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Diverting Ostomy Practices in Burn Surgeons Treating Full-Thickness Perianal Injuries.
Annie Cate Schmidt1, Anne Seyferth1, Michelle Hughes2
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, United States.
Summary
Diverting ostomy is rarely used for perianal burn injuries by burn surgeons. Most surgeons manage these challenging wounds with non-surgical alternatives and appropriate critical care, achieving good outcomes without fecal diversion.
Area of Science:
- Surgery
- Burn Management
- Wound Care
Background:
- Perianal burns present unique management challenges including tissue complexity, contamination, and stress.
- Fecal diversion via ostomy is considered for wound healing but carries risks like ileus and fistula.
Purpose of the Study:
- To ascertain burn surgeons' perspectives on using diverting ostomy for perianal burn injuries.
- To evaluate current practices among burn center directors in the Northeast Region of the American Burn Association (ABA).
Main Methods:
- A survey was distributed to 12 burn center directors in the ABA Northeast Region.
- 11 out of 12 (92% response rate) physicians responded regarding their practices for full-thickness perianal burns requiring skin grafts.
Main Results:
- Over half (54.5%) of surveyed surgeons reported 'Never' performing a diverting ostomy for these injuries.
- The remaining surgeons perform diverting ostomies 'Rarely' (<10%), typically for associated intra-anal or anorectal trauma.
Conclusions:
- Diverting ostomy is an uncommon practice for managing full-thickness perianal burns.
- Effective wound and critical care management can lead to good outcomes without ostomy.
- Non-surgical fecal diversion alternatives are frequently employed by specialists.
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