Buttocks Skin Graft Protection Strategies???

Specialties Burn

Published

Specializes in Burns.

I've seen multiple burn patients with burns to their buttocks/rectal areas requiring skin grafting. What are your strategies for protecting dressings/grafts in that area if the patient is either incontinent of stool or has a leaky fecal management system? Stool infiltrating fresh grafts/dressings seems to be a common problem on our unit that results in frequent graft failure.

Specializes in Trauma/Burn ICU.

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. 

Specializes in Burn, ICU.

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.

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