Stoma Wound Care: Evidence-Based Approach
For the first week after stoma creation, perform daily aseptic wound care with sterile cleansing and breathable dressings, then transition to simple soap and water cleansing 1-2 times weekly once the site is healed. 1
Initial Week (Days 1-7): Intensive Wound Care
Daily monitoring and aseptic technique are essential during tract formation:
- Inspect the stoma site daily for bleeding, pain, erythema, induration, leakage, and inflammation 1
- Cleanse with 0.9% sodium chloride, sterile water, or freshly boiled and cooled water 1
- Apply a sterile Y-dressing (non-fiber shedding) under the external fixation plate to absorb drainage and cushion movement 1
- Use a breathable, skin-friendly, solvent-free dressing over the site 1
- Never use occlusive dressings—they create moisture that causes skin maceration and infection 1
- Ensure the external fixation plate has minimal traction with at least 5mm free movement to prevent buried bumper syndrome 1
- Dry the wound area completely after each cleansing to prevent tissue maceration 1
Alternative First-Week Approach (Grade B Evidence)
Consider glycerin hydrogel or glycogel dressings as a cost-effective alternative to daily standard dressings:
- Apply the hydrogel dressing the day after stoma placement 1
- Change weekly rather than daily during the first 4 weeks 1
- This approach significantly reduces infection scores compared to standard dressings 1
- Eliminates the burden of daily dressing changes while maintaining wound protection 1
After Initial Healing (Week 2 Onward): Simplified Maintenance
Once the stoma tract is formed and the incision healed (typically 1-2 weeks), dramatically simplify the care routine:
- Reduce dressing changes to 1-2 times per week 1
- Cleanse with simple soap and tap water of drinking quality—sterile solutions are no longer necessary 1
- A simple plaster around the wound is sufficient 1
- Alternatively, dressings can be completely omitted and the site left open 1
- Showering, bathing, and swimming are permitted (use waterproof dressing for public pools) 1
Managing Peristomal Leakage
If gastric contents or intestinal output leak around the stoma, protect the surrounding skin aggressively:
- Apply zinc oxide-based skin protectants, barrier films, pastes, or creams to prevent breakdown 1
- Use foam dressings rather than gauze—foam lifts drainage away from skin while gauze promotes maceration 1
- Verify proper tension between internal and external bolsters without excessive pressure 1
- Address underlying causes: infection, increased abdominal pressure, constipation, tube malposition, or granulation tissue 1
Critical Pitfalls to Avoid
The most common complications stem from improper technique during the initial healing phase:
- Excessive tension on the external fixation plate causes tissue ischemia and buried bumper syndrome—maintain 5mm free movement 1
- Insufficient incision size (less than 8mm) creates pressure necrosis—ensure adequate opening 1
- Occlusive dressings trap moisture and cause maceration—always use breathable materials 1
- Failure to mobilize the tube after healing leads to adhesions—push tube 2-3cm inward and rotate daily after week 1 1
- Inadequate drying after cleansing promotes skin breakdown—thoroughly dry before applying new dressings 1
Special Considerations for High-Risk Patients
Patients with impaired wound healing require extended intensive care:
- Continue daily monitoring beyond 7 days for patients with diabetes, immunosuppression, malnutrition, ascites, or corticosteroid use 1
- Watch for delayed tract formation (may take up to 14 days instead of 7) 1
- Treat local fungal infections with topical antifungals if they develop alongside leakage 1
When to Escalate Care
Return to daily intensive wound care if any of these develop after the initial healing period: