Do you leave skin around the stoma showing when you cut your wafer

Hello again,

The WOC nurse just visited and changed my dd's appliance with me. According to her we should be cutting the hole around the wafer much bigger so that the stoma has room to move / grow. Up until now we were always told the closer to the stoma the better, and that's what we've been doing. We actually had the perfect fit. There was no skin showing around the stoma once the wafer was on.
Today she made me cut the hole so big, that there is skin around the entire stoma showing.
When you prepare your wafers do you leave skin showing or not?

also, I should add my dd is only 3. Maybe it's different with children?? We just got over a really bad skin irritation. Her skin actually seems to be healing and I don't want this to irritate it again.
thanks again,

Francine~is the skin that shows the red/pink area that is directly around the stoma or Katie's actual skin? I wouldn't worry if it is the red/pink skin but would question the decision if, when you change the next time, there are issues.

My reason for asking that is because I was having issues with breakdown and leaks when I measured right up to my stoma...when I increased my wafer opening 1/8" my problems went away. I am an adult and not growing anymore but I am sure Katie will grow for a little while longer!!

Also, are you using anything like an Eakin Seal? If you are, I would think it would keep that little bit of skin healthy and give as she grows.

Just another thought: you could call the appliance manufacturer and get their opinion!

We had to change it again last night and it was irritated again. This time I left a little room near the stoma. (just the pink around the stoma) We don't use any paste or eakin seal b/c when we did her skin got more irritated. I guess I can start using the seal again on top of the wafer. This way it doesn't touch her skin.
I am realizing this whole process is just a trial and error.
I am calling some other companies today and am going to ask for some pediatric samples.
thanks again for all your help,

I would be questioning the stoma nurse - does she not know that when exposed skin gets stool on it, that skin gets sore and irritated?

Cut the wafer as close as you can while still giving the stoma room to move (you'll know if it's too tight - blood flow constricts and the stoma will turn a paler pink colour) and if you use paste or seals, they will cover the exposed skin not covered by the wafer - it's what they're meant to do. To have exposed skin is just asking for trouble.

If you have an ileostomy, the stool is much more acidic than a colostomy; therefore, it will eat up the exposed skin around the stoma. Cut your wafer close to the stoma, but not touching the stoma, as you do not want it to cut into the stoma. If the stoma is new, it will continue to shrink post-operatively for several weeks. You will need to measure the stoma with the measuring guide that comes with your kit and then cut out the appropriate size from the wafer. Be sure to run your finger around the cut out edge of the wafer to ensure there are no sharp edges that could poke into and irritate your stoma. Once your stoma shrinks down some and the size remains the same, you can purchase pre-fit/pre-cut wafers. They are more expensive but quicker. For skin breakdown around your stoma, and for cleaning your stoma..be sure to never use soap on that skin. Soap can irritate and will also cause the wafers/adhesives to not stick as well. Only use water and paper towels or soft cloth. To help irritated skin heal, clean skin with water and paper towel only. Pat dry. Layer Stoma Powder and 3M no-sting skin barrier spray, starting with the Stoma powder. Dust a light coating on dry skin, then spray no-sting skin barrier to cover powder. Repeat layering a couple of times then proceed with applying wafer. The layering of those two things will allow the skin to heal underneath the wafer. You can also try just using the 3M no-sting skin barrier and it will help. Use Eakin to fill in any gaps between wafer and stoma.