Peristomal Wound Research Articles

Negative Pressure Wound Therapy for Patients With Complicated Mucocutaneous Separation Following Ileal Conduit Urinary Diversion: A Case Series.

Mucocutaneous separation (MCS) is one of the early stomal complications of ileal conduit diversion after radical cystectomy. It can result in abdominal infection and sepsis, prolonging patient recovery. Negative pressure wound therapy (NPWT) has been widely used for abdominal wounds after orthopedic and burn surgery. This case series describes its use in complicated MCS and ostomy retraction after ileal conduit diversion. We describe a case series of 3 patients with moderate to severe MCS with and without infection after robot-assisted radical cystectomy with ileal conduit diversion. Our patients were treated with NPWT to avoid infection and create a satisfactory environment for healing MCS. After 2 to 4 weeks of NPWT, all 3 patients had normal micturition function with no additional peristomal wounds or complications. Negative pressure wound therapy may be used in the management of complicated MCS after ileal conduit diversion.

Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series.

One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.

Healing peristomal wounds around retracted stomas with negative-pressure wound therapy: a case series

Healing peristomal wounds around retracted stomas with negative-pressure wound therapy: a case series

Effectiveness of betadine-coating gastrostomy tube to reduce peristomal infection after percutaneous endoscopic gastrostomy: a randomized controlled trial

BackgroundPeristomal wound infection is a common complication in patients receiving percutaneous endoscopic gastrostomy (PEG). The main reason for peristomal infection might be the oral microbes coating the gastrostomy tube during implantation. Povidone-iodine solution can be applied for skin and oral decontamination. We designed a randomized controlled trial to test the effectiveness of a Betadine® (povidone-iodine) coated gastrostomy tube to reduce peristomal infection after percutaneous endoscopic gastrostomy.MethodsA total of 50 patients were randomized to Betadine and control groups (25 patients in each group) from April 2014 to August 2021 at a tertiary medical center. All patients received the pull method for PEG implantation using a 24-french gastrostomy tube. The primary endpoint was peristomal wound infection rate 2 weeks after the procedure.ResultsChanges in Neutrophil/Lymphocyte ratio (N/L ratio) and C-Reative protein (Delta CRP) at 24 h after PEG were higher in the control group than in the Betadine group (N/L ratio, 3.1 vs. 1.2, p = 0.047; CRP, 2.68 vs.1.16, p = 0.009). The two groups did not differ in post-PEG fever, peristomal infection, pneumonia, or all-cause infection. Delta CRP could predict peristomal infection and all-cause infection within 2 weeks (AUROC 0.712 vs. 0.748; p = 0.039 vs. 0.008). The best cut-off-point of Delta CRP for the diagnosis of peristomal wound infection was 3 mg/dl.ConclusionThe betadine coating gastrostomy tube method could not reduce peristomal infection after percutaneous endoscopic gastrostomy. CRP elevation of less than 3 mg/dl may be used to exclude the potential peristomal wound infection.Trial registrationNCT04249570 (https://clinicaltrials.gov/ct2/show/NCT04249570).

The Structural Relationships Between Quality of Life and Mental Conditions in Stoma Patients

Background: Peristomal wounds have a remarkable negative impact on the quality of life (QOL), including the social activities, of stoma patients. Although the number of stoma patients is increasing, the relationship between peristomal disorders and QOL is not widely understood. Objectives: The aim of this study was to elucidate the relationship between the QOL status of stoma patients and the condition of the peristomal skin through structural equation modeling (SEM), which could help provide a comprehensive overview of the factors affecting the health of such patients. Design: Observational study of prospectively collected data. Setting: This study was conducted in the colorectal unit of two educational hospitals in Sapporo, Japan. Patients and Methods: Outpatient patients with a stoma were recruited between July 11, 2019 and November 30, 2019. The relationship among the clinical variables were identified using SEM analysis. Sample Size: Sixty-seven consecutive stoma patients. Main Outcome Measures: The Ostomy Skin Tool [used to assess the discoloration, erosion, and tissue overgrowth (DET) score], Stoma-QOL, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D-5L questionnaire were employed. Results: The observation period in the low DET score group was longer than that in the high DET score group. An SEM-derived path diagram, which exhibited high goodness-of-fit indices, revealed the relationships among the clinical factors. Patient satisfaction was positively associated with the Stoma-QOL score and negatively associated with the HADS-anxiety score but not the HADS-depression score. Conclusions: Peristomal skin disorders did not affect QOL or mental health status. The QOL scores of the patients with mild peristomal skin disorders markedly varied. Anxiety, but not depression, reduced the satisfaction of stoma patients and was alleviated over time. Limitations: A cross-sectional observational study cannot be used to precisely determine causal relationships. Conflict of Interest: The authors have no conflict of interest to declare.

