This topic is about managing severe skin irritation around a high-placement colostomy and understanding concerns related to a potential total colectomy. The person sharing their experience has had two emergency surgeries due to diverticulitis, resulting in a temporary colostomy with a stoma positioned high in the mid-abdomen. They are struggling with keeping pouches adhered, leading to extremely raw and painful skin. Additionally, they are confused about their surgeon's mention of possibly removing their entire colon during an upcoming reversal surgery. Here are some practical tips and insights that might help:

1. To remove the flange and any residual skin-prep without further irritating the skin, use a medical adhesive remover, either in spray or wipe form. You might need two packets to do this gently.

2. After removing the appliance, wash the area with a mild, fragrance-free soap like Ivory. Rinse thoroughly and make sure the skin is completely dry before applying any barrier products.

3. Try the "crusting" method: apply a skin-prep, sprinkle stoma or karaya powder, and then reapply the skin-prep to seal it before attaching the pouch.

4. Consider using these recommended products:
- Eakin Cohesive Seals or Eakin rings (also known as Slims or Perfect Choice)
- Karaya powder
- Anacept Gel or Spray (from Anacapa Technologies) as a wound-care layer under the barrier
- SenSura Mio one-piece drainable pouch (from Coloplast)

5. Some people find that using fewer layers works better, while others prefer an Eakin (or similar) seal along with a flange and pouch. It's a good idea to get free samples from different manufacturers to find what works best for your skin.

6. Persistent skin irritation often results from frequent appliance changes or systems that don't fit well. Try experimenting with different pouch brands and sizes until you find one that stops leakage and allows your skin to heal.

7. Regarding the surgical concerns, when a surgeon talks about "removing your entire colon," they usually mean a total colectomy. After this procedure, an ileostomy is more common than a straightforward reversal. It's important to have a detailed discussion with your surgeon about:
- Whether the plan involves an ileostomy, a J-pouch, or a permanent end-ileostomy
- The number of stages involved and the expected duration of hospital stays
- What to expect in terms of continence and how it might affect your quality of life.