Volume 46 Number 1 Supplement
From theory to bedside: applying convex ostomy principles in clinical care
Natasha Rolls, Florian Spahn, Rachael Berger, Jose Manuel Roman Marin, Rasmus Lundgaard,
Agnieszka Bochynska, Anne Steen Hansen
Keywords clinical practice, parameters of convexity, flexible adhesive, patient-centricity, soft convex
For referencing Rolls N, et al. From theory to bedside: applying convex ostomy principles in clinical care . WCET™ Journal Supplement. 2026;46(1)Sup:s8-12.
DOI 10.33235/wcet.46.1.sup.s8-12
Abstract
Introduction Convex ostomy baseplates are designed to help minimise the risk of leakage and support the maintenance of peristomal skin health. Their performance is defined by five key characteristics: depth, slope, tension location, compressibility and flexibility. The adhesive component further plays a role in ensuring a secure and comfortable seal.
Aim The aim is to translate technical parameters that define convexity into practical clinical guidance, illustrating how these characteristics inform product selection and support optimal patient outcomes.
Methods This article synthesises current evidence and definitions of convexity parameters and integrates them with clinical reflections from two experienced stoma care nurses. Two real-world clinical cases are presented to demonstrate the practical application of convexity principles in postoperative stoma management.
Results Across the two cases, clinicians applied the five convexity parameters together with adhesive considerations to address challenges such as uneven abdominal contours, firm or bending abdominal walls, peristomal folds, mucocutaneous dehiscence and risks of leakage. In both scenarios, tailored convex product selection supported secure sealing and protected peristomal skin.
Conclusion Understanding the clinical relevance of convexity characteristics and adhesive performance is essential for effective product selection in stoma care. Individualised product selection based on patient-specific needs enables clinicians to optimise fit, maintain peristomal skin health and improve clinical outcomes.
Introduction
Leakage remains one of the most prevalent and distressing complications following ostomy surgery, often leading to peristomal skin complications, discomfort and negatively affected quality of life1-3. Convex skin barriers were specifically developed to address anatomical and topographical challenges around the stoma, which may be difficult to manage effectively when using flat baseplates.4,5,6 The function of convexity is to:
- flatten irregular peristomal contours;
- apply mechanical tension to the peristomal skin; and
- elevate the stoma above skin level7-8.
Historically, nurses have primarily recommended using convex ostomy products for patients experiencing leakage and peristomal skin complications—as a solution to these issues. Early post-operative use of convexity was often discouraged due to concerns about mucocutaneous separation (dehiscence) and other complications.9,10 However, subsequent clinical research has demonstrated that it is safe to apply convex devices even in the immediate post-operative period when clinically indicated.11 With growing evidence, clinical guidelines and practices have evolved.5,6 Now, more clinicians recognise that convex products are not only safe but can offer significant benefits in the post-operative period. As convex products facilitate immediate and consistent contact between the ostomy appliance and the peristomal skin, they may help to improve the reliability of the seal and reduce the risk of leakage, particularly for poorly spouted stomas.12,13
The aim of this article is to translate the technical parameters that define convexity—depth, slope, tension location, compressibility and flexibility—into practical guidance for clinical decision-making. In addition to exploring these five core convexity characteristics, the adhesive is highlighted as a critical component of any ostomy baseplate in achieving a secure, reliable seal. Finally, two clinical cases demonstrate how stoma care specialists apply these principles in daily practice; aligning product features with individual anatomical and clinical needs to prevent leakage and optimise patient outcomes.
Five parameters of convexity
In recent years, the industry has worked to standardise the description of convex baseplate features to help clinicians make informed product selections and allow for evidence-based comparisons across brands and patient groups.14 The five fundamental characteristics—depth, slope, tension location, compressibility and flexibility—have been defined and published as a basis for this framework.14-16 In Table 1, we briefly present the definition of each parameter and provide considerations for clinical practice.
Table 1. Five parameters of convexity and their clinical relevance14,17.
The adhesive component
While the mechanical parameters of convexity have been widely discussed in literature,14-16 the adhesive is an equally critical factor when it comes to ensuring a secure seal and reducing the risk of leakage. Ostomy adhesives belong to the class of pressure-sensitive adhesives (PSAs), which develop immediate adhesion under light pressure. Their role extends beyond fixation in that the adhesive helps to:
- support the pouch;
- protect peristomal skin from effluent exposure; and
- ensure a predictable wear time.