Topical sucralfate for prevention of peristomal wound reaction related to percutaneous endoscopic gastrostomy in children: A randomized controlled trial.

There are no standard protocols for peristomal skin care in children with percutaneous endoscopic gastrostomy (PEG) tubes. This clinical study aimed to evaluate the efficacy of topical sucralfate as a prophylactic intervention in the peristomal wound reaction (PWR)/infection-associated PEG insertion in children. This study was a randomized, single-blind, controlled trial recruiting child under 18 years old who submitted for PEG insertion. Patients were randomly divided to receive topical sucralfate + peristomal wound care (intervention) or peristomal wound care alone (control). In the intervention group, the participants used topical 4% sucralfate cream four times a day for 2 months. Participants were assessed using the total peristomal infection score and PWR grading system at baseline week 1, and monthly up to 5 months after the initiation of the study. Forty-four children after PEG insertion were randomly assigned to two groups. Baseline characteristics of both groups were statistically similar (p > 0.05). Friedman test demonstrated statistically significant differences in grades of PWR during the follow-up period in the control group (p=0.01); while there was not significantly different in the intervention group (p=0.47). This finding suggests that the intervention had a prophylaxis effect. Also, there were statistically differences in the score of erythema (p=0.001) and exudate (p=0.06) at the seven-time points in the control group. Topical 4% sucralfate can be considered an affordable and available prophylactic treatment for reducing the PWR/infection associated with PEG insertion in children.

242 Peristomal ulcer as presenting feature of inflammatory bowel disease (IBD)

77-year-old female with a history of diverticulitis and bowel perforation with subsequent hemicolectomy presented with three weeks of abdominal pain, bloody output from ostomy and rectum, and an enlarging painful peristomal wound. She was initially seen by outpatient dermatology for a small ulcer; wound culture grew E. coli, and she was started on ciprofloxacin. Over the next week, the ulcer rapidly grew and inpatient examination revealed an 11.5 x 11 x 0.5 cm deep peristomal ulcer with violaceous borders.

Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidences.

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA-approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post-radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief.

A Study To Determine The Effect Of Egg Albumin Dressing On Peristomal Wound Healing of the Colostomy Patients In A Selected Hospital, Kolkata, West Bengal

The researcher conducted a quasi experimental study to evaluate the effect of egg albumin dressing on peristomal wound healing in a selected hospital, Kolkata, with the objectives to assess the peristomal skin condition of colostomy patients before treatment, to evaluate the effect of egg albumin dressing on healing of peristomal area and reduction of pain, to find out the association between the peristomal wound healing and selected variables. The final study was conducted at Curzon ward, Victoria ward of SSKM hospital, Kolkata. Ethical permission was sought out from Ethical Committee of SSKM hospital, Kolkata. Informed consent was taken from all respondents. The sample was selected according to their selected criteria. The sample selection was done by purposive sampling. They were randomly assigned into two groups (experimental and control group) in 1:1 ratio. The study concluded with its limitations, implications and recommendations for conducting a study may be conducted for a longer duration of observation with the treatment.

External stoma diversion: a palliative measure for peristomal wound healing in resource-limited settings.

The provision of intestinal stoma care is challenging in austere settings due to limitations in surgical and wound care access as well as the high cost and sparsity of ostomy supplies. As a result, many surgical patients suffer from ostomy-related complications such as peristomal wounds and are unable to find relief for these complications from standard treatments and measures. This article describes the external stoma diversion, a cost-effective palliative surgical procedure that assists in the healing of peristomal wounds in resource-limited settings.

Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial.

Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02-1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%-1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

What Is the Best Approach to Prevent Advanced-Stage Pressure Injuries After Pediatric Tracheotomy?

The use of collagen and hyaluronic acid dressing in peristomal wound care

The use of collagen and hyaluronic acid dressing in peristomal wound care

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy: A Retrospective Case-Series Study in a Single Institution

Introduction: Superior mesenteric artery syndrome (SMAS) is a relatively rare cause of chronic duodenal obstruction, owing to the compression of the third portion of the duodenum. Objectives: This retrospective study aims to discuss the efficacy of enteral nutrition (EN) therapy in nutritional status and symptom improvement at a short-term follow-up for SMAS patients. Methods: We retrospectively analyzed clinical data of patients diagnosed as SMAS and treated with EN from September 2012 to January 2019. Results: Twenty-six patients were included (16 women; mean age 24.96 ± 11.77 years), none was excluded, and one was lost to follow-up. The patients’ mean body weight was 40.94 ± 10.16 kg, mean weight loss 11.73 ± 7.58 kg, and mean body mass index (BMI) 14.82 ± 2.52 kg/m². The mean duration of EN therapy was 10.10 ± 4.66 months. Serum level of nutritional indicators, BMI and body weight increased after EN therapy. During a median follow-up of 24 months (9–44) after EN therapy, the mean symptom score decreased from 24.28 ± 9.57 to 8.06 ± 8.29 (p < 0.0001), and 65% of patients’ symptoms resolved and 15% of patients’ symptoms improved. In total, 16 complications occurred, including tube blockage, peristomal wound infections, peristomal leakage, granulomas, and nasopharyngeal pain. Conclusion: EN therapy may be an effective option for SMAS patients. While it might not remove all symptoms, it can improve the nutritional status to support subsequent treatments.

