Techniques - Fistula Solution

Protecting Periwound Skin: What Clinicians Emphasize in Practice

Clinicians caring for complex wounds often describe periwound skin protection as one of the most important and consistent priorities in day-to-day care. Across conversations at conferences, workshops, and bedside discussions, clinicians highlight how changes in output, anatomy, and wound environment can make protecting the surrounding skin one of the most challenging aspects of complex wound management.

While every wound is different, certain themes appear repeatedly when clinicians talk about periwound skin protection in real-world practice.

Why Periwound Skin Matters So Much in Complex Care

Clinicians frequently mention that when the surrounding skin remains healthy, the entire care plan tends to feel more manageable. Healthy skin often supports pouch adherence, patient comfort, and the ability to adapt when output or anatomy changes.

Because of this, clinicians often view skin protection as the foundation that supports everything else—especially in cases where output is high or the fistula location is difficult to manage.

The Impact of Even Brief Effluent Exposure

In many clinical discussions, even short contact with effluent is described as a factor that may contribute to irritation or reduce adherence. This can cause more frequent disruptions in care, which clinicians say may add to patient discomfort and make consistency harder to maintain over time.

Teams often describe these situations as routine parts of complex care rather than exceptions.

Themes That Make Skin Protection Challenging

Clinicians also discuss how periwound skin is influenced by anatomy. Irregular openings, tucked positions, steep angles, or fistulas near skin folds can make it difficult to support the surrounding area from shift to shift.

While each clinician approaches these challenges differently, many note the importance of having adaptable options when anatomy does not match ideal conditions.

How These Themes Shape Clinical Decisions

These observations reflect what clinicians emphasize most when talking about periwound skin protection in complex care. They also highlight why many teams look for options designed to help support predictable pouching and periwound skin health when conditions are difficult.

If you would like to explore tools developed for skin protection, you can learn more about the Wound Crown, Fistula Funnel, and Isolator Strip in our Knowledge Center at FistulaSolution.com. If your team sees similar themes in daily practice, we welcome hearing the general patterns you notice—no patient details, simply the observations you encounter in complex care.

Real-World Effluent Challenges Clinicians Talk About

Complex fistula care is unpredictable, and clinicians often discuss how real-world effluent challenges affect day-to-day routines and pouching success. Effluent isolation is rarely simple, and these conversations help us understand the patterns clinicians encounter most. Hearing these shared experiences also highlights where additional educational support may be helpful.

Irregular or Changing Wound Contours

Many clinicians describe fistulas that do not form predictable shapes. Openings may shift or merge, which can make seal reliability difficult. These changes may require adaptable options that support isolation in unpredictable conditions. Clinicians often emphasize the importance of approaches that can be adjusted as the wound evolves.

Protecting Periwound Skin

Periwound skin is highly impacted by effluent exposure. Even limited contact may contribute to irritation or reduced adherence. Clinicians often share that maintaining skin integrity supports patient comfort and the overall plan of care. When skin remains stable, teams note that other aspects of care become more manageable.

Reducing Improvisation Across Care Teams

Improvisation is part of complex care, but clinicians frequently note that it can be challenging to standardize across teams or shifts. Professional education resources such as Wound Care Today USA may help support a more consistent approach to effluent isolation. Consistency is a common theme clinicians highlight, especially in high-output or rapidly changing wounds.

Real-World Effluent Challenges in Practice

Effluent management involves ongoing problem-solving, and clinicians continue to demonstrate adaptability and commitment in complex care settings. Hearing these shared experiences helps strengthen the conversations we have as a clinical community and allows us to focus future educational resources on the topics clinicians identify most often.

If you have general insights or experiences to share about the real-world challenges of effluent isolation, we would love to hear from you. No patient details, simply the themes or situations you see in your everyday practice.

Want to explore more educational resources? Visit our Knowledge Center at FistulaSolution.com.

New Technique to Protect Perineal Skin Grafts without a Diverting Ostomy at EAST Conference

David Dries, MD will present Massive Burns After Forge Explosion: New Technique to Protect Perineal Skin Grafts without a Diverting Ostomy at 4:06 PM EST on January 14th, 2021 during the Eastern Association for the Surgery of Trauma's Annual Scientific Assembly – Virtual.

One of the difficult aspects of maintaining good wound healing and perineal wounds is fecal contamination. Diverting colostomy and ileostomy are treatment options along with administration of materials which affect bowel motility.

Dr. Dries will present a new technique using a fecal collection circuit combined with an isolation device to avoid redirection of the fecal stream with the associated additional operative procedures of colostomy and ileostomy formation. This Master Class Surgical Video presentation will illustrate a step-by-step application of this technique through case-study pictures and illustrations.

Isolation of Enteric Fistulas for Skin Graft Placement

The Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) has shared the case study poster Isolation of Enteric Fistulas to Allow Adjacent Skin Graft Placement.

Download the poster to see how Fistula Solution devices help manage intestinal effluent during the placement of skin grafts or artificial skin substitutes onto nearby wounds.

Fistula Isolation for Skin Grafting

Type: pdf Size: 2.67 MB

Belted Pouching with Fistula Solution Devices

A high-output enterocutaneous fistula or ostomy may produce two to seven liters of effluent per day which can be devastating to the skin and can cause pain, infection and emotional isolation.

Using a belted ostomy pouch with Fistula Solution devices can be a good effluent management option, particularly when:

The perifistula topography of a patients body, creases, or scars make adhesive pouching difficult, or
Ostomy pouches will not adhere to excoriated and weeping peristomal skin.

In these cases intestinal effluent can cause further irritation and wound formation of perifistula skin. To seal and protect the skin from effluent, Fistula Solution devices can be compressed around the patient’s enteric fistula or ostomy with a belted pouching system.