Their key attributes include secure sealing, moisture absorption, resistance to effluent erosion and ease of removal when needed.18 In convex products, the combination of an appropriate adhesive and a well-designed convex shell is essential to ensure both immediate skin contact and long-term wear performance. Table 2 contains a summary of the key adhesive performance factors relevant to convex systems.
Table 2. Key adhesive performance factors for ostomy (convex) products and their clinical relevance during the cycle of product application, wear time and removal.
When applying the product onto the skin, convexity helps to achieve consistent contact by projecting into the peristomal skin and applying gentle tension, which flattens creases and enhances adhesive engagement. To illustrate this, we conducted a computational simulation comparing the application with four fingers of one-piece SenSura® Mio products: a light convex and a flat baseplate, (Figure 1), (technical details of the conducted simulation can be found in the appendix to this article, available online). The visualisation demonstrates that when a flat product is applied, initial contact occurs primarily under the fingertips, creating localised pressure points. The product then needs to be smoothed out to make sure it has uniform contact with the skin. By contrast, the convex product distributes pressure more evenly across the baseplate during application, promoting immediate and uniform skin contact. This feature can be particularly beneficial for individuals with limited dexterity or reduced visibility.
Figure 1. Computational simulation of pressure distribution during the application of an ostomy baseplate with four fingers on the skin (The red circle in the middle represents the stoma).
a) When applying the convex product, the pressure is distributed evenly around the stoma promoting immediate skin contact.
b) When applying the flat product, pressure is localised under the fingertips during immediate application, requiring additional manual smoothing to achieve uniform contact and a secure seal.
Once the product is in place, the adhesive must work with the elastic convex shell to maintain seal integrity during dynamic movements, such as bending, stretching, sitting and lying down, while offering optimal elasticity (Figure 2). This interaction ensures that the appliance remains stable without compromising comfort.
Figure 2. Example of a convex product combining flexible shell design with elastic adhesive (SenSura Mio Convex).
Application and reflections on the use of convexity in clinical practice
Two experienced stoma care specialists have contributed clinical cases to demonstrate how they have used convex ostomy products to address specific patient challenges in their daily practice. Both highlighted that selecting the right convex product requires an individualised approach, considering each patient’s unique body profile, stoma type and peristomal skin condition.
Clinical case 1: Postoperative stoma management in a patient with a complex abdominal profile
Patient profile
A 73-year-old male underwent a protective loop-ileostomy following rectal resection. After surgery, the patient experienced prolonged intervals (4–8 hours) without stoma output, followed by sudden releases of large volumes (500–800ml) of thin stool, typically after stoma digitalisation or catheter insertion. These measures were necessary to ensure the stool flow and thus to alleviate the symptoms of pain and nausea, which raised concerns about paralytic ileus or stoma torsion.
Clinical assessment
A postoperative physical examination revealed an uneven abdominal topography with deep folds, and a stoma positioned adjacent to the umbilicus. The stoma itself was at skin level, with intact sutures and healthy mucosa (Figure 3a).
Therapeutic approach and ostomy appliance selection
Given the anatomical and postoperative challenges, the healthcare professional (HCP) prioritised preventing leakage and avoiding skin complications. Although a convex baseplate would have been optimal, it was necessary to allow digitalisation and the insertion of a catheter during the long phases without stoma output, and to ensure that the subsequent high output volume was directed into the stoma bag. For this reason, the HCP chose a flat baseplate with post-operative drainable bag (equipped with the opening to access the stoma), combined with a convex hydrocolloid seal and stoma paste to level creases and folds (Figure 3b-d). The preferred long-term solution was identified as a SenSura Mio Soft Convex baseplate (Coloplast) with a drainable bag, supplemented by a hydrocolloid seal and belt. Monthly body profile checks were recommended to make sure the product continued to fit properly.
