Rethinking Decades of Surgical Practice: Embracing Soft Convexity in the Operating Room

Clinical Situation: Within 24-48 hours post-operatively, leakage of effluent frequently occurs under a flat ostomy barrier, which may come in contact with the midline incision. Peristomal skin irritation may also be associated with the leakage, which has contributed to pain and quality of life concerns in the early days of stoma creation.  A recent convexity consensus publication concluded that “a convex ostomy pouching system can be safely used regardless of when the stoma was created. Actions Taken:  A case series involving 7 patients (4 ileostomy, 2 urostomy, 1 colostomy) was undertaken at a large teaching hospital in Western Canada. Ages ranged from 55—88 years old with varying etiologies including Crohn’s, diverticular disease, rectal cancer, bladder cancer and pancreatic cancer. A decision was made to apply a ceramide infused soft convex skin barrier on all ostomy patients in the operating room. A slim barrier ring was added to the ostomy barrier to enhance the seal around the ostomy.

Results/outcomes: No leakage was noted in all seven patients from time of application to time of first barrier removal for ostomy teaching. All subjects exhibited intact peristomal skin during the first barrier removal which occurred between post-operative days 2-4. These cases suggest that the use of a ceramide infused skin barrier with soft convexity helped increase barrier wear time without stomal complications,

Target Audience: Nurses, physical therapists, dietitians, and other healthcare professionals interested in wound care.

At the completion of this presentation, the participant will be able to:

• Review outcomes of newly created stomas placed in soft convexity
• Discuss the approach for ALL ostomy surgery (ileostomy, colostomy & urostomy)
• Present the steps to include for changing a practice of several decades

Course Originally Released on: 6/04/2024
Date of Most Recent Review: 6/30/2027
Course Termination/ Update Date: 6/30/2027

Accreditation Information

In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.