To the Editor:
I am very belatedly responding to the excellent article Descriptive Study of Peristomal Complications, by Catherine R. Ratliff, Kathryn A. Scarano, and Ann M. Donovan (JWOCN 2005; 32:33-37).
In 2000, I was invited to Australia to participate in their 29th annual ET nursing Conference. Priscilla Stevens, an ET nurse from South Africa, and I were asked to prepare a pre-conference workshop on Stomal Complications. At the beginning of each of two identical sessions, we asked participants to identify their three most significant stomal complications. Each table of 8 ET nurses pooled their ideas to come up with three responses. We were quite surprised with one of the responses: mucocutaneous separation. Although we had both experienced this in our practices, it was not a significant complication.
There were 10 tables at each of the two sessions for a total of 20 sets of three responses. As the participants were not asked to identify complications in order of significance, each of the 60 responses was considered separately. For ease of tabulation, the responses were divided based on the actual labels given by the participants, into two categories, skin complications and stoma complications. There were two responses of "leakage," which did not fit into either category. The complications were then divided into subcategories, four for stoma complications and two for skin complications. The actual labels for the responses used by participants are noted in the attached table.
Mucocutaneous separation was the most frequent skin complication, accounting for over half of the complications in the skin category (Table). And yet in your and other articles on parastomal complications, this specific complication is not mentioned. This omission is most probably related to the timing of mucocutaneous separation, an early complication, occurring shortly postoperatively. One would hope the wound had healed prior to entry into the clinic system, where many studies are conducted. Yet, the resultant scarring of full thickness separation may cause stomal stricture with its resultant difficulties.
Nancy Ann Faller, PhD, MSN, RN