To the Editor
Cathy's answer to my letter (Faller NA. RE: Ratliff CR. Descriptive study of peristomal complications [letter to the editor]. J Wound Ostomy Continence Nurs. 2007;34(2):127-128) raises new questions.
Are the 4 categories of skin complications in the ET nursing Guidelines for Management: Caring for a Patient with an Ostomy evidence-based?1 Why are the guidelines not consistent with the newly proposed diagnosis of moisture-associated skin damage (MASD)? Or, why is the newly proposed diagnosis of MASD not consistent with the guidelines?2 (Watch for more on that to follow).
Two articles appear consecutively in the September 2004 issue of Ostomy Wound Management.3,4 The first, addressing stomal complications, includes mucocutaneous separation. The second, addressing peristomal skin complications, includes mucocutaneous separation. A more recent book chapter on peristomal skin complications includes mucocutaneous separation.5 See schema in Figure 1. Is mucocutaneous separation purely a stomal complication or is it, in fact, a peristomal skin complication?
Am I correct in suggesting that there are 2 distinct types of mucocutaneous separation? Type A is complex with deep separation possibly associated with necrosis that may result in retraction. Type B is simple with superficial separation that may result in stricture. Is type A a stoma complication? Is type B a skin complication? Or, are both types of complications stoma complications and skin complications? Were the participants at the Australian ET Nursing Conference referring to a type A complication or a type B complication or another phenomenon?6
In any case, ET nursing care must include assessment and treatment. Assessment must include location on the circumference of the os, depth, and width of the associated skin defect. Treatment must include filling the associated skin defect and pouching for the effluent.
Thank you for allowing me to continue this discussion.
Nancy Ann Faller, RN, MSN, PhD, CETN
References