Following ostomy surgery, which creates a stoma to divert waste, a specialized pouching system collects output and protects the surrounding skin. The system has two main parts: the collection pouch and an adhesive base that attaches to the body. This adhesive piece, often called the flange, ensures the entire system remains securely in place. This article details the function of the flange and how it differs between available system types.
Defining the Ostomy Flange and Its Purpose
The ostomy flange is the adhesive portion of the pouching system that sticks directly to the skin around the stoma. It is also frequently referred to as a skin barrier or a wafer. The flange serves two functions: providing a secure, adhesive base for the collection pouch and protecting the sensitive skin surrounding the stoma, known as the peristomal skin.
Most flanges are made from hydrocolloid, a skin-friendly material derived from natural ingredients like pectin, gelatin, and cellulose. Hydrocolloid is naturally hydrophilic, meaning it absorbs moisture. This property allows it to adhere securely to the skin while managing the body’s natural moisture.
This moisture-absorbing property prevents the flange from breaking down quickly and protects the peristomal skin from irritation caused by contact with stoma output. The hydrocolloid formulation forms a gel when it interacts with moisture, ensuring a tight seal that prevents effluent from leaking onto the skin. By adhering to the skin, the flange maintains a clean environment for the peristomal area.
One-Piece vs. Two-Piece Systems: The Role of the Flange
The meaning of “flange” differs depending on whether the user has a one-piece or a two-piece ostomy system. Both systems utilize a skin barrier, or wafer, but the component is most distinctly defined as a flange in the two-piece system. Understanding this distinction is key to navigating ostomy supplies.
In a two-piece system, the flange (skin barrier) and the collection pouch are separate items that connect together. The flange is the plastic ring on the skin barrier component that allows the pouch to snap or click onto it. This design provides flexibility, allowing the user to change the soiled pouch without removing the adhesive skin barrier from the body. Keeping the skin barrier in place for several days reduces skin irritation caused by frequent adhesive removal.
Conversely, the one-piece system permanently fuses the skin barrier and the pouch into a single unit. When changing the pouch, the entire unit, including the adhesive barrier, is removed from the skin. Although the adhesive barrier is technically a flange, the term is less often used because there is no separate coupling mechanism. The one-piece system is less bulky and offers a lower profile under clothing due to its integrated design.
Essential Flange Care and Sizing
Proper care and accurate sizing of the flange are necessary for preventing leakage, the most common cause of skin complications for ostomy users. The flange opening must be precisely sized to fit snugly around the stoma, allowing output to drop directly into the pouch without contacting the peristomal skin. For the first several weeks after surgery, the stoma will be swollen and gradually shrink, requiring the user to measure its length and width at each change.
A measuring guide is used to determine the stoma’s size, and the correct opening is cut into the flange material. The opening should allow for a minimal gap of about 1.5 to 3 millimeters between the stoma and the adhesive edge. Cutting the opening too large exposes the skin to output, while cutting it too small can constrict the stoma.
When applying the flange, the user must ensure the skin is clean and completely dry to achieve a secure, wrinkle-free seal. A secure application is important because any lifting or wrinkling of the adhesive can create a channel for effluent to seep underneath, leading to skin irritation and premature barrier breakdown. Though the flange can often be worn for several days, it must be changed immediately if leakage is suspected or if the edges begin to lift.