Stoma wound care....?

Hi,

I'm just wondering what theory your doctor is following which his recommendations. As I understand it, the reasoning behind leaving the wound open is that there is reduced problems due to something getting inside a closed wound. And the reasoning behind packing it is so that it doesn't heal from the outside first, but rather has to heal from the inside out. 

He must have his reason for leaving it open but not packing, perhaps he can explain it to you and the nurse?  

The Doctor in question is a Professor and also the Surgeon who has created my J pouch and performed my reversal surgery.

I feel I shouldn't have to question my surgeons reasoning, after all he's the expert and surely the district nurse should just follow his instruction.

I'm sure your surgeon is expert and the nurse should definitely do as instructed. As for me, I don't consider asking the reasoning the same as 'questioning'. I just personally feel more assured when I understand.  But maybe that's just me and my curiosity. Hope all goes well for you!

Theory is that should the wound be closed from the surface, there's a far greater risk of developing an infection between the muscle wall and flesh, thus developing an abscess.

By remaining open the wound will heal from the inside and outwards, preventing an abscess from forming.

The wound eventually becomes a smaller & smaller circle and such a healing process will leave less of a scar once completely healed.

Packing a wound of such a depth increases the risk of infection, therefore my Surgeon has instructed that the wound should not be packed.

I hope your district nurse is following his instructions!

I've had my stoma moved 3 times and each time they have had to allow the stoma to close on its own. No memory of it ever having been packed either. 

They kept it clean, used a tube of saline to rince it out each time, covered it with a dressing and waited for it to granulate. It took quite a while to close completely.

The first one I allowed to close 100% naturally and it left a rather unfortunate looking scar.

The next 2 I allowed to close up until a certain point (around the 6th week...just before the skin started to close) and then added a couple of steri strips to bring the edges closer together.  It made for a nicer scar.

My surgeons always gave the initial instructions but the nurses, who are the ones who see the scars daily and have probably more experience on that level, take it into their own hands to assure a healthy healing process. 

If they have never done this sort of thing before then please, have them follow the surgeon's orders.

Sharon

I thought just gauze was strange too but he's correct. My visiting nurse was wonderful and never questioned. Mine healed up nicely and continues to get flatter as time goes on. Listen to your doctor!

All sorted now. Nurses are following my Surgeons instructions, although dressing the wound every couple of days rather than daily.

This post has been helpful to me. I'm two weeks out and have a follow up with my surgeon today. My site is left open, but I do pack it (lightly) every day.  His reasoning is exactly

the same as your surgeon's, though I think he also felt the packing would help remove what needs to be cleaned, as well as make ultra sure it doesn't heal at the top first. I will ask him if that is still necessary, because it would be nice to not have to do it,  it stings when unpacking. Happily, it is healing well. 

 

Also, so, I will ask him about using steri strips to maybe minimize the scarring. Thanks for that tip, Sharon!