Authors (including presenting author) :
Li YS , Tseng Y , Wong H C, Kan W Y, Yeung C Y
Affiliation :
Wound Care Team, POK OI Hospital
Keyword 1: :
Mucocutaneous separation
Keyword 2: :
Barrier powder
Keyword 3: :
Non surgical intervention
Introduction :
Mucocutaneous separation is an early ostomy complication, characterized by breakdown of the sutured junction between the stoma mucosa and peristomal skin, and has been reported in approximately 3–25% of ostomy patients. This complication frequently results in pain, appliance leakage, and difficulties in maintaining a secure pouching system due to premature wound dehiscence and impaired healing. Peristomal assessment is commonly undertaken using structured instruments such as the Ostomy Skin Tool, which facilitate standardized evaluation and monitoring of peristomal skin complications over time. Conventional management typically includes moist wound dressings (hydrogel, hydrocolloid, or alginate), absorptive cavity fillers for exudative wounds, and pectin-based stoma powder for shallow separations. However, empirical evidence supporting the effectiveness of these approaches remains limited, underscoring the importance of evidence-based, nurse-led interventions in this area. In the presence of overt infection, with pronounced peristomal erythema, exudate, and local signs of inflammation, these traditional measures may be insufficient to control bacterial burden and support timely granulation. Iodosorb Powder®, a cadexomer iodine formulation, provides sustained iodine release, reduces local bacterial load, absorbs exudate and debris, and promotes a moist wound environment conducive to healing. On this basis, a 1:1 “mixture powder” of Iodosorb Powder® and pectin-based stoma powder was introduced for application into the mucocutaneous gap, aiming to achieve complete healing of infected mucocutaneous separation without recourse to surgical revision.
Objectives :
1. To reduce the bacterial load within the infected mucocutaneous gap, stabilize the pouching system, and facilitate granulation tissue formation in conjunction with systemic or topical antimicrobial therapy. 2. To alleviate the patient’s pain, decrease the incidence of pouch leakage, and achieve resolution of mucocutaneous separation. 3. To optimize pouch adhesion and thereby improve patients’ overall health-related quality of life.
Methodology :
A total of 62 ostomy patients presenting with clinically infected mucocutaneous separation were managed using the 1:1 mixture of Iodosorb Powder® and pectin-based stoma powder between January 2024 and June 2025. Following cleansing of the peristomal area with 0.05% Chlorhexidine Gluconate (Cedium), the mixture powder was gently packed into the separation defect, after which a stomahesive wafer and an appropriately sized pouching baseplate were applied to ensure accurate fit and seal. The pouching system was replaced once daily for each patient throughout the treatment period, with ongoing assessment of wound status, symptom relief, and appliance performance.
Result & Outcome :
Application of the 1:1 mixture powder (Iodosorb Powder® and pectin-based stoma powder) yielded uniformly positive wound healing outcomes across all 62 cases. Mucocutaneous separation resolved completely, with granulation tissue fully replacing the defect and infection rates markedly diminished within one week. Clinical signs of infection, including erythema and exudate, abated within 7 days in every instance, culminating in mucocutaneous closure without surgical intervention. Discussion This conservative regimen underscores the mixture's efficacy in fostering secondary intention healing for infected mucocutaneous separations. It harnesses Iodosorb's antimicrobial debridement and sustained iodine release alongside pectin powder's exudate absorption and protective barrier function, thereby surmounting the shortcomings of conventional barrier powders in managing infected peristomal wounds. Conclusion Prospective controlled studies are warranted to corroborate these observations, elucidating optimal formulation ratios, long-term recurrence profiles, and pharmacoeconomic considerations to facilitate incorporation of this therapeutic admixture into evidence-based ostomy care guidelines.
