Enteric and urinary effluent on infant skin can cause skin irritation ranging from peristomal dermatitis to maceration to skin loss. The chemical dermatitis is due to irritants in the effluent such as pH, unbalanced electrolytes, and increased enzyme content. The exact content varies depending on whether the internal source is from the proximal or distal portion of the organ. Powders, skin barrier creams, and pouching often can manage the output and prevent skin excoriation and breakdown.
In infants and young children, standard techniques of skin protection and treatment are not always sufficient. Also, the adhesives on pouches often can add to the problem. We decided to try a hydroconductive dressing (Drawtex Hydroconductive Dressing, SteadMed Medical LLC, Fort Worth, TX), known to draw off excessive exudate, bacteria, and harmful chemicals,1,2 as a means to protect and treat the problems accompanying urinary and enteric fistulas in young children.
Eight cases of either enteric or urinary drainage onto skin were treated with hydroconductive dressings after standard treatments were unsuccessful. The hydroconductive dressings were continued until standard therapies could be reinstituted, surgical intervention, or healing occurred. In each of the 8 cases, the hydroconductive dressings provided a solution to allow the damaged skin to sufficiently heal. Four cases from the series are presented.
Case 1. A 3-month-old boy presented after a bowel resection for a bowel obstruction and subsequent complications of fistulas, wound dehiscence, infection, and feeding intolerance. The dehisced wound measured 15 cm x 7 cm x 0.5 cm with a jejunostomy, mucous fistula, and 5 fistula tracts (see Figure 1a). Negative pressure wound therapy was used with and without Drawtex (see Figure 1b). Later, Drawtex dressings alone were used to draw off the output (see Figure 1c). This treatment resulted in wound contraction, allowing definitive surgical closure.
Case 2. A 3-year-old boy with infantile Crohn’s Disease 2˚ IL-10 receptor mutation underwent a fourth bone marrow transplant, necessitating treatment with Thiotepa. This agent burns the skin, negating use of adhesive dressings or pouches. A burn occurred inferior to the stoma (see Figure 2a). Drawtex was used to control the wound, and a second layer of Drawtex separated from the wound dressing was used to draw off the stomal effluent (see Figure 2b). The patient has remained on immunosuppression, limiting attempts to finalize wound healing, but the Drawtex has allowed enhanced management of the skin (see Figure 2c).
Case 3. A 6-month-old boy (born at 27 weeks’ gestation) with Respiratory Distress Syndrome and short-gut syndrome required an ileostomy and mucous fistula due to cecal perforation. The incision dehisced, a bowel fistula occurred, and continuous dumping of liquid gastric secretions caused severe skin excoriation (see Figure 3a). Pouching was unsuccessful despite multiple attempts with different products. A combination of a liquid skin barrier and Drawtex within the incision and on the skin have decreased the skin excoriation and allowed nurses to contain the output (see Figure 3b).
Case 4. A newborn girl with an omphalocele, bladder exstrophy, and imperforate anus had a first-stage repair that involved separating the bladder plates from intestinal structures and joining the bladder halves with an end colostomy in the left lower quadrant (see Figure 4a). Treatment goals were to protect the open bladder from stool, keep it moist and clean, and contain the urine. Drawtex was used to outline the edges of the bladder plates to absorb urine and prevent the transparent dressing from disengaging (see Figure 4b). This arrangement, including the ostomy pouch, was changed daily.
In summary, our experience has demonstrated hydroconductive dressings known to draw off excessive exudate, bacteria, and deleterious chemicals are useful in protecting and treating skin damaged by urinary and enteric effluent in young children.
This article was not subject to the Ostomy Wound Management peer-review process.