This topic is about dealing with recurring open wounds around a long-term ileostomy stoma. The person sharing their experience has had an ileostomy since 1991 and only recently started experiencing painful open wounds on the skin around the stoma. Despite no changes in their routine or products, these wounds keep coming back, causing issues with appliance seals and leaks. Medical tests have shown normal results, and specialists have not been able to provide an explanation. Here are some suggestions and insights that might help:

1. Perfect the wafer opening and application:
- Cut the wafer hole to fit snugly around the stoma.
- Use ostomy powder, seal it with a protective skin barrier twice, and warm the adhesive well before applying.
- Gently push the stoma in and press the adhesive firmly to prevent leaks.

2. Rule out a parastomal hernia:
- Consider getting a CT, MRI, or ultrasound to check for hernias that might be affecting the wafer fit and causing ulcers.

3. Consult a dermatologist immediately:
- A dermatologist can help identify less common skin disorders that might be causing the wounds.
- Be aware of conditions like pyoderma gangrenosum, which may require specific treatments like high-dose Prednisone or immunosuppressants.

4. Use barrier dressings under the flange:
- Apply thin dressings like Duoderm over the injured skin before attaching the wafer to protect and aid healing.

5. Improve the seal on uneven or damaged skin:
- Try moldable Eakin Seals or Salts Healthcare "Stoma Seal" rings to enhance the seal.

6. Change appliance style or manufacturer:
- Consider using convex wafers and an ostomy belt to reduce leaks.
- Experiment with different barriers from various companies, as adhesive formulas and skin sensitivities can vary.

7. Try topical soothers:
- Some people have found relief using Domboro solution soaks or Witch Hazel compresses, though results can vary.