Peristomal skin care after total laryngectomy
Reducing irritation and preventing medical adhesive related injuries in people with total laryngectomy.
This content has been adapted from the Atos Medical whitepaper “Atos Medical, Whitepaper: Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation” (2023), which serves as the original source for this blog.
Skin care is one of the most important aspects of reducing laryngectomy-related skin conditions associated with wearing an adhesive and promoting consistent Heat and Moisture Exchanger (HME) usage. In this article, we will outline the importance of good skin care, common adhesive-related skin injuries, patients that are at risk, and how to prevent adhesive-related skin injuries.
Why is skin care important for people with laryngectomy?
Healthy peristomal skin forms the foundation for adherent HME use and an airtight seal for efficient tracheoesophageal speech. Peristomal skincare helps to minimize skin irritation and medical adhesive-related skin injuries (MARSI).
Common medical adhesive-related skin injuries
The most common medical adhesive-related skin injuries in total laryngectomy patients are skin stripping and irritant contact dermatitis.
- Skin stripping is trauma that can occur after removing an adhesive incorrectly where one or more layers of the stratum corneum is removed. (1,2,3)
- Irritant contact dermatitis is an inflammatory skin response to chemical irritants that can cause dryness, scaling, cracking, redness, swelling, and increased skin permeability. Irritant contact dermatitis is non-allergic and commonly resolves shortly after the chemical exposure is cleared. (8,9)
"Skin tends to get thinner as we age. As people get older their skin becomes more fragile. And the same holds true for people who had radiotherapy at the site and people who use topical steroids that cause thinning of the skin. In addition to age, diabetes can also slow down skin regeneration and weakens the skin. Thus, people who suffer from long-term diabetes also have fragile skin and an increased risk for wound infection. In these cases, you should pay extra attention not to harm the patient by removing the adhesive with too much force or by leaving it on for too long.” (22)
Prof. Dr. Thomas Rustemeyer
Professor in dermato-allergology and occupational dermatology at the Department of Dermatology-Allergology at the Amsterdam University Medical Centers, the Netherlands.
Which laryngectomy patients are at greater risk for developing MARSI?
MARSI can affect any type of patient, but factors that can indicate a greater risk for developing MARSI are, among others:
- Age. Skin changes with aging include epidermal thinning, loss of moisture, and loss of elasticity, which makes older adults more susceptible to skin injury (1, 6). Since TL (total laryngectomy) patients are typically older, this is of particular relevance for this patient population.
- Race/ethnicity. Differences in skin structure and function among different race and ethnic groups may cause a difference in susceptibility to skin injury (7).
- Pre-existing dermatological conditions. Eczema, dermatitis, chronic exudative ulcers, epidermolysis bullosa (10, 11).
- Underlying medical conditions: Diabetes, infection, renal insufficiency, venous hypertension, peristomal varices (10, 11, 12, 13).
- Malnutrition (10,11)
- Dehydration (10,11)
Other extrinsic risk factors include: drying of the skin (for example due to harsh cleansers), prolonged exposure to moisture, certain medications (for example chemotherapy), radiation therapy, photodamage, adhesive tape removal and repeated adhesive tape application (10, 11, 14, 15, 16).
Due to the nature of their underlying condition and their typically more advanced age, many TL patients may have medical conditions such as diabetes, may suffer from malnutrition or dehydration and will most likely have been exposed to radiotherapy and/or chemotherapy (17 -19). All these factors can negatively impact their peristomal skin condition and susceptibility to MARSI.
Preventing MARSI after laryngectomy
A few of the preventable causes of MARSI and the steps you can take to mitigate them are (10, 20, 21) :
- Improper removal technique
Slowly and gently remove the adhesive starting at the finger lift tab. User Provox Adhesive Remover for easy removal. Remember to use water to remove the Night Adhesive. Remove at 180 angle and support the skin at the peel line. - Improper choice of adhesive
If possible, select the most skin-friendly option based on the patients’ skin and communication needs. Provox Life Sensitive Adhesive and Provox Life Night Adhesive are skin-friendly options. - Applying with tension
Apply the tape with the neck in neutral position, do not pull or stretch the tape when applying. - Applying in wrong direction
Start from the center, around the stoma, then outwards starting with the bottom then top and sides. - Leaving non-permeable adhesives on too long
Establish a change routine that optimizes for a good and secure seal for the duration of a full day, allowing for scheduled adhesive changes at a convenient time.
Access the whitepaper Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation here for more preventable causes of MARSI and possible solutions.
"Inform the patient to take their time to remove the adhesive. If possible, in front of a mirror. Gently peel it off millimeter by millimeter. Peel it off moving sideways because this is the direction in which the skin barrier is strongest. Leave the skin open for a couple of minutes so it can rest and evaporate. Maybe even a little longer, to help the skin settle down.” (22)
Prof. Dr. Thomas Rustemeyer
The information presented should not be considered medical advice for specific conditions. A patient’s individual circumstances and preferences should always be considered, and clinical practice should be in accordance with the principles of protection, participation and partnership
Provox Life Adhesives
Provox Life Adhesives were designed and developed taking into consideration the findings from the ethnographic and market research conducted by Atos Medical, scientific literature, and utilizing the most recent and advanced adhesive material technologies.
They all feature SecureFit technology, which gives an audible click to confirm that the HME is securely in place in front of the tracheostoma. Provox Life offers four adhesives: Sensitive, Night, Standard, and Stability, for different situations, skin types, and stoma contours.
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REFERENCES
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quiz E1-2.
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14 Frota OP, Pinho JdN, Ferreira-Júnior MA, Sarti ECFB, Paula FMd, Ferreira DN. Incidence and risk factors for medical adhesiverelated skin injury in catheters of critically ill patients – A prospective cohort study. medRxiv. 2022.
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17 Filimonov A, Brady JS, Govindan A, Merchant A, Eloy JA, Baredes S, et al. Postoperative complications of total laryngectomy in diabetic patients. Laryngoscope. 2017;127(10):2247-51.
18 Graboyes EM, Yang Z, Kallogjeri D, Diaz JA, Nussenbaum B. Patients undergoing total laryngectomy: an at-risk population for 30-day unplanned readmission. JAMA Otolaryngol Head Neck Surg. 2014;140(12):1157-65.
19 Nyszczy A. Total Laryngectomy Surgery in the United States and Spain: A Tale of Two Healthcare Systems: Williams Honors College, Honors Research Projects; 2019.
20 Bryant R. Types of skin damage and differential diagnosis. In: Mosby E, editor. Acute & Chronic Wounds: Current Management Concepts. 4th ed. 2012. p. 83-107.
21 Bryant RA. Saving the skin from tape injuries. The American journal of nursing. 1988;88(2):189-91.
22 Rustemeyer T. Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation. Atos Medical; 2023. p. 22.
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