Stomal Wounds

T.C. asks, "How do wounds around the stoma occur; and when they do, how should they be treated?"

Answer: Stomal erosion occurs as a result of either inward or outward traction against the tracheostomy tube. Outward traction is exacerbated with the use of added weight within the ventilator circuit, such as in-line suction systems, filters, and heat moisture exchangers. This outward traction can pull against the stoma enough to pull out the tube and can widen the stoma from the inside.

Measures to correct this outward traction include removing the added weight from the ventilator circuit and adequately supporting the ventilator circuit.

Inward traction occurs when the flange of the tracheostomy tube digs into the skin of the neck. This often begins during the first postoperative week when the tube is sutured securely to the neck and with a tube that has a hinged flange. Inward traction is best prevented by ensuring that the neck flange remains in a neutral position and by padding the stoma area with drain sponges, which also will collect secretions.

Stomal wounds can be challenging to manage, especially when they become infected.  It is often necessary to apply a packing, and debridement may be necessary to allow the wound to heal.