A pre-cut ostomy system refers to a pouch with a factory cut-out opening already in place. The opening is designed to fit the size of the stoma. This system is ideal for patients with a round stoma shape and are available in two types. As a flat pouching system (convenient for patients with stomas that protrude outwards at least an inch) and the convex pouching system which projects towards the stoma and is ideal for smaller, flatter or inverted stoma shapes.
The size of a pre-cut ostomy system is measured at the flange opening and there are many sizes to choose from depending on the size of the stoma. Available sizes depend on brand and pouch system type. Usually, the ideal size for each stoma is one slightly wider (about 3-4mm) than the edge of the stoma so as to allow more comfort while maintaining a snug fit. A same size or smaller flange opening is likely to cause trauma to the stoma during removal. Convex flanges have a higher risk of causing injury if an exact or compressing size is chosen. Pre-cut convex flanges are useful where flat pre-cut types are not effective. Such situations include:
- Stomas that are flat on the skin or are retracted. A standard flat flange placed on such a stoma runs the risk of leaking.
- Loop ostomy surgical procedures. These types of surgery result in a retracted stoma on most occasions.
- Skin wrinkles and creases on the peristomal skin. This makes it difficult for flat flange adhesive to remain in place. There can be areas without adhesion and stoma discharge can accumulate there causing leakage and skin irritation.
- Uneven surgical scars. The irregular skin surface is likely to leave some areas without adhesion when ordinary flat flange is used. Convex flanges cover such areas easier, reducing chances of leakage.
- Stomas that change with patient’s position. Telescoping stomas are an example as they are usually protruding when the patient is upright or sitting but retracts during sleep which can also result in leaking.
- A flabby abdomen. A flat pre-cut ostomy system is seldom effective in protecting the stoma and surrounding skin properly.
These factors are contra-indications for pre-cut flat ostomy flanges. When the stoma is regular with a spout-like shape, then a standard pre-cut flange is recommended. An absolute contra-indication of a convex flange is a peristomal hernia. The convex flange can exert pressure on such a hernia which increases risk of strangulation so generally speaking, a precut convex flange is indicated when the stoma has contour issues.
Even with a convex flange, the difficult peristomal surface elevates the risk of leaking and skin damage. To further reduce this risk, ostomy belts can be used together in tandem with a convex flange. These belts, known as ostomy support belts or hernia belts, assist the flange to maintain an even pressure on the entire baseplate adhesive even where the contours create creases as the case in an overweight or flaccid abdomen. For best results, use a belt from the same manufacturer of the flange you are using.
The advantages of pre-cut ostomy systems are that they are faster to apply and more user friendly to patients with insufficient hand dexterity or painful conditions such as arthritis. Unlike cut-to-fit systems, user errors that can lead to leakage and skin irritation as a result of incorrect cutting and handling are greatly reduced.