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications.

Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. A total of 181 patients (48 female, median 67.5years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.

Stoma Bridge Types and Their Impact on Patient Outcomes: A Retrospective Analysis and Prospective Global Survey of Surgical Practice.

The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist. Retrospective chart review and cross-sectional survey. The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS). In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist. Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team. Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

Treatment of peristomal wounds with a topic Neem and Red Hypericum Oil application: Case Studies

Background: Peristomal skin disorders are one of the most frequent complications on the abdominal stoma. Currently therapeutic approaches do not take into account the specific characteristics of this type of wound. &#x0D; Objectives: To assess in a first series of patients not responding to treatment with traditional dressings, the effectiveness of a topic wound dressing with Neem Oil and Red Hypericum Oil, applied so as to guarantee the adhesiveness of the pouching system. This product, currently indicated to treat wounds of all aetiologies, acts as antimicrobial, bacteriostatic and mechanical barrier and promotes natural tissue repair. &#x0D; Methods: The two patients we enrolled presented peristomal wounds not responding to treatment with traditional dressings. To comply with the need of applying adhesive pouching we had to devise a suitable wound dressing. The patients were treated twice weekly, by applying the product on an hydrofiber dressing support, protected by a transparent film. No local antiseptics were used. &#x0D; Results: Complete healing of the lesions, in the first case after 14 days, in the second after 28 days, with immediate pain decrease. Both patients showed a positive attitude towards the treatment. The dressing design allowed the appliance to remain in place for three days with no complications.&#x0D; Conclusions: The use of the Neem Oil and Red Hypericum Oil dressing can be a valid therapeutic solution in the treatment of difficult to heal peristomal wounds, and therefore deserves to be confirmed through studies involving a higher number of patients.

Liver abscess as a rare complication of PEG

Introduction: Percutaneous endoscopic gastrostomy (PEG) is one of the most effective methods of providing long-term enteral nutrition in patients with the impossibility of oral intake. Complications are relatively common. The most common is peristomal wound infection at the site of the insertion and leakage along the cannula. Lesscommon complications are colo-cutaneous fistulas and peritonitis. A very rare complication is liver abscess. Case report: The authors describe a case of a 51-year-old man with a hepatic abscess with inoperable pharyngeal carcinoma with PEG. The patient was admitted to hospital with a developing septic condition due to a liver abscess. The liverabscess resulted from the buried bumper syndrome of the PEG and subsequent complete dislocation of the bumper into the left liver lobe area.. This condition was treated by a surgical review with abscess drainage and the construction of classical gastrostomy. Conclusion: Buried bumper syndrome with its complications, such as a liver abscess is a relatively rare complication, but challenges both the diagnosis and therapy of the syndrome itself. Its management requires a close cooperation between a gastroenterologist and a surgeon. Early recognition and treatment can prevent the progression of the condition to sepsis or a septic shock, which can lead to death.

Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients.

Background and study aims Performing a percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients can be challenging because of the presence of trismus, pharyngeal obstruction by tumor, and pharyngoesophageal strictures or fistula. Pharyngocutaneous fistula (PCF) is a major postoperative concern in patients submitted to total laryngectomy (TL). In the medical literature to date, the cervical fistula has been used as an access to PEG in only four reports. The aim of this study was to evaluate the safety of cervical fistula for insertion of a PEG tube. Patients and methods Retrospective study at a single tertiary referral center, regarding the technical feasibility, safety and outcomes of a PEG tube introduced by a cervical fistula in HNC patients with obstructive lesions of the oropharynx. Results The procedure was technically successful in all 21 patients. A PEG tube was used for a minimum of 1 month and a maximum of 120 months. Twelve patients died while using the PEG tube, 8 had it taken out because it was no longer needed, and only 1 had the tube still in use. Adverse events occurred in 8 patients: granuloma (19 %), dermatitis (9.5 %), accidental late removal of the tube (9.5 %), periprocedural gastric wall hematoma (9.5 %), peristomal wound infection (4.7 %), buried bumper syndrome (4.7 %), and traumatic gastric ulcer (4.7 %). Conclusion A postoperative cervical fistula can successfully work as a reliable and safe access for a PEG tube procedure in HNC patients, avoiding unnecessary surgery and reducing costs.