References
Developments in silicone technology for use in stoma care
Abstract
Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit trans-epidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal trans-epidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.
Silicone describes any long-chain inert polymer that contains repeating chains of the element silicon, along with oxygen, carbon and hydrogen. There are a variety of silicone compounds used for various industrial purposes, but this article will focus on the type of soft silicone used in therapeutic medical devices. It charts the development of this technology and reviews the evidence for its efficacy compared with more traditional materials, beginning with silicone's established use in dermatology, wound care and stoma accessories. This is followed by an acknowledgement of the challenges presented by moisture management that have limited silicone's application in flanges for stoma appliances. The article then introduces new silicone compounds that are able to overcome these limitations with a novel method of moisture management, with considerable advantages over traditional hydrocolloid appliances.
Soft silicone polymers have a variety of advantages that make them particularly suitable for use. They are highly flexible, which allows them to conform well to the shapes and contours of the body. They have a tacky quality that allows them to adhere to dry surfaces and a low surface energy that provides instant adhesion. They are non-toxic, non-odorous and have a low allergy potential, as well as being impermeable to bacteria and incapable of being absorbed into the body, all of which makes them comfortable and hygienic to wear (Meuleneire and Rücknagel, 2013; Cronin, 2016).
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