The following "how-to" steps illustrate the use of the Fistula Funnel in these challenging situations.

1. Tailor the Fistula Funnel by cutting along the exterior scribe line to form a skirt. The skirt will help form a good seal around the fistula or ostomy and protect the surrounding skin from effluent.

2. Check the fit of the tailored Fistula Funnel to ensure it will seal when compressed to the surface of the body.

The visible portion of the compression area is indicated by the yellow shape.

3. Center fistula or stoma in opening and compress the device. The fistula or stoma should be visible through the device opening after placement on the patient.

4. Apply a belted ostomy pouch appliance to compress the device to seal and protect skin and capture intestinal effluent.

This technique can be used to protect the skin from effluent and enable healing when other methods may not work and can dramatically improve quality of life for the patient.

High-output Fistula and Ostomy Effluent Containment

Managing effluent from a high-output fistula or ostomy can be a challenge. Even large, high-output pouches can prove insufficient when a patient puts out 5 to 10 (or more) liters of effluent daily.

Pictured is a technique for managing high volumes of effluent. A container is connected to the pouch using large bore corrugated tubing. Then, as prescribed by the provider, intermittent wall suction is applied to the container to draw effluent out of the pouch.

1. Connect and seal a suction tube near the top of a 3000 ml or other large container. Do not extend the tube more than 3 inches / 6 cm inside the container. Connect the free end of the tube to wall suction.

2. Connect and seal corrugated tubing to the top of the container. Ensure tubing is long enough to reach from the floor to the patient's pouch.

3. Fasten the top to the container and place the container on the floor near the patient.

Note that the container inlets for corrugated tubing and wall suction are spaced apart. This is so the effluent that is drawn into the container will drop to the bottom of the container and not be drawn into wall suction.

4. Connect and seal the free end of the corrugated tubing to the pouch drain.

As indicated by the healthcare provider, apply intermittent wall suction to draw excess effluent out of the pouch and through the corrugated tubing into the container.

This technique tip can help eliminate pouch clogs and effluent overfilling that can result in pouch adhesion failure and spills

The fill level of the large container should be monitored and the container can be emptied as needed. When a patient needs to move the suction tube can be disconnected from the wall so the patient can take the container with them.

Stop Pouch Attachment Leakage

Leaks can happen at the interface of a pouch appliance and Fistula Solution device. Usually leaks are because the pouch opening is cut too small or because of poor pouch adhesion.

The goal is to direct ALL effluent into the pouch appliance with no leaks. These technique tips will help assure success.

Click here for a detailed pouching video that demonstrates these technique tips.

1. Add a thin ostomy barrier ring to the top flange of the of the Fistula Solution device. This landing zone is where the high output ostomy pouch or wound manager will be placed.

2. Cut the opening in the high output ostomy pouch or wound manager generously. Make the opening diameter about 1 cm larger than the Fistula Solution device opening. Then place the pouch appliance on the landing zone.

3. Bridge the gap between the opening of the pouch appliance and the landing zone with another ostomy barrier ring. A barrier ring can be cut and applied in segments as shown in the image to the right.

Work the pouch appliance into the barrier rings. Have the patient lay quietly for 30 minutes or more to allow the pieces to warm up and adhere to each other.

These technique tips can help stop leaks from happening at the interface of the pouch appliance and Fistula Solution device, and ensure all effluent goes into the pouch where it belongs.

Protect Perineal Burns and Wounds without a Diverting Ostomy

A common mitigation approach to fecal contamination of perineal wounds and skin grafts is to create an ileostomy or colostomy. However, the Fistula Funnel can be paired with standard fecal management systems to isolate burns and wounds to the perineum without surgical redirection of the fecal stream.

This illustration depicts how the Fistula Funnel can be employed to isolate a fecal management system. The "how-to" steps to assemble the devices follow.

Click here to see a video that demonstrates this technique.

1. Tailor the Fistula Funnel and create a skirt by cutting along the scribe line. The skirt is intended to seal and protect the perineum from fecal management system leakage.

2. Disinfect the Fistula Funnel with skin or wound cleaning solution, then pull the fecal management system through the Fistula Funnel opening.

3. Apply dressings to Fistula Funnel, ensuring the skirt around the base of the Fistula Funnel opening faces toward the anus.

4. Apply an ostomy barrier ring to the base of Fistula Funnel to help form a seal between the skin and the device.

Compress the prepared Fistula Funnel against the skin around the fecal management drain to seal and protect the perineum.

Stabilize PEG Tubes and Wound Drains to Reduce Insertion Site Leakage

Gastric fluid leakage or wound drainage around medical tubes is an unfortunate occurrence. The leaked fluid can cause skin irritation, infection, reduced healing times, and general patient discomfort. Leakage often occurs because patient movement rubs the tube against the insertion site and widens the incision over time

The Fistula Funnel can be used to stabilize tubes and reduce tube friction on the insertion site. The "how-to" steps follow.

1. As shown, place the bottom half of the Fistula Funnel around the tube prior to tube placement if possible.

If the tube is already in place, tailor the Fistula Funnel by cutting as indicated by the dotted line so it can be placed around the tube.

2. Place a contact layer followed by a flat ostomy barrier ring on the perimeter skin. Notch the flange to allow the device to flex, then place it around the tube so that the notched flange rests on the ostomy barrier ring.

3. Fasten the Fistula Funnel to the patient by placing adhesive strips on top of the base flange. Use zip ties or tape to fasten the Fistula Funnel to the tube. The stabilized tube should stand perpendicular to the patient's body.

This technique can stabilize PEG tubes and wound drains in order to reduce tube rubbing on the insertion site and mitigate incision widening. The Fistula Funnel and companion dressings can also help seal and protect the skin from leakage when applied as shown.