Challenges with Stoma Wound Care and Wound Vac Management

It won’t let me upload picture of wound I’m describing...Wound Care is having a lot of trouble filling in negative space next to stoma (it’s several inches deep), blocking that part off by building wall and separating it from the incision wound area where wound vac is being applied directly under incision site. They used to be two wounds. They are now one large wound. They are torturing my mothers peristomal area and filling in the negative space on that side of stoma with paste. Because they are having trouble figuring this out, there has been major leakage of stool into wound, and they constantly have trouble keeping a seal on barrier flange. Her surrounding skin is being compromised and I keep asking for adhesive remover to be used when taking off tape. I suggested using a barrier ring around stoma to protect peristomal area, but the last wound care nurse was so confused on how to fill the negative space next to stoma she put tons of paste in negative space, a wound vac next to that and paste all around stoma before pushing down super hard to lock down bag. Oh! And I forgot to mention that she didn’t measure the stoma and when she cut size on wafer, she also didn’t cut in a nice circle, it was uneven and jagged and I feel she’s smothering the outer area of my mom’s stoma. I am so beyond stressed out because I put my mother in LTAC specifically for wound care and this is what’s happening. If I can figure out how to build a wall to make it two wounds for the vac safety that would help. Any ideas? Have any of you experienced this? There is still necrosized skin needing debridement in this pic, it the yellow that you see and I put blue arrows wher I need to fill in the space. I also asked nurse to use crusting technique around the other part of stoma that isn’t damaged yet. Thank for any help. They’re going to eventually send her home and I need to know how to do this.

Hello lovemystoma.  This sounds horrendous and without a picture it is difficult to envisage. However, 'if' I have it right, it could be that you need two seaparted byt ajoined portective units- one for the stoma and one for the wound. In which case I would suggest ASKING FOR SOME SAMPLES OF DERMACOL STOMA COLLARS, from Salts healthcare. I beleive they make them in differing sizes so you would need to know what size you needed. I found these very comfortable and protective, My concept in your case would be to adapt the collars by cutting the flange so that the respective two collars fitted over both the stoma and the wound.

I don't know if this would work but it might be worth a try.

Best wishes

Bill 

Bill, thank you for your reply! I didn’t even know those existed:). We waited all day for Wound Care and asked several times for them when they didn’t show up and they still never came when I left just now. They’re most likely going to come when I’m not there at that crack of dawn tomorrow. But I’m going to be sure and order those samples and ask questions. I also left some of her nice samole products in the room hoping that they would see them and use them because whatever brand they’re using (they don’t leave stuff in the room) it keeps breaking down, popping off and is cheap product. The staff ignores emptying it and then it fills with gas and put stress on the bag. Tomorrow if it happens again I’m going to emoty the bag myself and write down output measurement and hand the paper to the charge nurse. I just am afraid of them treating my mom worse by pissing them off, but it’s already a bad situation and so I’m hoping maybe I can contact somewhere where they’ll teach me the things I need to know so that I can get her home and start taking care of it mys

Hello lovemyostomy. On either side of your screen there are advertisements for the ME+ site, which purports to offer help and advice and support for ostomy related issues. I have never needed this sort of stuff myself but I did have a brief look to see what they were offering and it sounded like a useful online resource. Perhaps if you contact them, you could let us knw how effective they are in their supportive role. 

Best wishes

Bill