Figure 3. a) Photo of the stoma and peristomal area post‑operatively, b) Supporting products used on uneven peristomal topography: convex hydrocolloid seal to balance the flush stoma and paste to even deep folds, c) Hydrocolloid seal with paste after application on the skin, d) Initially used flat baseplate with post‑operative bag equipped with a window allowing access to the stoma (applied on the skin).
The convexity characteristics considered in this case were:
- Compressibility: A soft-convex product was selected to avoid excessive pressure on the firm abdominal wall.
- Flexibility: This was necessary to accommodate abdominal wall movements, as the stoma was located along a bending line.
- Depth: A convexity depth of 6mm was deemed sufficient.
- Slope: A wide plateau and flatter slope were preferred to compensate for peristomal folds.
- Tension location: The tension point was positioned further from the stoma to better manage creases and folds in the skin.
Follow-up
Four days after surgery, intestinal paralysis resolved, and the ileostomy began producing ‘mushy’ stool. During this period, the initial post-operative appliance maintained a secure seal, and there was no leakage. The appliance was then changed to a SenSura Mio one-piece Convex Soft system with stoma paste, and the use of an ostomy belt was recommended for added stability. By day 12, abdominal swelling had subsided and parastomal sutures were removed, allowing the folds to recede and eliminating the need for stoma paste. The patient adapted well to instructions in the clinic and was discharged on day 14, managing self-care independently. Transition to outpatient follow-up occurred without complications.
Healthcare professional’s reflections
The clinician emphasised the importance of individualised product selection in complex postoperative cases. The use of convexity, even in the early postoperative period, was justified by the patient’s anatomical abdominal features and the subsequent risk of leakage. The combination of a convex hydrocolloid seal and paste addressed the immediate need for a secure appliance fit, while ongoing regular assessment ensured adaptability to changes in the patient’s body profile.
The case illustrates the need for frequent assessments in the early postoperative phase to address immediate anatomical and functional challenges associated with increased risk of leaking stoma appliances. The goal was to prioritise leakage prevention and individualised product selection for a secure fit.
Clinical case 2: Postoperative stoma management in a patient with cognitive impairment
Patient profile:
A 74-year-old retired nurse underwent emergency surgery for large bowel obstruction with intra-abdominal sepsis secondary to benign diverticular disease. Preoperative stoma site marking was performed, but due to significant abdominal distention and intra-abdominal inflammation, the loop trephine colostomy was located higher than planned, in the epigastric region, under the left breast.
Clinical assessment:
The patient showed signs of impaired cognition and was being cared for by family members. After surgery, the stoma was flush with the skin. There was immediate mucocutaneous dehiscence on the lateral side, along with induration and erythema radiating toward the left ribs. Within 48 hours, a large, ulcerated area developed, progressing to dehiscence at the mucocutaneous junction, forming a cavity (Figure 4a). Initial concerns included possible fistula formation, which was excluded. There was a risk of faecal contamination of the cavity, pain from effluent contact with the skin and septic complications.
Figure 4. a) Stoma site 48-hours post-surgery, visible mucocutaneous dehiscence and ulceration around the stoma, b) Stoma site at the follow-up visit, cavity had resolved and peristomal skin had improved.
Therapeutic approach and ostomy appliance selection
Initial management included insertion of a gelling fibre wick (Aquacel, ConvaTec) to soak slough and wound exudate away from the cavity and into the bag and protective thin, hydrocolloid seals, placed in one layer circumferentially around the stoma up to the mucocutaneous junction, to provide a levelling effect, with further seals, placed at the lateral edge to provide levelling, and to ensure extra absorptive element to cope with exudate and keep the area intact until next pouch change.
Despite theoretical concerns about convexity on compromised peristomal skin, a SenSura Mio one-piece Convex Soft (Coloplast) with drainable bag was applied to capture effluent and prevent leakage into the wound. This decision was based on clinical experience and the need to maintain a secure seal while protecting vulnerable tissue. Family involvement was structured: caregivers were reassured that complex wound care would remain under professional supervision, while pouch changes were standardised and simplified for eventual delegation. The use of a gelling fiber wick was replaced by enzyme alginogel (Flaminal gel, Flen Health) as it was easier for the family to use. Both the wick and the gel have the same absorptive properties for soaking up exudate and wick it away from the base of the wound to allow the granulation at the base.
