Abstract
There are many stoma complications that can impact an ostomate's quality of life, particularly those affecting the surrounding skin, which is essential for maintaining appliance integrity to prevent leakage of effluent. Peristomal skin conditions affect up to half of new ostomates and can make psychological adaptation more difficult. Among the most common of these conditions is mucocutaneous separation, which affects up to a quarter of new ostomates. Reported incidence is highly inconsistent, likely due to disparate assessment criteria, poor recognition and/or underreporting. Mucocutaneous separation occurs in the first month following surgery and is caused by a breakdown in the wound healing process. The resulting cavity between the stoma and peristomal skin causes pain and discomfort, as well as impeding appliance adherence, increasing the potential of leaks. Although there is no standardised system of categorisation for assessment, nurses can use the Ostomy Skin Tool or the mild–severe system of Herlufsen et al along with management guidelines. Wound care principles should be applied to promote healing by secondary intention. In superficial mucocutaneous separation, pectin-based stoma powder can aid adherence. A moist environment can be cultivated with wound dressings, such as hydrogel, hydrocolloid or alginates. Slough can be treated with irrigation or a desloughing agent. Any wound exudate suggests the cavity should be filled with paste or absorptive dressing. Hydrocolloid wafers, pastes, mouldable rings and seals may have helpful healing properties and can create a smooth surface. Nutrition should also be addressed. Nurses must rely on experiential learning for treatment strategies and product selection. However, empirical evidence on the efficacy of these therapies in mucocutaneous separation would be invaluable in guiding evidence-based clinical decisions. Stoma care nurses have an essential role in assessing and treating this common and challenging condition.
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