WoundReference improves clinical decisions
 Choose the role that best describes you
We have a pt that has had a colyectomy and has setons X 2 in his rectal area. Pt has constant drainage. His skin in the gluteal clave and rectal area is horrible. We have tried ABX, topical and oral antifungals, 3M advance skin protectant , calmosceptine. Any ideas?
Jan 23, 2019 by Kim Harris, Nurse Manager Wound Care & HBO
8 replies
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Hi Kim thank you for your question. Can I clarify if the patient has had a total colectomy with end ileostomy or if he still has a rectal vault that drains mucous? Are the setons due to fistulas?
Jan 23, 2019
Kim Harris
Nurse Manager Wound Care & HBO
Pt had a complete colectomy with creation of a J pouch in 2013. Yes the setons are for fistulas. I'm unsure about the rectal vault, but something is draining.
Jan 23, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Thank you for the clarification, Kim. Are the BMs loose, frequent or other? Does he have drainage on his clothing that he can describe? Does he use any type of wipes or other products to clean himself? How does he bathe/what type of peri cleanser is he using? Is he chairbound/bedbound? Is he obese? When was his last follow up with the surgeon that places the setons for his fistulas? Does he rely on a caregiver to perform hygiene or is he independent?

Sorry for all the questions, just helps to give accurate recommendations.
Jan 23, 2019
Kim Harris
Nurse Manager Wound Care & HBO
No problem about all the questions! He has frequent loose stools, they are acidic. I'm not sure of any products to clean or what peri wound cleanser he uses. He is mobile and is slightly obese. He followed up with his surgeon 2 months ago and they placed another seton. He can do most of his care but, does have a wonderful wife to help if he needs it.
Jan 24, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Thank you. That’s great that he had a good support/assistance system. Do you know if his surgeon that performed his colectomy/jpouch has given him resources for appropriate diet? Patient with a jpouch essentially have to follow an ileostomy style diet, such as the one described on page 3 of this publication by Cleveland clinic: https://my.clevelandclinic.org/ccf/media/files/Digestive_Disease/HealthyPouch_Spring_2009.pdf. If his skin breakdown is associated with dietary issues causing acidic frequent loose stools/expose to bike acid salts, this may help from an education and lifestyle standpoint. I would follow the guidelines for MASD/IAD and have him utilize an appropriate cleanser and barrier each time he toilets. Does he use wet wipes frequently? These can also contribute to excess moisture and superimposed fungal issues if the area is not dried appropriately after use. If he is using a harsh cleanser such as antibacterial soap, this can also contribute to irritation in the gluteal cleft/perirectal area.
Jan 24, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
https://www.nursingcenter.com/journalarticle?Article_ID=1346150&Journal_ID=448075&Issue_ID=1345760

This article from the WOCN Journal includes a treatment tool in chart form for MASD/IAD.
Jan 24, 2019
Kim Harris
Nurse Manager Wound Care & HBO
Thank you so much!
Jan 24, 2019
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Hi Kim, how has this patient been doing? Any updates? Thank you :)
Feb 14, 2019
* Info provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional.