Management of a Flush or Retracted Stoma 

       The ideal stoma is one that protrudes above the skin, but this is not always possible and a flush (skin level) or retracted  (below skin level) stoma may result.

       The surgeon may be unable to mobilize the bowel and mesentery (membrane that attaches organs to abdominal wall) adequately or to strip the mesentery enough without causing necrosis or death to the stoma. Some causes of stoma retraction after surgery may be weight gain, infection, malnutrition, steroids or scar tissue formation.

      Stomas that are flush or retracted can lead to undermining of the pouch by effluent (drainage). This continued exposure can lead to irritated and denuded skin, as well as frequent pouch changes. These problems can be very stressful and expensive.

      The inability to maintain a pouch seal for an acceptable length of time is the most common indication for a product with convexity.

Convexity Requirements:

• Shallow – For minor skin irritations and occasional leakage.
• Medium – Stoma in deep folds; severe undermining and frequent leakage.
• Deep – Used when medium convexity is not sufficient, stoma is retracted or in deep folds, or leakage is very frequent and skin is denuded.

Ways to Achieve Convexity:

Convex inserts:  Inserts can be applied to a two-piece system by snapping an insert into the ring of the flange. The outer diameter must match the flange size. This can be cost effective as this insert can be cleaned and reused.

Pouches Designed with Convexity:  These are available in both one and two-piece systems. They can be shallow, medium, or deep. They come as either precut, cut or cut to fit.

Addition of Skin Barrier Gaskets:  These are used around the stoma and can be cut or purchased precut. One layer or several layers can be used.

Eakins Wafer / Colorplast Strip Paste:  These are products that can be pressed into shape around the stoma to protect the seal. 

Other Ways to Increase Wear Time and Prevent Leakage:

An ostomy belt may be helpful. The opening should clear the stoma one-eighth inch only to give skin maximum protection.

Use Ostomy paste for “caulking.” Always read and follow manufacturer’s direction for product use.

Product Information:

Most ostomy companies make pouches with convexity and carry inserts as well as belts. 

ConvaTec uses a product called “Durahesive,” which has a turtleneck effect around the stoma.

Hollister has the “Premier” series that does not erode.

Nu-Hope makes barriers that are oval as well as round and which have deep convexity. Nu-Hope also makes support belts and Hernia belts for urostomies.

(Gloria Johnson, WOCN)