Managing Peristomal Open Wound: Need Advice on Barrier Usage

I had a ruptured diverticulum on August 16 and have a colostomy. I have an area above the stoma that started as several small tears where the sutures were and now is one large open wound. I had tried managing with powder and barrier crusting, then tried a thin hydrocolloid bandage over that, with the barrier applied directly over that. After about 4 days it is worse, not better. My WOCN today said it needs to breathe, so she wants me to not use any products at all on it, and also to cut the barrier large enough that it does not come in contact with the open areas. If I do that, the effluent will of course come in contact with the open wound. Does anyone have any experience with something like this? I don't see how I can leave it open to the effluent - first of all it will burn like crazy, but won't that risk a major infection? The area is not infected now, but it is very tender.

Hi Mick, I don't want to scare you but I have had a lot of experience with an open wound next to the stomach. Years ago, my ICU nurse put the bag on badly and rotated me on my side. The shit got in the wound, length of the whole belly. I got a very bad infection. It took about 9 months for it to close, so for all that time, I did all the wound care myself. You need some kind of barrier, seal between your stoma and the wound to stop contamination. At night, you should lie in a way that keeps the open wound below the stoma in case of leaks. My wound had to be left open, like yours. In the shower, I had to debride the whole wound, get off the granulation that forms on the new skin. I was absolutely terrified doing this, but after a few times, I was okay. You have to be your own nurse basically. You should get onto Johns Hopkins or the Mayo Clinic websites. You will find excellent resources there that you can trust. Do not go to websites that have lots of ads. One very helpful thing I did was get liquid capsules of Vitamin E, any liquid form of it, and squeeze the liquid contents onto the wound. You should have lots of soft gauze. Cotton balls might leave residue, and if the new skin grows over the residue from a cotton ball, it will not be fun for you! Gently rub the Vitamin E all over the wound. I used to wash my wound in the shower myself. A light pulse action from the showerhead and a little light rubbing with sterile gauze will take off dead or dying skin so you have a nice pink color. After the shower, lie on your back and squeeze in the Vitamin E. My sister was a wound care specialist in Washington DC, so she coached me on this. Squeeze it onto the wound, and it will spread by itself. Then wipe it gently with a new sterile gauze, spread the liquid into nooks and crannies in the wound. I could only lie on my right side for nearly a year! So the wound was above the stoma, in case of baggie leaks.

I actually had three leaks last night! And I'm a "veteran" with this stuff. Ask your WOCN about the Vitamin E. Never put anything, creams, etc., on an open wound without asking the wound care person.

The story of my peritonitis from a badly placed bag is absolutely crazy. I wrote about it before but will do it again. Spoiler Alert! The scene in Alien when Jon Hurt has the little weird dude splitting him open from the inside and jumping out of his chest... yeah, almost that weird except it was real!

Have patience Mick, you will need it. Only time fixes an open wound, but you can help it along.

Eamon, best wishes.

Thanks for the info! Sounds just awful - sorry you had to deal with that! I am glad to hear from an expert. I've texted my nurse my concerns, so we'll see what she comes up with. If I get lucky and have a night like last night, I might go 8-10 hours without any output at all, but that would be a rare occasion. The wound is not infected, but I think I've been "too good" at covering it up, so it has just stayed moist. There were a couple of sutures right in the middle of it that seem to have finally dissolved or pulled out, which has made part of it less tender. Still have several sutures that are taking their sweet time dissolving and they are stiff from all the powder and such, so when I press the bag down it's still slightly tearing the skin. I'm wondering about just using powder under the bag barrier, and nothing else. I don't think I can keep the stuff off of it if it's uncovered, regardless of how I lay or sit. My stoma is not completely flat, but it doesn't protrude much. And the wound is right up against the stoma at the top, an area about 1/4" x 1-1/4". Oh - I also asked my nurse about manuka honey for wound care. She said they do use it, and if I want to try a honey product (like Medihoney) to check with the doc. My next doc appointment is Monday. I'm hoping this issue is better by then! I only brought up the honey because of an experience my sister had with her dog. The dog ran after a squirrel under the hay fork on a tractor and tore a huge chunk of skin from his side. It was an area probably 8 inches in diameter. The vet used raw manuka honey to dress it. It took a long time, but with consistent treatment it has completely healed. The progress in a short time was amazing. The vitamin E sounds like a great option as well. I am hoping I don't need anything more than just a simple change in products..... Maybe just discontinuing the use of the hydrocolloidal dressing will be enough.

