An ostomy is a surgical procedure that creates an opening, called a stoma, in the abdomen to allow waste to exit the body into a collection pouch. The ostomy pouching system secures this bag to the body and maintains skin health. The flange, also commonly referred to as the skin barrier or wafer, is the most important component of this system. It is the adhesive portion that adheres directly to the skin surrounding the stoma. This piece forms a secure seal that prevents irritation and ensures the proper function of the entire appliance.
Defining the Flange and Its Protective Purpose
The flange is a flexible, adhesive disk that serves as the foundation for the ostomy pouch, providing a stable base against the abdomen. Its primary composition is a specialized material called hydrocolloid, which consists of moisture-absorbing and thickening agents dispersed in an adhesive base. This formulation allows the flange to adhere securely to the skin while remaining flexible enough to move with the body.
The flange performs two functions: creating an airtight seal and protecting the skin. It must form a tight perimeter around the stoma to prevent effluent, or stoma output, from leaking onto the surrounding skin. Since the waste can be corrosive, the hydrocolloid material acts as a protective shield for the peristomal skin, the area immediately next to the stoma. Hydrocolloid is hydrophilic, meaning it absorbs moisture from the skin and minor leakage, helping to maintain a normal moisture level and avoid skin damage.
Exposure to moisture from the stoma output causes the hydrocolloid to absorb fluid and slowly break down, often turning gelatinous. This breakdown indicates the material is working to absorb moisture, but it also signals that the flange will lose its adhesive properties. Regular changes are necessary to prevent leakage and subsequent skin irritation.
Understanding One-Piece Versus Two-Piece Systems
The design of the flange determines whether the ostomy system is a one-piece or a two-piece appliance. In a one-piece system, the flange is permanently attached to the collection pouch, forming a single unit. The advantage of this design is its simplicity and low profile, making the system less visible under clothing.
When changing a one-piece system, the entire unit must be removed and replaced simultaneously. This means the adhesive is pulled off the skin with every change, which can lead to skin tenderness or irritation with frequent removal. This system is favored by those who prioritize discretion and a simpler application process.
The two-piece system separates the flange from the pouch itself. The flange adheres to the skin and features a coupling mechanism, often a plastic ring, to which the collection pouch attaches. This separation allows the user to change the pouch without removing the skin barrier, which is gentler on the peristomal skin and permits longer wear time for the flange. While a two-piece system can be slightly bulkier, it offers greater versatility, allowing the user to swap pouches without disturbing the skin seal.
Achieving a Secure and Healthy Fit
Achieving a secure and healthy fit begins with accurately sizing the opening in the flange to the stoma. The opening must be precisely measured to ensure it is snug around the stoma base without constricting it. Ideally, the hole should allow for a gap of 1.5 to 3 millimeters between the stoma and the inner edge of the flange. If the opening is too large, the peristomal skin will be exposed to output, leading to irritation and breakdown.
Proper application of the flange maximizes its wear time and effectiveness. Before applying the adhesive, the skin must be completely clean and dry to ensure optimal adhesion. Applying gentle pressure and warmth to the flange after placement helps activate the adhesive components and create a more secure, lasting seal.
A proper fit is crucial because an ill-fitting flange is the primary cause of peristomal skin complications. Signs of a poor fit or a failing seal include itching, burning, or visible irritation on the skin surrounding the stoma. Since a stoma can change size and shape, regular re-measurement is advised to adjust the flange opening and maintain the protective seal.