The convexity characteristics considered in this particular case were:
- Compressibility and flexibility Soft convexity minimised pressure and accommodated abdominal contour and wound discomfort.
- Depth and slope Adequate depth and gentle slope directed effluent into the pouch, reducing leakage risk.
- Tension location A wide plateau ensured adhesion over the dressings without compromising wound healing.
Follow-up
At follow-up two weeks post-discharge, the cavity had resolved, peristomal skin was healthy (Figure 4b), and the patient continued using a soft convex pouch with stable output in terms of volumes, consistency and regularity. Care transitioned successfully to the family members, supported by ongoing professional oversight during rehabilitation.
Healthcare professional’s reflections
Early demonstration of a manageable routine was critical to reduce family anxiety and promote confidence. Pain management (regular analgesia, pre-change dosing) and nutritional support were emphasised.
The case illustrates the importance of individualised product selection, balancing theoretical contraindications with practical needs to achieve containment of stool, protect skin integrity and support caregiver involvement.
Conclusion
A thorough understanding of the clinical relevance of convexity parameters: depth, slope, tension location, compressibility, and flexibility, is crucial for the effective use of convex products in stoma care. Equally important is the selection of a flexible adhesive, which ensures a secure seal and adapts to body movements. By combining individualised product selection with regular reassessment, clinicians can optimise comfort, protect peristomal skin, and deliver better outcomes for patients living with a stoma.
Conflict of interest
NR and FS are members of Coloplast global ostomy advisory board, however, they did not receive remuneration for contributions to this manuscript. RB, JMRM, RL, AB and ASH are employed by Coloplast A/S.
