Stoma is an artificial opening in the intestine, created in the abdominal wall to divert bowel contents, which may be temporary or permanent. It may be ileostomy, jejunostomy or colostomy. Peristomal skin erosion or excoriation commonly develops near a stoma site in few days or weeks but may present as a late complication after months or years. If proper care is not taken, the excoriation may extend to the skin of the whole abdomen or full thickness ulcerations may develop at places. Due to frequent or continuous outflow of intestinal contents from the stoma or fistula site, the peristomal skin starts inflamed and changes occur afterwards slowly. Sometimes, it may be due to frequent appliance changes and leakage. Skin excoriation due to allergic reaction to the adhesive or skin barriers also is common. It is noted that in 18%–73% of stoma patients have peristomal skin-related complications and are commonly seen on those who had loop ileostomies.
MATERIALS AND METHODS
This case-control study was conducted in NEIGRIHMS hospital, Shillong from January 2015 to October 2020. A total of 38 patients with skin excoriations following ileostomy/enterocutaneous fistulae [Figure 1] were included in the study. Nineteen cases with post ileostomy or enterocutaneous fistulae with skin excoriations were managed with aluminium paint [Figure 2] and their data were compared with 19 other patients with peristomal skin excoriations post-ileostomy or enterocutaneous fistulae, who were managed earlier with conventional dressings with normal saline and zinc oxide creams etc., as controls. Written informed consents were taken from patients. Necessary approval was obtained from Institute Review Board. Eight patients were post ileostomy and eleven post enterocutaneous fistulae in the aluminium group as against nine patients post ileostomy and ten patients post enterocutaneous fistulae in the control group. Thus, the two groups were similar in their aetiology of skin excoriations. Aluminium paint was applied every 3rd day till epithelisation [Figure 3] and healing of excoriations. The average number of stoma bag changes per week was more or less similar in both the groups, 3.5 bags in the aluminium group versus 3.8/week in the control group. Four patients in the aluminium group had abdominal tuberculosis as against five patients in the control group. Nutritional supplementation and electrolyte management in both groups were similar. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Released 2015. The mean between the two groups was compared using the Independent Samples t-test.
Among the 38 patients, 11 were female and the rest were males. Mean age and body mass index were comparable in both groups as shown in Table 1. Haemoglobin and serum albumin levels were also comparable in both groups.
Ileostomy was created in 17 patients who presented with complications due to abdominal tuberculosis and in 9 cases due to traumatic bowel injury with gross contamination and 4 cases were following non-traumatic bowel perforation. Another eight patients developed skin excoriations due to post-operative fistulae.
Aluminium paint dressing around the stoma resulted in early healing in comparison to the conventional dressings group which was statistically significant (P = 0.001).
Hospital stay was also significantly shorter in the aluminium paint group (P = 0.001).
Skin excoriation around stoma and enterocutaneous fistulae is a painful and uncomfortable condition for the patients and also occasionally frustrating for the treating physicians. Small bowel stoma or fistulae have more tendencies to develop skin related complications as its contents are bilious effluents rich in digestive and proteolytic enzymes, with more corrosive actions than the distal bowel contents.
In the management of peristomal skin excoriations, many other agents such as petroleum jelly, betel leaf, gum acacia and glycerine were used and have been found to be effective in wound healing. Aluminium paint is a cheap means of managing skin excoriations but has been used less frequently. It is cost-effective, easily available and easy to apply. Time to epithelisation was much quicker and hospital stay was also shorter in comparison to conventional dressing with normal saline and zinc oxide skin ointment (P = −0.001). Kumar et al. did a comparative study on aluminium paint, gum acacia and karaya gum in peristomal skincare. They concluded that aluminium paint was also as efficacious as the other two. Aluminium paint formed an impermeable coating which prevented corrosive effluents of the bowel to come in contact with the excoriated skin and helped in the healing of the peristomal inflamed skin. Aluminium absorption through the skin is negligible and contact dermatitis is very rare. The primary factor that is responsible for rapid epithelisation seems to be avoidance of wound from those corrosive effluents of the bowel.
Aluminium paint is a cheap and effective means of managing peristomal and post enterocutaneous fistulae skin excoriations. It will be especially useful for rural surgeons with limited resources.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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