasing and changing supply needs, eventually leading to the patient limiting his nutritional intake, and significant weight loss.  When commercially made products were found to be insufficient, an interdisciplinary team collaborated to provide patient driven care to develop a reusable flange which provided a very deep customized convexity as well as allowing for use of a belt compatible with the unique peristomal contours. 

Conclusion: This custom-made ostomy flange provides a strong rim in which to attach a belt avoiding skin injury over the iliac spine. It also provides deep, firm convexity to use along with disposable ostomy supplies to help provide a more consistent means of containing ileostomy effluent.  Using this innovative design, this customized device extends ostomy appliance wear time for the patient, decreases incidences of leakage, allows the patient to develop and plan routine appliance changes, decreases supply usage and painful skin breakdown, increases opportunity for the patient to improve nutritional intake with healthy weight gain and an overall improved quality-of-life.