Peristomal skin lesions are all too common and traditionally difficult to heal. A comprehensive review of the literature identifies an incidence of up to 55% for the overall rate of peristomal skin complications. The belief among most clinicians is that ostomy complications are seriously underreported. This is supported by another study where the authors concluded that most patients living with a stoma will experience a peristomal complication severe enough to require treatment at some point in their lifetime. When the complication results in a partial or full thickness lesion, the challenge is providing appropriate wound care that works beneath an ostomy barrier because drainage from peristomal lesions compromises barrier adherence. Salves and a variety of dressings can further complicate the problem. My case study aims at identifying an optimal treatment strategy for managing peristomal lesions while achieving an acceptable pattern of pouch wear time.
Traditional treatment relied on crusting with ostomy powder and skin barrier films for superficial lesions and soft, absorbent foams, hydrofibers and/or alginates for deeper lesions. Although these are the products most clinicians initially use, they did not consistently maintain moist wound healing, effectively manage high levels of exudate or promote rapid healing. Furthermore, with Peristomal Pyoderma Gangrenosum (PPG), more aggressive therapies can add the the pathergy of PPG, further compromising and delaying wound healing.
In a search for a strategy to more effectively manage partial and full thickness lesions under ostomy barriers, a trial was initiated using a Modified Collagen powder and a high absorbency sodium polyacrylate wound filler. The collagen powder was substituted for traditional ostomy powder and used to stimulate healing in both superficial and full thickness lesions. Traditional wound dressings were replaced with the sodium polyacrylate wound filler for wounds deep enough to require packing and for those with heavy exudate. The goal was to provide effective wound management and maintain pouch adherence to 4 -7 days. Ostomy paste was used to contain the dressings in place and a thin hydrocolloid was used to stabilize the dressings beneath the ostomy wafer.
The modified collagen powder successfully initiated and controlled the inflammatory phase of healing. This stimulated normal progression through the healing cascade and prompted rapid healing- even in wounds that presented as chronic. The sodium polyacrylate wound filler effectively conformed to the shape of the lesions, absorbed copious exudate and maintained moist wound healing. The majority of patients had used other dressings before beginning treatment with these two products. They reported decreased pain and a higher level of satisfaction with this innovative approach.
In this study, the use of modified collagen powder and sodium polyacrylate promoted faster healing and eliminated unnecessary pouch changes. This resulted in improved patient satisfaction and decreased cost to healing. Further research is needed to effectively compare and contrast wound dressings and identify protocols for best practice.
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