从理论到床旁：凸面造口原理的临床应用
Natasha Rolls, Florian Spahn, Rachael Berger, Jose Manuel Roman Marin, Rasmus Lundgaard,
Agnieszka Bochynska, Anne Steen Hansen
DOI: 10.33235/wcet.46.1.sup.s8-12
摘要
引言 凸面造口底盘旨在最大程度降低渗漏风险，并维护造口周围皮肤健康。其性能由五个关键特征定义：深度、坡度、张力位置、可压缩性和柔韧性。粘胶成分进一步在确保安全舒适密封方面发挥重要作用。
目的 本文旨在将定义凸面的技术参数转化为实际的临床指导，说明这些特征如何影响产品选择并支持最佳的患者结局。
方法 本文总结了当前关于凸面参数的证据和定义，并将其与两位经验丰富的造口护理护士的临床反思相结合。通过两个真实世界的临床病例，展示了凸面原理在术后造口管理中的实际应用。
结果 在两个病例中，临床医生结合考虑了五个凸面参数和粘胶因素，以应对如不平的腹部轮廓、坚硬或弯曲的腹壁、造口周围褶皱、黏膜皮肤分离及渗漏风险等挑战。在这两个场景中，量身定制的凸面底盘选择均实现了牢固密封，并保护了造口周围皮肤。
结论 理解凸面特征和粘胶性能的临床相关性对于造口护理中有效的产品选择至关重要。基于患者特定需求的个性化产品选择使临床医生能够优化贴合度、维护造口周围皮肤健康并改善临床结局。
引言
渗漏仍然是造口手术后最常见且令人困扰的并发症之一，通常会导致造口周围皮肤并发症、不适感以及生活质量的下降。1-3 凸面造口底盘是专门为解决造口周围解剖和体表轮廓问题而开发的，这些问题在使用平面底盘时可能难以有效管理。4,5,6 凸面的功能包括：
- 压平不规则的造口周围轮廓；
- 对造口周围皮肤施加机械张力；
- 使造口高出皮肤平面。7-8
历史上，护士主要建议在出现渗漏和造口周围皮肤并发症的患者中使用凸面造口产品，作为解决这些问题的方案。由于担心黏膜皮肤分离（即裂开）和其他并发症，早期术后往往不鼓励使用凸面底盘。9,10然而，随后的临床研究表明，在临床指征下，即使在术后早期也可以安全地使用凸面底盘。11随着证据的増加，临床指南和实践也得到了发展。5,6现在，更多的临床医生认识到，凸面底盘不仅安全，而且在术后阶段可以提供显著的益处。由于凸面底盘促进了造口设备与造口周围皮肤之间的即时且持续接触，它们可能有助于提高密封的可靠性，并减少渗漏风险，尤其适用于造口突出不足的情况。12,13
本文的目的是将定义凸面的技术参数Å\Å\深度、坡度、张力位置、可压缩性和柔韧性Å\Å\转化为临床决策的实际指导。除了探讨这五个核心凸面特征外，本文还强调，对于任何造口底盘而言，粘胶都是实现安全、可靠密封不可或缺的组成部分。最后，本文通过两个临床病例展示了造口护理专家如何在日常实践中应用这些原理；通过将产品特性与个体的解剖结构和临床需求相结合，防止渗漏并优化患者结局。
凸面底盘的五个参数
近年来，行业致力于标准化凸面底盘特征的描述，帮助临床医生做出明智的产品选择，并使不同品牌和患者群体之间能够进行基于证据的比较。14 这五个基本特征Å\Å\深度、坡度、张力位置、可压缩性和柔韧性Å\Å\已经被定义并发布，作为该框架的基础。14-16 在表1中，我们简要介绍了每个参数的定义，并为临床实践提供了考虑因素。
表1.凸面底盘的五个参数及其临床相关性14,17。
粘胶成分
尽管凸面底盘的机械参数已在文献中广泛讨论，14-16粘胶在确保安全密封和减少渗漏风险方面同样是一个至关重要的因素。造口粘胶属于压力敏感粘胶（PSA）类，在轻微压力下立即产生粘附作用。粘胶的作用不仅限于固定，它还帮助：
- 为造口袋提供支撑；
- 保护造口周围皮肤免受排泄物的侵害；
- 确保可预测的佩戴时间。
其关键特性包括安全密封、湿气吸收、耐排泄物侵蚀性，以及便于在更换时移除。18 在凸面底盘中，适当的粘胶与精心设计的凸面外壳的结合对于确保皮肤的即时接触和长期佩戴性能至关重要。表2总结了与凸面系统相关的关键粘胶性能因素。
表2.造口（凸面）产品的关键粘合性能要素，及其在产品应用、佩戴及移除周期中的临床相关性。
在将产品贴敷于皮肤时，凸面设计可通过对造口周围皮肤形成适度的凸出作用并施加轻柔张力，实现均匀一致的贴合，从而抚平褶皱并増强粘胶的贴附性。为了说明这一点，我们进行了一次计算机模拟，比较了采用四指按压方式贴敷的一体式SenSura® Mio产品：一个轻凸面和一个平面底盘的应用（图1）（该模拟的技术细节可参见本文的附录）。视觉化结果表明，当使用凸面底盘时，初始接触主要发生在指尖下，产生局部压力点。然后，产品需要被抚平，以确保它与皮肤均匀接触。相比之下，凸面底盘在应用过程中更均匀地分布压力，促进了皮肤的即时且均匀的贴合。这一特性对于手部灵活性受限或视力受限的个体尤为有利。
