With the aim of supporting nurses who manage patients with stomal mucocutaneous separation（SMS）, we developed a trial version of an SMS care algorithm（trial version）consisting of a wound management and stomal appliance selection algorithm. The trial version was revised after testing with randomly-selected WOC nurses using pictures of several SMS cases. In the second, revised version, the option of a moderate amount of exudates was deleted from the wound management algorithm, and the height of the stoma was added to the stomal appliance selection algorithm. Version 2 was again tested with randomly-selected WOC nurses using pictures of several SMS cases and further revised（version 3）. In version 3 the depth of the wound cavity was clearly defined as 5 mm in the wound management algorithm, and some explanatory notes were added to the stomal appliance selection algorithm. Herein we present an overview of the development and revision of the SMS care algorithm for nurses practicing SMS care to promote wound healing and stomal rehabilitation. Further study in a clinical setting is needed.
The purpose of this study was to clarify the risk factors for skin disorders that develop at the margins of dressings applied to surgical wounds. Twenty-six patients who underwent respiratory tract surgery in the lateral position were included. The shear force and thickness of adipose tissue in the midaxillary line were assessed preoperatively. In the postoperative period, the absence or presence of perspiration and heat was recorded. Skin disorders（erythemas or blisters）were visually monitored for up to seven days after surgery by one certified nurse. Of 21 patients who were evaluated, skin disorders developed in ten. A comparison of patients who developed skin disorders and those who did not demonstrated a significant difference in the shear force in the midaxillary line at nipple height and in the body mass index（BMI）with a cut-off level of 28.5 mm and 23.4 kg/m2，respectively. Logistic regression analysis only demonstrated a significant difference in the shear force at the midaxillary line at nipple height. BMI and shear force were found to be risk factors for skin disorders developing at the margins of dressings applied to surgical wounds in respiratory surgical patients.