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Stoma shape and wafer cutting

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Posted 6/3/2011 12:29 AM (GMT 0)
My stoma is an irregular oval and has these puckers at the base where the stoma attaches to the skin that sort of look like flower petals (I am guessing they are indentations left behind from healing around the stitches). Does anyone else have these? Do you cut your wafer to account for them, or do you just cut a general circle/oval? I don't have any problems with these "petals" and my Eakin Seal sort of fills in any space between them, but I always wondered how folks who don't use barrier rings deal with them. It seams like there could be a tiny bit of unprotected skin. I sort of cut the petal shapes into my pattern, but I am not sure it is necessary, and then I have to get it placed perfectly.

On a completely random side note, I am still always amazed that skin can heal right to your intestine like it does with a stoma. Seems like the stoma would be too darn slippery and that it wouldn't attach or would get infected all the time. It is pretty crazy that it actually works to have one's intestine sticking out of their belly:)
Posted 6/3/2011 3:44 AM (GMT 0)
i think that its weird how it stays out like that too.  i also think its weird that the area under my wafer will never have a tan again.

But anyway, back to your question, i have no idea what you mean, but i just cut the hole and my stoma smooshes to fill it.  and if it doesnt the paste fills it likeyou said.  I don't understand how someone could cut it to the exact shape.

Posted 6/7/2011 2:30 AM (GMT 0)
blueheron:

These "petals" you describe...do they cause you any pain?

I finally got to a WOCN at a wound clinic here in Florida (will be another post in a few days)...and, I showed her my two "petals" or "growths." They are granulomas..caused by .. too tired to explain..

Anyway, she (the WOCN) cut my wafer to go around the granulomas (after she treated them with silver nitrate..burns terribly bad)...so, now I have a new pattern...glad I went to her as I was sizing wafer based just on the stoma...would not have been fun after another week or two...

Hopefully, granulomas will be gone after a few treatments or will have the Dr. remove them...

Good news..the nurse said without the granulomas I could get a pre-cut wafer to go around stoma....or, use moldables...
Posted 6/7/2011 3:01 AM (GMT 0)
No- they don't cause any pain and I looked up photos of granulomas on the internet and they are definitely not that. I think they are just part of my stoma and the way it ended up attaching to my skin. If you imagine the way you drew a simple flower when you were a kid, only with really shallow petals, that is kind of what parts of the perimeter of my stoma look like from a birds-eye view (really hard to explain). The indentations between the "petals" are where I remember the stitches being, so again, think it is just the way it healed. I do think it is somewhat normal, as when I look up photos of stomas on the internet there are a lot that look kind of wavy and puckered around the outside perimeter. I honestly don't have any issues and my skin is doing great. I remember my stoma nurse at the hospital just cutting an oval, but I could see skin between some of the wavy sections. I started to get paranoid that my skin was going to get eaten away in those spots so I began to cut the pattern to account for those irregularities. I am guessing this isn't really necessary and just wastes time as now I am using Eakin seals which fill in any gaps.

NASCARon- I cannot use Convatec moldables because the medium size is too tight on the long side of my oval-shaped stoma and the large size leaves too much of a gap on the short side of my stoma. The Convatec rep told me they wouldn't work. I wrote Convatec and told them they should make an oval version:)
Posted 6/7/2011 10:35 AM (GMT 0)
Blueheron, my nurse told me I had an oval stoma a bit ago -- I hadn't realized it (and I'm a math nerd -- but it's a weird angle looking at it directly or in the mirror). I don't think it's as elongated as yours, but yesterday I was trying to figure out whether the moldables would work for me. The range is really small for each, guess that makes sense. There would be a lot of possibilities for an oval one, I can see why they don't make them, sadly....

I was just reading yesterday about how before Brooke figured out how to do end ileos the way we have them, they had tried just sticking the intestine out of the belly, without turning it inside out. Apparently the outside is like a sausage casing, and the body sees it as a wound that needs to heal up ... so the end would get more and more narrow and would shrink back into the body, so people would get blockages and have to keep redoing the surgery. But turning it inside out and sewing it up works.

This surgery really is remarkable. I mean, you know how many people in history have died of diarrhea? Well, I don't, and unfortunately, people still do today.... but then that people figured out this surgery and even with the glitches it works so well, it's just stunning if you think about it. I just feel grateful that smart, compassionate people are willing to go into colo rectal and be gi docs -- it's not glamorous, and they have other options.... good to remember this when the poop is squirting all over the bathroom.....
Posted 6/7/2011 12:25 PM (GMT 0)
Blueheron,

I felt the same way when leaving the hospital..the WOCN at the hospital said the wafer would swell to cover my skin..well...she must have been thinking about moldables...cut-to-fit wafers don't really swell much if at all...

I will say this, after having seen the WOCN at another hospital (who cleaned my skin/stoma/ and gave me a new pattern for the granulomas), she gave me a book that talks about leaving a little bit of space between the wafer and the stoma so the stoma can move about.....this seems a bit odd but is good advice if you have an eakin seal to protect the skin....I still think they are learning about this (as per blueglass's post). Too bad you can't wear a moldable.....I wonder what people did before EAKIN seals????? It must have been really disconcerting to be leaking after a day or so....I guess they used paste but that doesn't help with skin healing....
Posted 6/7/2011 11:59 PM (GMT 0)
Enigma- I have found that I do need to leave a gap and I am soooo thankful for Eakin seals. My stoma really shrinks and swells as it is wiggling and dancing about. I have watched it get at least 1/8 inch wider when I have been changing my appliance sometimes. One time I cut my wafer flush to the edges of my stoma and the poor thing turned a bit black and blue in places. Healed quickly once I made my next wafer a bit bigger, but it is something I hope not to repeat:)
Posted 6/8/2011 8:05 PM (GMT 0)
Blueheron, I know the convatec person said that a mouldable wafer wouldn't work for you but there may be a way to try it. You say the medium size is too tight on the long side of your oval. The mouldable ones can still be cut if you're careful.

Have you tried a medium one and just trim the area where you need the bit of extra room. You still want it to be a snug fit so if you have a cutting template, use that as a guide and cut the mouldable on those long sides ensuring you make it couple of mms smaller than you would normally, if you see what I mean. May be worth a try with a few samples of them and see how you get on.
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