图1.使用四指按压将造口底盘贴合于皮肤时的压力分布计算仿真（中间的红色圆圈代表造口）。
a）使用凸面底盘时，压力均匀分布于造口周围，从而促进底盘与皮肤的即时贴合。
b）使用凸面底盘时，在初始贴合阶段，压力集中于指尖下方；因此，需要额外进行手动抚平操作，方能实现均匀贴合并确保密封稳固。
底盘就位后，粘胶必须与弹性凸面外壳协同工作，确保在弯曲、拉伸、坐着和躺下等动态运动中保持密封完整性，同时提供最佳的弹性（图2）。这种相互作用确保了设备在不影响舒适度的情况下保持稳定。
图2.结合柔性外壳设计与弹性粘胶的凸面底盘示例（SenSura Mio Convex）。
凸面造口产品在临床实践中的应用与反思
两位经验丰富的造口护理专家分享了临床案例，旨在展示他们在日常工作中如何运用凸面造口产品，以应对患者面临的特定护理难题。两位专家均强调，选择合适的凸面造口产品必须采取个体化策略，充分考量每位患者独特的体型特征、造口类型以及造口周围皮肤的状况。
临床病例1：具有复杂腹部轮廓的患者术后造口管理
患者概况
一名73岁的男性患者在接受直肠切除术后进行了保护性回肠袢造口术。手术后，患者经历了长时间（4-8小时）没有造口排泄物，随后突然排出大量（500-800 mL）的稀便，通常发生在造口手指探查或插管操作之后。此措施是必要的，以确保排便流畅并缓解疼痛和恶心的症状，但这导致了对麻痹性肠梗阻或造口扭转的担忧。
临床评估
术后体格检查发现，患者腹部形态不平，存在深褶皱，造口位于肚脐旁。造口本身位于皮肤水平，缝合完好，黏膜健康（图3a）。
治疗方法和造口产品选择
考虑到解剖和术后挑战，医护人员（HCP）优先考虑预防渗漏并避免皮肤并发症。虽然凸面底盘会更为理想，但在长时间无造口输出的过程中，仍需进行手指探查和插管，并确保随后的高排出量能够引导到造口袋中。为此，HCP选择了一个平面底盘与术后引流袋（配有可接触造口的开口），并结合凸面水胶密封和造口膏来平整褶皱（图3b-d）。长期解决方案确定为SenSura Mio Soft Convex底盘（Coloplast），配合可引流造口袋使用，并辅以水胶密封和腹带。建议每月检查身体轮廓，以确保产品继续贴合。
图3. a）术后造口及造口周围区域的照片；b）用于造口周围皮肤表面不平整时的辅助产品：用于弥补平坦造口高度不足的凸面水胶密封，以及用于填平深层褶皱的造口膏；c）贴敷于皮肤后的水胶密封及造口膏；d）最初使用的平面底盘及术后造口袋（贴敷于皮肤上），该造口袋配有便于观察造口的视窗。
在该病例中考虑的凸面特征：
- 可压缩性：选用了一款软凸面底盘，旨在避免对坚实的腹壁施加过度的压力。
- 柔韧性：此特性必不可少，以便适应腹壁的活动，因为造口恰好位于身体的弯曲部位。
- 深度：6 mm的凸面深度被认为足以满足需求。
- 坡度：首选宽阔的平台及较为平缓的坡度设计，以有效填补造口周围的皮肤褶皱。
- 张力位置：张力施加点被设置在距离造口较远的位置，从而能更好地应对皮肤上的褶痕与皱纹。
随访
术后四天，肠麻痹症状缓解，回肠造口开始排出糊状粪便。在此期间，术后最初使用的造口装置密封良好，未发生渗漏。随后，将造口装置更换为SenSura Mio一体式软凸面造口系统，并配合造口膏使用，同时建议使用造口带以増加稳定性。至术后第12天，腹部肿胀消退，造口旁缝线拆除，造口皱襞回缩，不再需要使用造口膏。患者对门诊指导依从性良好，于术后第14天出院，能够独立进行自我护理。随后顺利转入门诊随访，未出现并发症。
医护人员的反思
临床医生强调了在复杂术后病例中个性化产品选择的重要性。尽管在术后早期使用凸面底盘仍存在一些理论担忧，但由于患者的解剖特点和随后的渗漏风险，凸面底盘的使用是合理的。凸面水胶密封和造口膏的组合满足了造口装置牢固贴合的即时需求，而持续的定期评估则确保了其能够适应患者体型的变化。
该病例表明，在术后早期阶段需要频繁评估，以应对与造口装置渗漏风险増加相关的即时解剖和功能挑战。目标是优先预防渗漏，并根据个体情况选择合适的产品以确保其牢固贴合。
临床病例2：认知障碍患者的术后造口管理
患者概况：
一名74岁的退休护士因良性憩室病继发大肠梗阻及腹腔败血症，接受了急诊手术治疗。术前虽已进行了造口部位标记，但由于患者腹胀显著且腹腔炎症严重，最终实施的袢式穿孔结肠造口术位置较原计划偏高，位于上腹部、左乳下方区域。
临床评估：
