The Ostomy Files: A Content-Validated Tool to Effectively Document Peristomal Skin Lesions

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Eileen McCann, RN, BSN, CWOCN, Ostomy Clinical Sales Specialist, ConvaTec Inc.

  Peristomal skin disorders can lead to patient frustration and poor quality of life, making early intervention and effective management paramount. A recent cross-sectional study by Herlufsen et al1 found that 45% of people with permanent stomas had peristomal skin disorders and 76% of these problems lasted more than 3 months.

  The first step to determining the appropriate intervention is conducting an accurate assessment; however, available tools to describe peristomal skin problems are limited. A recent systematic review2 that the reported incidence rates for peristomal complications varied immensely between studies underscores this dilemma. The author suggested that “evidence of the reliability of measures of stomal and peristomal skin complications is lacking and a likely contributor to inconsistency across studies.”

  A prospective, observational study3 was conducted in Italy to assess and classify peristomal skin lesions. This study collected data from eight centers from December 2003 to February 2006 and led to the development of a classification scheme called the SACS™ Instrument (Studio Alterazioni Cutanee Stomali or Study on Peristomal Skin Disorders). Presented at the 2010 WOCN/WCET Conference, the premise of the SACS™ Instrument is to facilitate accurate description of peristomal lesions, taking into account two factors: the depth of skin involvement and peristomal location. The depth of skin involvement is measured through one of five possible categories (L1 to LX). Each category is accompanied by operational definitions and photo images. Peristomal lesion location is measured using a clock-face grid which divides the peristomal plane into one of five quandrants (T I – T V) — for example, from 12 o’clock to 3 o’clock = T I (see page 26 to view this instrument.)

  Validated in Italy and the US, the SACS™ Instrument is currently the only content-validated peristomal skin assessment and classification instrument, with a content validity index of 0.94 out of 1.0 (N = 166).3 It has been adopted throughout Italy and has been endorsed by the Italian ET Association (AIOSS).   The potential benefits of using an objective, standard language for describing peristomal skin disorders may include:

    • Facilitating effective communication and documentation among physicians and ostomy practitioners;
    • Enhancing consistency in care, early intervention, and treatment;
    • Providing a positive influence on clinical outcomes as well as on the patient’s satisfaction and quality of life;
    • Reducing costs for care and preventable complications that result from inaccurate or incomplete assessment and documentation.

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The Ostomy Files is made possible through the support of ConvaTec, Skillman, NJ. The opinions and statements of clinicians providing The Ostomy Files are specific to the respective authors and not necessarily those of ConvaTec, OWM, or HMP Communications.

This article was not subject to the Ostomy Wound Management peer-review process.


1. Herlufsen P, Olsen AG, Carlsen B, et al. Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs. 2006;15(16):854–862.

2. Salvadalena G. Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. J WOCN. 2008;35(6):596–607.

3. Bosio G, Pisani F, Lucibello L, et al. A proposal for classifying peristomal skin disorders; results of a multicenter observational study. Ostomy Wound Manage. 2007;53(9):38-43.

4. Beitz J, Gerlach M, Ginsburg P, et al. Content validation of a standardized algorithm for ostomy care. Ostomy Wound Manage. 2010;56(10):22–38.