Cut to fit ostomy systems are used mainly where the stoma is irregular and as its name implies, it means cutting an opening on the flange that fits around your stoma. Normally, a well-rounded and protruding stoma will need a pre-cut ostomy system. Some of the types of stomas that are typically recommended to use a cut-to-fit system include non-circular stomas, oval stomas and reduced/shrinking stomas.
The above stoma shapes can arise as a result of various factors. For example, the stoma can heal with scarring tissue that distorts its shape or the current contours of the abdomen can also determine the final appearance and shape of the stoma. Immediately after surgery, the stoma is usually much bigger due to the natural inflammation and swelling process. With time, the stoma size reduces until it settles on a final size when healing is complete. A cut-to-fit system helps the patient to adjust the size of the stoma flange accordingly in order to prevent leakage and skin irritation. What this means for the ostomy patient is to measure the size of the stoma as frequently as recommended by their ostomy nurse or health care provider, which is generally done once a week.
The cut-to-fit ostomy procedure
There are two ways of doing this. The first is by using scissors and the second is by the use of a flange cutter which is commercially available from various ostomy product manufacturers. They are much easier to use and give finer results than scissors.
The flange is placed and cut on a hard surface since a soft surface can lead to it being damaged and may result in an irregularly cut opening. The size of the opening is determined by the latest stoma measurements. It is important to cut the opening about 3-4mm larger than the stoma outline because this extra space helps to prevent stoma trauma during flange removal.
The usual skin preparation is carried out before placing the flange on the peristomal skin. Different professionals have different ways of doing this but the common goal is to prevent or reduce skin infection and skin irritation. Common pouching products used include skin sealants, skin barrier pastes, powders, and solvents.
A cut-to-fit ostomy system serves the same purpose as a pre-cut ostomy type. This includes:
- Facilitating effective and hygienic discharge collection
- Protection of the skin around the stoma from stoma discharge. This in turn prevents skin irritation, inflammation and infection.
- Prevention of bad odor
Advantages of a cut-to-fit ostomy system
- Can be adjusted to fit the size and shape of the stoma
- Doesn’t require any skilled personnel to cut the opening after the patient has had the initial training.
- There is reduced risk of discharge accumulation behind the flange.
- Ostomates with dexterity problems due to hand arthritis or other causes can find it difficult to cut-out the opening with sufficient precision.
- There are increased chances of mistakes that can lead to poor flange placement and increased risk of leakage and skin irritation.
- It is cumbersome to perform the procedure while travelling or when in a public rest room
- Can interfere with social life owing to the time needed to perform the procedure during a pouch change.
The caring of your stoma when using a cut-to-fit ostomy system is the same as when using other types of ostomy systems and is of utmost importance to practice appropriate stoma management regardless of system.