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Dietmaier L, Summa S, Ronicke M, Erfurt-Berge C. Peristomal skin lesions - identifying patients at risk. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024. [PMID: 39074813 DOI: 10.1055/a-2360-5099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND AND OBJECTIVES Diagnosis and therapy of peristomal skin lesions are challenging for the majority of therapists. Established diagnostic tools have not yet been validated. Our objective was to outline the spectrum of and to identify risk factors for skin lesions in ostomy patients. A focus was set on peristomal ulcerations and their differentiation as peristomal pyoderma gangrenosum. METHODS In a retrospective analysis, frequency and character of peristomal skin lesions in patients presenting at two departments were analysed. Patients suffering from peristomal ulcerations were subjected to a more detailed analysis including application of the PARACELSUS score. RESULTS A total of 565 patients with ostomy were analysed; 40.2% (n = 227) presented with peristomal skin lesions. Moisture-associated skin damage (27.9%) was the most common, while ulcerations (21.9%) and eczematous skin alterations (19.1%) were seen with comparable frequency. Peristomal pyoderma gangrenosum was diagnosed in 7.9% of all observed peristomal lesions. Among patients with inflammatory bowel disease (n = 98), peristomal ulcerations were the leading finding (35.7%), and pyoderma gangrenosum was more frequent in these patients (16.3%). CONCLUSIONS It is necessary to assess and classify peristomal skin lesions. Further studies for the validation of different scores or the development of diagnostic tools are needed.
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Affiliation(s)
- Louisa Dietmaier
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus der Barmherzigen Bürder, Regensburg, Germany
| | - Scarlett Summa
- Department of Surgery, Section of Coloproctology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Erlangen, Germany
| | - Moritz Ronicke
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Erlangen, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Uniklinikum Erlangen, Erlangen, Germany
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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Singh M, Teodorescu DL, Rowlett M, Wang SX, Balcells M, Park C, Bernardo B, McGarel S, Reeves C, Mehra MR, Zhao X, Yuk H, Roche ET. A Tunable Soft Silicone Bioadhesive for Secure Anchoring of Diverse Medical Devices to Wet Biological Tissue. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307288. [PMID: 37865838 DOI: 10.1002/adma.202307288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/21/2023] [Indexed: 10/23/2023]
Abstract
Silicone is utilized widely in medical devices for its compatibility with tissues and bodily fluids, making it a versatile material for implants and wearables. To effectively bond silicone devices to biological tissues, a reliable adhesive is required to create a long-lasting interface. BioAdheSil, a silicone-based bioadhesive designed to provide robust adhesion on both sides of the interface is introduced here, facilitating bonding between dissimilar substrates, namely silicone devices and tissues. The adhesive's design focuses on two key aspects: wet tissue adhesion capability and tissue-infiltration-based long-term integration. BioAdheSil is formulated by mixing soft silicone oligomers with siloxane coupling agents and absorbents for bonding the hydrophobic silicone device to hydrophilic tissues. Incorporation of biodegradable absorbents eliminates surface water and controls porosity, while silane crosslinkers provide interfacial strength. Over time, BioAdheSil transitions from nonpermeable to permeable through enzyme degradation, creating a porous structure that facilitates cell migration and tissue integration, potentially enabling long-lasting adhesion. Experimental results demonstrate that BioAdheSil outperforms commercial adhesives and elicits no adverse response in rats. BioAdheSil offers practical utility for adhering silicone devices to wet tissues, including long-term implants and transcutaneous devices. Here, its functionality is demonstrated through applications such as tracheal stents and left ventricular assist device lines.
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Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Debbie L Teodorescu
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, 90048, USA
| | - Meagan Rowlett
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Mercedes Balcells
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Bioengineering Department, Institut Químic de Sarrià, Ramon Llull Univ, Barcelona, Spain, 08017
| | - Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Bruno Bernardo
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sian McGarel
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Charlotte Reeves
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- SanaHeal, Inc, Cambridge, MA, 02139, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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Hill RH, Smith SL. Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series. J Wound Ostomy Continence Nurs 2023; 50:521-524. [PMID: 37966082 DOI: 10.1097/won.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. CASES Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. CONCLUSIONS For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.
