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fecal diversion for pressure ulcers

Patricia Conley, David McKinsey, Olwyn Ross, Anthony Ramsey, Jennifer Feeback
BACKGROUND: Incontinence-associated dermatitis (IAD) is a potentially serious skin injury that can lead to pressure ulcers (PUs). Multiple studies have indicated the need for evidence to find the most effective skin care protocol to reduce the incidence and severity of IAD in critically ill patients. OBJECTIVE: To compare the incidence and severity of IAD in two groups on a progressive care unit (PCU) using a defined skin care protocol: cleaning with a gentle cleanser and moisturizer, then applying a skin protectant/barrier...
December 2014: Nursing
Mikel Gray
Incontinence-associated dermatitis (IAD), sometimes referred to as perineal dermatitis, is an inflammation of the skin associated with exposure to urine or stool. Elderly adults, and especially those in long-term care facilities, are at risk for urinary or fecal incontinence and IAD. Traditionally, IAD has received little attention as a distinct disorder, and it is sometimes confused with stage I or II pressure ulcers. However, a modest but growing body of research is beginning to provide insights into the epidemiology, etiology, and pathophysiology of IAD...
2010: American Journal of Clinical Dermatology
Carlton C Barnett, Jamil Ahmad, Jeffrey E Janis, Joshua A Lemmon, Kevin C Morrill, Robert N McClelland
Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord, as well as creation of conduits for diversion of the urinary and fecal streams. A review of the literature reveals that the surgical technique has been relatively unchanged since 1960. The standard anterior to posterior approach is associated with significant blood loss and morbidity, likely contributing to lengthy hospital stay...
December 2008: American Journal of Surgery
Barbara Hocevar, Mikel Gray
BACKGROUND: Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence...
March 2008: Journal of Wound, Ostomy, and Continence Nursing
Claire Z Kalpakjian, William M Scelza, Martin B Forchheimer, Loren L Toussaint
BACKGROUND/OBJECTIVE: Although the impact of secondary conditions after spinal cord injury (SCI) on health, well being, and financial burden have been studied, there are psychometrically sound scales of secondary conditions in the extant literature. The use of such scales allows for cross-sample comparison of secondary condition prevalence rates and associations with functional, medical, and psychosocial factors. Thus, the purpose of this study was to evaluate the preliminary reliability of a SCI secondary conditions scale...
2007: Journal of Spinal Cord Medicine
Chikashi Shibata, Yuji Funayama, Kouhei Fukushima, Ken-ichi Takahashi, Fumito Saijo, Munenori Nagao, Sho Haneda, Kazuhiro Watanabe, Katsuyoshi Kudoh, Atsushi Kohyama, Iwao Sasaki
The aim was to study determinants of postoperative bowel function after restorative proctocolectomy for ulcerative colitis. Medical records of patients who underwent proctocolectomy with ileal J pouch-anal anastomosis (IPAA) in two- or three-stage operations and whose status of defecation was known via a questionnaire were retrospectively reviewed. Bowel function, including stool frequency, stool consistency, and degree of nighttime soiling, was correlated with age at the time of surgery, time after ileostomy closure, mean resting anal pressure, longitudinal length of ileal J pouch, and duration of fecal diversion by using univariate and multivariate analyses...
July 2006: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Sebastian G de la Fuente, L Scott Levin, James D Reynolds, Carmen Olivares, Theodore N Pappas, Kirk A Ludwig, Christopher R Mantyh
PURPOSE: Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not. METHODS: A retrospective review was performed on all disabled patients who underwent surgery for medically intractable pressure ulcer from 1993 to 2001...
November 2003: Diseases of the Colon and Rectum
Rita Ayyangar
Health and health-related needs of children with disabilities are very broad in scope, and it is impossible to adequately cover all aspects in a single article. This article has tried, however, to highlight the issues common to disability, and lay the groundwork for the development of health maintenance guidelines for this population. The prevalence of childhood disability is on the rise, yet life expectancies are improving, and it is not uncommon for children even with severe disabilities to live well into adulthood...
November 2002: Physical Medicine and Rehabilitation Clinics of North America
G R Deshmukh, D C Barkel, D Sevo, P Hergenroeder
PURPOSE: The purpose of this study is to evaluate the effectiveness of colostomy performed as an adjunct measure in the attempt to heal pressure ulcers by flap closure. METHODS: Twenty-seven consecutive patients who underwent colostomy for healing of pressure ulcers were studied by chart review and patient questionnaire. Fecal diversion was accomplished by colostomy in each case. RESULTS: There were four (15 percent) deaths. Twenty-three patients subsequently underwent flap closure of their ulcer...
July 1996: Diseases of the Colon and Rectum
R J Staniunas, J O Keck, T Counihan, P Marcello, R C Barrett, M Oster, P L Roberts, D J Schoetz, J J Murray, M C Veidenheimer
PURPOSE: Our aim was to determine manometric status and functional outcome of the ileoanal pouch procedure in a subset of patients with defunctionalized anal sphincters as a result of long-term fecal diversion. METHODS: The anal manometric profiles of 12 patients defunctionalized for one year or more were compared with 26 patients with nondefunctionalized anal sphincters. Functional data were obtained from the Lahey Clinic Ileoanal Pouch Registry. RESULTS: Preoperative manometric data revealed a mean resting pressure of 91...
May 1995: Diseases of the Colon and Rectum
T C Stelly, J W McNeil, S R Snypes, W O Thomas, C B Rodning
Intractable decubitus ulcers and femoropelvic osteomyelitis are rare sequelae of paraplegia. Therapy for these conditions ranges from the simple to the complex, including wound debridement and care, alimentary and urinary tract diversion, hip disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting sepsis; marasmus; hip and knee flexion contractures; suppurative sacral and femoropelvic decubitus ulcers, exposed bone, and osteomyelitis; and fecal and urinary incontinence...
1995: Clinical Anatomy
D Doughty
Enterostomal therapy (ET) nurses specialize in the management of patients with urinary and fecal diversions, draining wounds and fistulas, fecal and urinary incontinence, and chronic wounds such as pressure ulcers and vascular ulcers. ET nurses have much to offer in the management of patients with cancer. Such nurses play a major role in the rehabilitation of patients undergoing fecal or urinary diversions. Preoperative services include: counseling regarding planned surgical procedure, the impact of an ostomy on the patient's life, and the basics of ostomy management; sexual counseling; and stoma site selection...
September 1, 1992: Cancer
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