Abstract

  Dynamic retention suture techniques that allow gradual reapproximation of abdominal midline muscles and fascia as well as sufficient freedom of movement for breathing and patient care commonly are used to prevent lateral retraction of the abdominal fascia in patients whose abdominal wound closure must be delayed. A 58-year-old otherwise healthy man was admitted with severe abdominal sepsis and following surgery, which included the creation of a stoma, a dynamic wound closure system was applied. Mucocutaneous stomal dehiscence was observed a few days after starting the treatment. The complication was believed to have occurred as a result of traction on the proximal end of the stoma (the bowel inside the abdomen) due to tension on the sutures of the small part of the bowel outside the abdomen. Definite, primary closure of the abdominal fascia was achieved after 16 days, at which point the stoma was reinserted with good results. Since using a modified procedure that involves cutting a groove in the protective drape and carefully placing two flaps around the stoma, this complication has not been observed with similar patients in the authors’ facility.

  On a recent Google ostomy search, I came across the term stomatologist. Wondering whether this was the same as an enterostomal therapy nurse or ostomy nurse — ie, the nurses who specialize in the study and care of stomas — I then googled stomatologist. It turns out a stomatologist is a person who studies the mouth and its diseases; a dentist could be a stomatologist.

  In the age of Google and other search engines, the consistency and accuracy with which medical terms are used are critical. The goal should be to avoid confusing the clinician in search of evidence-based direction to care, as well as the consumer searching for solutions to a particular healthcare problem.

When work, commitment, and pleasure all become one and you reach that deep well where passion lives, nothing is impossible. — Anonymous

  Nearly 37 years ago, Vickie Schafer, RN, MSN, CWOCN, CCRA, was strongly encouraged by colleagues and peers at Quakertown Community Hospital in Pennsylvania where she was an LPN to advance her burgeoning nursing career. She did so with great success and now has a position in industry with ConvaTec (Skillman, NJ). Throughout her career, her clinical, research, and educational responsibilities have reflected a patient-centered focus; whether she is serving as practitioner or industry spokesperson, she is gratified to be able to make a difference in a patient’s life.

Abstract

  Stoma complications are classified and treated based on the etiology, pathology, location, and clinical presentation of the complication. Clinical assessments and descriptions of abdominal stomal topography differ among care providers, hampering interpretation and communication. Using existing literature and clinical experience at the State Scientific Centre of Coloproctology in Russia, algorithms were developed to facilitate a uniform approach to the diagnosis and choice of treatment of ostomy complications. The algorithms consist of a definite sequence of explicit step-by-step procedures, including visual inspection, digital exploration, and instrumental exploration, for determining whether complications should be categorized and treated as a stoma problem or peristomal skin disorder. The algorithm was subsequently used by nonexpert nurses for all consecutive patients who visited the clinic during a 2-year period. Of the 1,427 patients seen, 553 (38.8%) had 742 complications. Of those, 387 were stoma complications and 355 were classified as peristomal skin disorders (eg, contact dermatitis, hypergranulation of the skin, allergic dermatitis, folliculitis, psoriasis and herpes). Of the 553 patients with complications, the most frequent complications were found to be contact dermatitis (184 patients, 33.3%), parastomal hernia (97, 17.5%), and mucocutaneous separation (72, 13.0%); 176 patients were referred to surgery and 377 received conservative treatment. Although the algorithms remain to be validated, the authors believe that studying the manifestation and causes of complications will help in the selection of justified treatments, which will eventually reduce the number of complications and improve the quality of stoma care.