Selecting convexity to improve and maintain peristomal skin integrity
Each person with a stoma is an individual who may react differently when faced with similar situations and, as such, each patient needs to be considered on a person-by-person basis to address their needs, support their acceptance of living with a stoma, as well as to encourage their rehabilitation. This article discusses the benefits that a convex flange can offer ostomates to reduce and minimise leakage episodes and in doing so support peristomal skin integrity and, in particular, the benefits of a convex pouch with a hydrocolloid flange containing medical grade Manuka honey. It reports on the findings of an independent nurse study, which included discussions about the varying types of convexity offered to ostomates, following an assessment of patients' needs.
The following question was posed to the authors after they had presented the findings of their previous retrospective peristomal skin studies, which looked at pouches containing Manuka honey, at the 2019 conference of the European Council of Enterostomal Therapists (ECET): ‘Was any improvement in peristomal skin attributable to the benefits of convexity as opposed to the Manuka honey convexity flange?’ As clinicians, we felt obliged to investigate further. The primary focus of the study described in this article is therefore whether the use of a Manuka honey convexity flange improves peristomal skin integrity for patients experiencing sore skin, despite using other convex flanges. Patient assessment and evaluation was undertaken independently by patients’ stoma care nurses (SCNs).
An extensive literature search was undertaken to try to establish a consensus on the definition of the term ‘convexity’ and to further investigate the uses of convex flanges and pouching appliances; several seminal texts were identified and are discussed in the article. Convexity appliances are generally used to help in the management and/or prevention of complications, such as output from the stoma seeping under the appliance adhesive. These appliances are designed to place pressure on the skin surrounding the stoma, increasing its protrusion and improving the seal between the appliance and the patient's skin, thus reducing the risk of leakage.
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