From the Guidelines
Excoriation under a belly flap should be treated with a combination of keeping the area clean and dry, applying topical antifungal medications, and preventing skin-to-skin friction. The management of this condition is crucial to prevent further complications, such as infection, which can lead to increased morbidity and mortality. According to the guidelines for the diagnosis and management of skin and soft tissue infections, the most important therapy for a wound infection is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention 1.
For excoriation under a belly flap, it is essential to clean the affected area gently with mild soap and water, then thoroughly dry it. Applying an antifungal cream such as clotrimazole 1% or miconazole 2% twice daily for 7-14 days can help prevent fungal infections. For inflammation, a low-potency steroid cream like hydrocortisone 1% can be applied sparingly for 3-5 days. To keep the area dry, use absorbent powders like zinc oxide or cornstarch between skin folds. Place a clean, dry cotton cloth between skin folds to reduce friction and moisture.
The guidelines for the management of intra-abdominal infections also emphasize the importance of source control, which includes all measures undertaken to eliminate the source of infection, reduce the bacterial inoculum, and correct or control anatomic derangements to restore normal physiologic function 1. However, in the case of excoriation under a belly flap, the primary focus is on preventing infection and promoting healing, rather than source control.
For severe cases with signs of infection (increased redness, warmth, pus, or fever), it is essential to see a healthcare provider as oral antibiotics may be needed. This condition occurs because the warm, moist environment under skin folds creates ideal conditions for yeast and bacteria to grow, leading to inflammation and skin breakdown. Weight loss may help prevent recurrence by reducing skin fold depth.
Key considerations for managing excoriation under a belly flap include:
- Keeping the area clean and dry
- Applying topical antifungal medications
- Preventing skin-to-skin friction
- Using absorbent powders to keep the area dry
- Placing a clean, dry cotton cloth between skin folds to reduce friction and moisture
- Seeking medical attention for severe cases with signs of infection.
From the Research
Excoriation Under Belly Flap
- Excoriation under the belly flap can be a complication of surgical procedures, such as extralevator abdominoperineal excision (ELAPE) with vertical rectus abdominis myocutaneous (VRAM) flap closure 2.
- The use of hydrocolloid dressings can be beneficial in managing excoriations, as they create a moist environment that promotes healing and protects new tissue 3, 4.
- Hydrocolloid dressings are designed to manage drainage and can be worn for up to a week, reducing the need for frequent dressing changes 3.
- In the case of excoriations under the belly flap, it is essential to consider the unique challenges of wound healing in this area, including the risk of infection and delayed healing 5, 6.
- The management of excoriations under the belly flap may require individualized treatment plans, taking into account the patient's overall health, age, and medical history 5, 6.
- The use of silver regimens or other advanced wound care strategies may be necessary to prevent tissue excoriation and promote healing in older patients with urinary or fecal incontinence 6.