SACS Study

1. 17 World Council of Enterostomal Therapist (WCET)
Congress
“All roads lead us together”
Multicenter
Observational Study on
Peristomal Skin
Disorders:
A Proposal of
Classification
Mario Antonini
ET Nurse – U.S.L. 11 Local Health Agency – San Giuseppe Hospital, Empoli, Italy
mantonini11@alice.it

2. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“How well ostomy patients adapt to
their new life depends, to a great
extent, on the preservation of
peristomal skin integrity”

3. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
The incidence of peristomal complications
that can compromise that integrity cannot
be easily determined.
*A review of literature indicates a
complication incidence ranging from 18%
to 55%.
* Colwell J, Goldberg M, Carmel J. The state of the standard diversion. JOWCN
2001; 28 (1): 6-17

4. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“In the authors experience caring for
nearly 700 patients per year over a mean
period of 10 years, it is estimated that
at least one third of colostomy patients
and up to two thirds of urostomy and
ileostomy patients are affected by at
least on peristomal lesion.”

5. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“Because the literature shows no
evidence of a tool classify peristomal
skin disorders, a prospective
observational study was conducted among
eight ostomy centers across Italy.”

6. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
“A study group comprised of seven
enterostomal therapy nurses and four
surgeons sought to provide an objective,
reproducible, standardized classification
instrument.”

7. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
Ostomy Centers across Italy
Ambulatorio Stomaterapia
Ospedale “San Giovanni
Battista”
Le Molinette – Torino
Ambulatorio Stomaterapia
Azienda Ospedaliera “San
Maurizio” - Bolzano
Ambulatorio Stomaterapia
Ambulatorio Stomaterapia
Ospedale “Misericordia e
Ospedale “San Giuseppe” –
Dolce” – Azienda U.S.L. 4
Azienda U.S.L. 11 Empoli
Prato
Ambulatorio Stomaterapia Ambulatorio Stomaterapia
Azienda Ospedaliera Policlinico Universitario
“Garibaldi” - Catania “Campus Biomedico” - Roma
Presidio Ospedaliero “San
Luigi Curro” - Catania
Ospedale “Piemonte” - Messina

8. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification

9. This study was published in the Journal
OWM - OSTOMY WOUND MANAGEMENT
A proposal for classifying peristomal skin disorders: results of a
multicenters observational study
2007; 53(9): 38-43

10. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
Skin lesions were examined at set intervals (weeks 0, 4, 12, 24)
Acquisition of digital images
Blood chemistry
Descriptive statistical analyses were conducted using the software SPSS 14.0
Consensus Conferences

11. Multicenter Observational Study on Peristomal Skin Disorders
Patient Demographic Group 1
<1 year after surgery
Time 0
Patien PARAMETRI CLINICI
t
Body
Pictu Blood Blood Bleeding at
Name Data Hemoglobin Weight Diuretic Degree of Peristomal skin lesion (1,2,3,4,X) Burning Itching Pain Bleeding Localization
re sugar Iron removal
(kg)
001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
016
017
018
019
020

12. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
February
2006
December
2003
A prospective, observational study
was conducted between December
2003 and February 2006.

13. Patient Demographic Group 1
<1 year after surgery
(N = 380)
Gender (%) Male: 60%
Female: 40%
Age Minimum: 25 years
Maximum: 85 years
Stoma type (%)
- Ileostomy 28,6%
- Colostomy 71,4%
Permanent stoma 62,6%
Temporary stoma 37,8%
Systemic disease Cardiopathy: 9,1%
Arterial Hypertension: 8%
Diabetes: 11,2%

14. Patient Demographic Group 2
>1 year after surgery
(N = 276)
Gender (%) Male: 65%
Female: 35%
Age Minimum: 26 years
Maximum: 91 years
Stoma type (%)
- Ileostomy 31,9%
- Colostomy 68,1%
Permanent stoma 87,5%
Temporary stoma 12,5%
Systemic disease Cardiopathy: 4,2%
Arterial Hypertension: 8%
Diabetes: 11%

15. Multicenter Observational Study on Peristomal Skin Disorders:
A Proposal of Classification
Peristomal: the term “peristomal”
is meant to include the whole skin
around the stoma (within 7,5 cm,
which is the maximum size of the
skin barriers available in the
market), even if it is not directly
linked with the stoma.
Predominant sign: it was
decided that the classification
should only refer to the
predominant sign (the most
serious one) and the
topography (T) of the lesion;
the classification will then
include only one “L” and in
case more than one “T”.

16. The peristomal complication
classification system developers
agreed to identify the quadrants around
the stoma in a manner similar to the
system used for breast cancer patients
to facilitate topographical description of
the lesions
7,5 cm 7,5 cm

17. Classification Topography
• L1 Hyperemic lesion (peristomal
skin reddening without loss of • TI = Upper left
substance)
• L2 Erosive lesion with loss of • TII = Upper right
substance NOT extending
beyond the dermis
• TIII = Lower right
• L3 Ulcerative lesion extending
beyond the dermis
• L4 Ulcerative fibrinous/necrotic • TIV = Lower left
lesion
• LX Proliferative lesions • TV = Total
(granulomas, oxalate deposits,
neoplasm)

18. Brochure
Once it was ascertained that the
classification system was a helpful
tool, a pocket ruler guide for the
classification was created to
provide a brief summary and
practical explanation on the
classification system to be used by
ET nurses in daily work.
Ruler

19. Peristomal
Skin
Integrity

20. SACS Classification:
L1: Hyperemic lesion
TV: total

21. SACS Classification:
L2: Erosive lesion with
loss of substance not
extending beyond the
dermis
TV: total

22. SACS Classification:
L3: Ulcerative lesion
extending beyond the
dermis
TIII-IV: lower right and
lower left

23. SACS Classification:
L4: Ulcerative
fibrinous/necrotic lesion
TIII-IV: Lower right and
lower left

24. SACS Classification:
LX: Proliferative lesions
(granulomas, oxalate
deposits, neoplasm)
TV: total

25. “Improving and maintaining the integrity of
peristomal skin is an important objective for
both ostomy patients and ostomy care
professionals.
Peristomal skin integrity plays a fundamental
role in the improvement of quality of life of
a patient with an abdominal ostomy.”

26. THANK YOU TO:
A.I.O.S.S. (Italian Association of
Enterostomal Therapist)
CONVATEC ITALY
The collegues of the study
THANK YOU FOR YOUR
ATTENTION!