Diverting Ostomy Practices in Burn Surgeons Treating Full-Thickness Perianal Injuries

Burns to the perianal region pose specific challenges in management due to the complex structure of the surrounding tissue, bacterial contamination, and repetitive stress. Fecal diversion via diverting ostomy may be elected in these injuries because of its potential to enhance wound healing and skin graft adherence; however, its use introduces alternative risks such as prolonged ileus, fistula, leakage, and failure of reversal. This study aimed to determine the perspectives of burn surgeons regarding the use of diverting ostomy for perianal burn injuries. We conducted a survey of 12 physicians who are burn center directors in the Northeast Region of the American Burn Association regarding their practices for patients with full-thickness perianal burn injuries requiring a skin graft. Response rate was 11/12 (92%). Six individuals (54.5%) reported "Never (0%)" to performing a diverting ostomy in this context; the remaining 5 individuals responded "Rarely (<10%)." Reasons stated for performing a diverting ostomy in the "Rarely" group included cases where the patient suffered an intra-anal or anorectal injury. These results were summarized with a relevant review of the literature and experience in our clinical practice. Our findings indicate that diverting ostomy is a relatively uncommon practice for burn surgeons treating full-thickness buttocks injuries. With appropriate wound care and critical care management, good outcomes can be obtained without the need for diverting ostomy. Non-surgical alternatives to fecal diversion are commonly used by burn specialists and should be considered in perianal burn injuries.