Response from the Author:

Thank you very much for your letter to the editor about peristomal skin complications. Peristomal skin complications have been described as skin problems, parastomal problems (mucocutaneous separation), retraction, stenosis, necrosis, prolapse, and hernias. In the article, "Descriptive study of peristomal complications," the description of peristomal skin complications was based on the WOCN Guidelines for Management: Caring for a Patient With an Ostomy, which divides peristomal skin complications into 4 categories: mechanical injury, chemical damage, infections, and allergic responses. Patients with mucocutaneous separation would certainly be at risk for peristomal skin breakdown probably due to chemical damage from the effluent staying on the skin. However, we specifically assessed for breaks in the peristomal skin and did not address problems with the stoma unless it affected the peristomal skin. Peristomal skin problems such as mucocutaneous separation were not captured in this study unless the patient developed a peristomal skin complication as a result of mucocutaneous separation.

The other piece is that hopefully over time the mucocutaneous separation will begin to close but then sometimes the stoma may be retracted when the separation begins to close and the area contracts and scars down, so depending on when one does the assessment, one might say the individual has a mucocutaneous separation or one has a retracted stoma.

I do not know how WOCN developed the peristomal skin complication classification or if it is evidenced based so this might be something that the organization would want to pursue.

Catherine R. Ratliff, PhD, APRN-BC, CWOCN