Buttocks Skin Graft Protection Strategies???

UMichSCN07 · Jan 26, 2022

Honestly, I’ve never found an acceptable solution short of advocating for a diverting colostomy and/or lots of prone positioning. FMS’s leak and can cause pressure/shearing. Same for “butt bags,” which can also sometimes make a bigger mess than not using one. Using chux to make “poop pants” keep the grafts/dressings too wet and can be a bigger mess too.

marienm, RN, CCRN · Jan 28, 2022

Agree with both of you. Apart from a diverting colostomy, the most helpful thing we've used is metamucil TID. You want that stuff to come out like formed jello! Our normal bowel regimen is colace/senna/miralax/lactulose which usually do get things moving but as soon as the pt starts having loose stool (especially when they are getting tube feeding, like most of them are), I push for metamucil instead. Dissolve it well so it doesn't clog the feeding tube.

Prone or hard side-lying positioning does help for reducing moisture overall, though, and can be good pulmonary hygeine as long as the patient tolerates it and is on a mattress that relieves pressure on the hip trochanters.

Check with your burn surgeon, but we do remove dressings that are soiled, even though our post-graft dressings would usually stay in place for 2-3 days before the first dressing change. If we have to remove part of the dressing, I replace it with 12x12 burn gauze on each cheek, loosely secured with netting, so that when it gets soiled again we can remove it easily. I think it's better to removed the soiled material (even though that disturbs the graft) versus leaving it in place. Your surgeon might have a different preference, though.