该患者表现出认知功能受损的迹象，目前由家属照料。术后，造口平面与皮肤齐平。造口外侧随即出现黏膜皮肤分离，并伴有向左侧肋骨方向放射的硬结及红斑。在48小时内，局部形成大片溃疡区，随后发展为黏膜皮肤交界处的裂开，继而形成一处腔隙（图4a）。初期曾疑有瘘管形成，但随后排除了这一可能性。目前存在腔隙受粪便污染、排泄物接触皮肤引发疼痛以及继发感染性并发症的风险。
治疗方法和造口产品选择
初步管理包括放置条状胶凝纤维敷料（Aquacel，ConvaTec）以吸收坏死组织和伤口渗出物，将其引流到造口袋中，并使用薄层水胶密封圈，围绕造口周围放置一层，以提供平整效果，同时在侧边再次使用密封圈以提供额外的吸收能力，处理渗出物并保持该区域完整，直到下次更换造口袋。
尽管从理论上讲，凸面底盘可能会对已经受损的造口周围皮肤造成影响，但为了收集排泄物并防止渗漏进入伤口，最终仍选用了SenSura Mio一体式软凸面(Coloplast)底盘。这一决策是基于临床经验，并且需要在保护脆弱组织的同时保持牢固密封。家庭参与环节经过了结构化设计：护理人员获悉，复杂的伤口护理仍将处于专业人员的监督之下；与此同时，造口袋的更换流程已被标准化并予以简化，以便最终能够交由家属代为执行。胶凝纤维敷料的使用被酶促海藻酸凝胶（Flaminal gel，Flen Health）所取代，因为后者对家属而言更易于使用。二者都具有相同的吸收性能，可以吸收渗出物并将其从伤口底部引导出来，促进基底的肉芽形成。
在该病例中考虑的凸面特征：
- 可压缩性和柔韧性 软凸面设计最大限度地减轻了压力，并能贴合腹部轮廓，缓解伤口不适感。
- 深度和坡度 适宜的深度与平缓的坡度将排泄物导入造口袋中，从而降低了渗漏风险。
- 张力位置 宽阔的平台区域确保了敷料的稳固粘附，且不影响伤口的愈合过程。
随访
在出院两周后的随访中，腔隙已消退，造口周围皮肤状况良好（图4b）；患者继续使用软凸面造口袋，造口排泄物的量、稠度及规律性均保持稳定。护理顺利转交给家属，并在康复过程中由专业人员持续监督。
图4. a）术后48小时造口部位，可见造口周围黏膜皮肤裂开及溃疡；b）随访时造口部位，腔隙已愈合，造口周围皮肤状况有所改善。
医护人员的反思
尽早建立一套易于操作的日常护理流程至关重要，有助于减轻家属焦虑并増强信心。疼痛管理（规律镇痛、换药前用药）和营养支持是重点。
该病例说明了个性化产品选择的重要性，需要在理论层面的禁忌顾虑和实际需求之间取得平衡，以实现控制粪便、保护皮肤完整性并支持护理人员参与。
结论
透彻理解凸面底盘各项参数（包括深度、坡度、张力位置、可压缩性及柔韧性）的临床意义，对于在造口护理中有效应用此类产品至关重要。同样重要的是选择一种柔性粘胶，以确保形成稳固的密封，并能随身体活动自如贴合。通过将个性化的产品选择与定期的复评估相结合，临床医生能够最大程度地提升舒适度、保护造口周围皮肤，并为造口患者带来更佳的治疗成效。
利益冲突
NR和FS是Coloplast全球造口咨询委员会的成员，但他们并未因参与本稿的贡献而获得报酬。RB、JMRM、RL、AB和ASH是Coloplast A/S的员工。
Author(s)
Natasha Rolls RN
Lead Specialist Stoma Care Nurse
University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
Florian Spahn RN SKW
Clinical Nurse Specialist in Stoma, Continence and Wound Care
LMU Klinikum München, Germany
Rachael Berger1 BS
Strategy Deployment Manager
Jose Manuel Roman Marin1 PhD
Principal Scientist, Pre-clinical, R&D
Rasmus Lundgaard1 MSc
Senior Simulation Engineer, PDE, R&D
Agnieszka Bochynska1* PhD
Senior Medical Specialist, Medical Affairs
Email dkagbo@coloplast.com
Anne Steen Hansen1 RN/MSc ET
Lead Medical Specialist, Medical Affairs
1Coloplast A/S, Holtedam 1-3, Humlebæk, Denmark
* Corresponding author
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