Mick. I had some open sores under my skin barrier. This happened early when I first had the bag. A nurse at USC Women's Hospital had me try putting karaya powder on the sore first, then dabbing over it with some liquid antacid like Maalox. I then covered that semi-paste with karaya paste, which hurt because there is alcohol in it, and completing the procedure with my normal skin barrier. It did the trick for me, but my sores don't sound as bad as yours. If you try this, I hope it works.

Hi Mick, I have heard about honey but I wouldn't do it without telling the Doc. The doctors have to take this seriously so they have to see it. Do not play down the problem Micki, a young English lady from Essex I used to chat with had several open circular wounds coming right up to the stoma edge and her docs didn't take it seriously. She required several surgeries to cut out tissue and close the holes. Not trying to scare you but if the wound/raw area gets to the stoma it becomes serious. As you say, it should be exposed so it does not fester and when it stays uncovered you can monitor it much better. The main thing is to make sure the docs know what it looks like, close to the stoma and how worried you are. As they say in New York..."keep your boot in their A.." ...in a nice way of course!!

My infection happened in the hospital. The full center incision in my belly from my breastbone all the way down to you know where, almost to my penis was open down to the last deep stitches and was black. The final row of stitches held it from letting my guts pop out!! I never realized how thick the belly flesh is. It slowly closed from bottom to surface. I stayed with my brother and his wife and their little dude about 4/5 years came in while I was lying there with it open and exposed. He walked over to the bed and looked down into the huge gash and very calmly said, "Wow, that looks like the Grand Canyon". He was so calm about it. I expected him to run from the room screaming but he just calmly asked a few questions about how I got my "Boo-Boo". I was amazed.

Remember, don't play it down!! The squeaky wheel gets the oil!!

Take care and I hope you feel better soon.

Eamon.

Hi Mick, I have heard about honey but I wouldn't do it without telling the Doc. The doctors have to take this seriously so they have to see it. Do not play down the problem Micki, a young English lady from Essex I used to chat with had several open circular wounds coming right up to the stoma edge and her docs didn't take it seriously. She required several surgeries to cut out tissue and close the holes. Not trying to scare you but if the wound/raw area gets to the stoma it becomes serious. As you say, it should be exposed so it does not fester and when it stays uncovered you can monitor it much better. The main thing is to make sure the docs know what it looks like, close to the stoma and how worried you are. As they say in New York..."keep your boot in their A.." ...in a nice way of course!!

My infection happened in the hospital. The full center incision in my belly from my breastbone all the way down to you know where, almost to my penis was open down to the last deep stitches and was black. The final row of stitches held it from letting my guts pop out!! I never realized how thick the belly flesh is. It slowly closed from bottom to surface. I stayed with my brother and his wife and their little dude about 4/5 years came in while I was lying there with it open and exposed. He walked over to the bed and looked down into the huge gash and very calmly said, "Wow, that looks like the Grand Canyon". He was so calm about it. I expected him to run from the room screaming but he just calmly asked a few questions about how I got my "Boo-Boo". I was amazed.

Remember, don't play it down!! The squeaky wheel gets the oil!!

Take care and I hope you feel better soon.

Eamon.

I don't have any of the karaya powder, but I may try the antacid idea! Nurse said if I don't feel comfortable leaving it uncovered to keep doing what I have done and consult the doc. So I'm definitely going to leave the extra dressing off. I think I'll try the antacid over the stoma powder and see how that works! Maybe I'll make a little progress overnight? Thanks for the suggestion!

You are right! It's at the point where the doc needs to see it. I've been taking pictures every bag change so I can compare and show the nurse. I have only had the nurse change the bag once and it lasted about two hours haha. I feel like I know how to get good adhesion so I haven't wanted to stray from my routine. But I guess it's time for the doc to check it out. Thanks so much for the input!

Oh and aren't little ones amazing? They can handle a lot more info than we give them credit for. My oldest daughter has epilepsy and daily seizures. My granddaughter's first time seeing multiple seizures I thought would be traumatizing for her, but she was fantastic. She just says her aunt has storms in her head, and even offers to help watch for anything unusual when we are around her. She recognizes there is some cognitive deficit (not severe, but recognizable) and simply stated one day that my daughter is "like a teenager" (she's 36).

