Surgery News - March 2008 - (Page 14) 14 ACROSS SPECIALTIES SURGERY NEWS • M A R C H 2 0 0 8 Botulinum Toxin A Seals Leaky Stoma Appliance Injections of botulinum toxin around this abdominal stoma reduced perspiration that was preventing skin from adhering to the stoma appliance. COURTESY DR. SAADIA LAKHANY RAZA BY BRUCE K. DIXON Else vier Global Medical Ne ws C H I C A G O — Thanks to a dermatologist’s clinical ingenuity in the use of botulinum toxin A, a young girl with a mysteriously quirky abdominal colostomy appliance is once again able to lead a relatively normal life. “This was a 6-year-old girl with a his- SAVE THE DATE! THE AMERICAN COLLEGE OF SURGEONS AT THE SOUTHWESTERN SURGICAL CONGRESS MONDAY, MARCH 31, 2008 8:00 AM–12:00 NOON Opening Remarks Alan G. Thorson, MD, FACS; Gerald B. Healy, MD, FACS Panel: What’s New at the ACS Moderator: Gerald B. Healy, MD, FACS Panelists: L. D. Britt, MD, MPH, FACS Josef E. Fischer, MD, FACS Thomas R. Russell, MD, FACS An exhibit will be presented at the time of the Southwestern Surgical Congress demonstrating the new educational programs and products of ACS that are specially designed to help practicing surgeons meet MOC requirements. Panel: What Practicing Surgeons Need to Know About Maintenance of Certification and How the American College of Surgeons Can Help Moderator: Barbara L. Bass, MD, FACS Panelists: Ajit K. Sachdeva, MD, FACS, FRCSC Russell G. Postier, MD, FACS Southwestern Surgical Congress MARCH 30–APRIL 2, 2008 Fairmont Princess Acapulco, Mexico To register, visit www.swscongress.org or call 913/402-7102 F O R M O R E I N F O R M AT I O N , contact Julie Tribe, MSEd, Senior Manager, Educational Programs, Division of Education, at jtribe@facs.org or 312/202-5433. FOR INFORMATION ON ACS, visit www.facs.org or call 800/621-4111. tory of cloacal exstrophy that had resulted in ileostomy, vesicostomy, and the creation of a right lower quadrant colostomy, Dr. Saadia Lakhany Raza said at the annual meeting of the American Society for Dermatologic Surgery. The girl presented with a chronic inability to maintain an effective seal between the stoma appliance and the skin, causing leaks of intestinal matter, multiple daily detachments of the colostomy appliance, and a rapidly deteriorating quality of life, said Dr. Raza, of the department of dermatology at Washington University, St. Louis. Stoma appliance failure can have multiple causes, including incorrect sizing, poor placement on the abdomen, skin folds caused by obesity, scarring from additional surgery, incorrect appliance application by the patient, irritation from intestinal fluids, eczema, and psoriasis, Dr. Raza said. “Initially, not knowing what to do, I referred the girl to a pediatric surgeon for evaluation and a possible long-term solution. [Because of] underdevelopment of her pelvic floor, she didn’t have enough musculature to make her a candidate for a permanent stoma takedown,” Dr. Raza said. The girl’s mother believed that the problem was caused by sweating around the stoma, but the pediatric surgeon stated that sweating was not an issue and the girl was referred to the Washington University stoma clinic. There, nurses concluded that yes, perspiration appeared to be the culprit. Botulinum toxin A has proven to be effective against hyperhidrosis, but its use to control normal perspiration around abdominal stomas to enhance adhesion of colostomy appliances had not been previously reported in the medical literature, Dr. Raza said. After being informed that the procedure had never been tried before under those circumstances, the mother gave her consent to proceed. After a starch-iodine test and meticulous cleaning of the peristomal skin with Betadine and 70% isopropyl alcohol, Dr. Raza delivered 20 U of botulinum toxin A at 10 sites around the stoma using a 30-gauge needle. The stoma area was recleaned and the wafer and bag were reapplied. “The patient noticed improvement within 10 days of treatment, and the results lasted through the summer,” she said, adding that the appliance now needs to be changed once every 3 days instead of three times a day and she no longer has to go to the school nurse’s office. “We learned that sweating contributing to the failure of the stoma wafer is an underrecognized problem by involved providers. In addition to controlling hyperhidrosis, botulinum toxin A can decrease normal perspiration,” she said. The patient, who is now 8 years old, continues to receive treatment at the university, Dr. Raza said, but she “is now able to ride the school bus with her classmates, and the family is planning their first vacation together.” ■ http://www.swscongress.org http://www.swscongress.org http://www.facs.org
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