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Affiliation(s)
- Rosemary H Hill
- Rosemary H. Hill, RN, BSN, CWOCN, WOCC(C), Vancouver Coastal Health, Lions Gate Hospital, North Vancouver, British Columbia, Canada
- Stephen L. Smith, PhD, Medline Industries LP, Northfield, Illinois
| | - Stephen L Smith
- Rosemary H. Hill, RN, BSN, CWOCN, WOCC(C), Vancouver Coastal Health, Lions Gate Hospital, North Vancouver, British Columbia, Canada
- Stephen L. Smith, PhD, Medline Industries LP, Northfield, Illinois
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Oğuz ID, Vural S, Cinar E. Peristomal Pseudoverrucous Lesions: A Rare Skin Complication of Colostomy. Cureus 2023; 15:e38068. [PMID: 37234144 PMCID: PMC10208549 DOI: 10.7759/cureus.38068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
A 56-year-old female patient with colostomy presented with skin-colored cobblestone and verrucous asymptomatic papules on her peristomal skin for three months; she was referred to dermatology. Histopathology revealed irregular acanthosis, tongue-like extension of rete ridges of mature squamous epithelium without atypical morphology, hyperkeratosis, and inflammation of the skin. The histopathologic appearance was evaluated as compatible with pseudoepitheliomatous hyperplasia. No signs of malignancy, fungus, or koilocytes were found. The lesions were diagnosed as pseudoepitheliomatous hyperplasia by clinical and histopathologic findings. In this case report, we review pseudoepitheliomatous hyperplasia associated with colostomy.
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Affiliation(s)
- Işıl D Oğuz
- Dermatology, Giresun University Faculty of Medicine, Giresun, TUR
| | - Selahattin Vural
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Esma Cinar
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
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Nunes MLG, Martins L, Conceição de Gouveia Santos VL. Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese. J Wound Ostomy Continence Nurs 2023; 50:124-130. [PMID: 36867035 DOI: 10.1097/won.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.
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Affiliation(s)
- Maristela Lopes Gonçalves Nunes
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Lina Martins
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Vera Lucia Conceição de Gouveia Santos
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
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Gunasegaran N, Ang SY, Ng YZ, Lee NES, Agus N, Lee CW, Ong CE, Mostafa SS, Aloweni F. The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial. J Tissue Viability 2023; 32:171-178. [PMID: 36717288 DOI: 10.1016/j.jtv.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. METHOD A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. RESULTS Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. CONCLUSION HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.
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Affiliation(s)
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Singapore.
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital, Singapore.
| | - Chee Woei Lee
- Nursing Division, Singapore General Hospital, Singapore.
| | - Choo Eng Ong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
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D’Ambrosio F, Pappalardo C, Scardigno A, Maida A, Ricciardi R, Calabrò GE. Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010079. [PMID: 36612395 PMCID: PMC9819694 DOI: 10.3390/ijerph20010079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care. METHODS A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy. RESULTS Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery. CONCLUSIONS PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.
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Affiliation(s)
- Floriana D’Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ciro Pappalardo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Scardigno
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ada Maida
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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McLarney BD, Huang S, Hsu S. Peristomal granulation tissue mimicking peristomal pyoderma gangrenosum in the context of urine-diverting ostomies. JAAD Case Rep 2022; 29:33-36. [PMID: 36186406 PMCID: PMC9522867 DOI: 10.1016/j.jdcr.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, Pieper D. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Colorectal Dis 2022; 24:904-917. [PMID: 35297146 DOI: 10.1111/codi.16118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
Abstract
AIM This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. METHODS MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. RESULTS This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. CONCLUSION Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.
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Affiliation(s)
- Peter C Ambe
- GFO Kliniken Rhein-Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany.,Department of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Friedel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.,University of Cologne, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
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