Sorry to stray off subject.... lol

Time to change the bag - wish me luck!

Yes indeed, the little ones can handle things like that if everyone stays calm and explains in a way they can understand. Kids only have a freakout if the adults get excited, they're always looking for signals as to how safe or unsafe they feel. Keep them feeling safe and they can handle a lot. My brother in Ireland tells me that his ten-year-old grandson Zack is amazing in dealing with his horribly sad situation. He has a glioblastoma, brain tumor, and his condition is always fatal.

Dinner bell just rang, gotta go, back later X

Mick:  I had a similar situation a couple of years ago, with an open wound about 1/2 inch away from my stoma.  The ostomy nurse gave me a product called OPTICELL AG, billed as a "silver antibacterial gelling fiber wound dressing."  It is a thin felt-like fabric that she had me cut a small piece from, then place it upon the wound, then put the appliance faceplate over it in a normal fashion.  It is made by a company called MEDLINE.  It worked wonderfully.  After about a week and a half, the wound healed under my appliance with this simple procedure.

That sounds like a great solution! My thoughts so far on the several nurses I've had is that they don't have a ton of experience with ostomies, maybe because I live in a small rural area? I'm not sure they keep products on hand for situations like this, since so far the powders and pastes I've used have been items I've ordered or purchased myself from a local pharmacy. They have ordered the bags, adhesive removal wipes, skin barrier wipes and some deodorizing liquid (which is blue? and absolutely worthless). It is taking so long to get supplies through home health that I have also ordered bags from Amazon. Insurance should cover it all, but when there's an immediate need; I don't really have that choice! It's aggravating, to say the least. So, my plan for now is to follow my nurse's advice until I see the doctor on Monday. Hopefully by then I will have made progress. Last night I did cut the barrier so it left the raw area uncovered. It stayed relatively clean, but I changed the bag again this morning, after showering with antibacterial soap. It seems less tender, so I think I'm making progress. I plan to ask the doc about the Opticell AG which sounds like it would take care of it, in the way that it absorbs the fluid. I tried to find it to order, but looks like it requires a prescription. The wound is very wet, though not infected at this point. The edges are somewhat macerated, but that has also improved slightly. I'm a little over 6 weeks out from my surgery and sure thought it would be healed by now, but apparently this is not unusual.

I appreciate so much the prompt responses from everyone!

My opinion would be to forget spending money on deodorizers for the pouch.  I've used baking soda for years, the stuff that comes in the little yellow box that people often put into their refrigerators because it absorbs odors.  It does the same job in an ostomy pouch.  Whenever I empty, I simply dip a small amount into the bag before I close it up.  I keep it in a small glass bowl beside the john.  A visitor would probably suspect that I do cocaine... 

Great, inexpensive option! I will try that!

I'm using the silver antimicrobial wound dressing cut larger than the wound. My ulcer was healing nicely, but I must be very careful when removing the pouch barrier. I use adhesive remover wipes. Sometimes I don't put anything on my skin after cleaning and drying. I occasionally use antifungal powder or skin prep alone or in combination.

I'm using the silver antimicrobial wound dressing cut larger than the wound. My ulcer was healing nicely, but I must be very careful when removing the pouch barrier. I use adhesive remover wipes. Sometimes I don't put anything on my skin after cleaning and drying. I occasionally use antifungal powder or skin prep alone or in combination.

I am happy to say my skin is almost healed! I tried a combination of things - leaving the area uncovered really jump-started the healing process, even though it was exposed to the output. I found a sample of some Silvex wound gel in a first aid kit and used that when it was left exposed. I had to cover about every other night just so I could rest. I was so concerned about it getting contaminated, and it hurt so bad with the least amount of pressure. It helped to block the filter and add some air so the bag wouldn't touch it. Ultimately, silver alginate dressing, covered with hydrocolloid then the pouch was what has finally given me the most comfort and relief. I appreciate all the suggestions from everyone. It was reassuring to hear from others dealing with the same thing. My reversal surgery is scheduled for December 3. I will be happy to put this behind me, though I am sure I will need to be more careful about what I eat. Also, I'm a true believer in water. Finally getting used to drinking the 64 oz + that my doc recommended. A squeeze of lemon or lime makes it easier to drink.

Fantastic news!!!