Peristomal Skin Health: The Foundation for Reliable Adhesive Use After Laryngectomy

Achieving a comfortable, reliable attachment is an important part of the rehabilitation journey after total laryngectomy. Attachments serve as the foundation for consistent Heat and Moisture Exchanger (HME) use. When the adhesive seal around the stoma is unreliable or when patients experience discomfort, 24/7 HME use may decline or be inconsistent. A key factor impacting success with adhesives is peristomal skin health. Peristomal adhesives are a commonly used and effective method for attaching HMEs, providing a comfortable, airtight seal that supports pulmonary air conditioning and facilitates speech for patients using a voice prosthesis. The benefits of HME use on pulmonary health, stoma hygiene and tracheoesophageal voicing are well established, however adherence varies across the laryngectomy population. Attachment-related challenges such as skin irritation, inconsistent adhesion, or difficulty achieving an adequate seal are commonly reported, particularly among patients with deep-set stomas.

Stomal anatomy

Stoma anatomy varies widely following total laryngectomy. Surgical technique, scarring, radiation effects, and natural differences in neck anatomy all contribute to a broad range of peristomal presentations. These variations do not prevent successful adhesive use, but they can make it more challenging to identify the most appropriate adhesive for each patient. Additional patient-specific factors, including skin moisture, activity level, and overall skin condition, further influence adhesive success and performance. Understanding how these variables interact helps clinicians consider the best choice adhesive for their patient that will result in a good seal, improved patient comfort, and overall, a more predictable and positive patient experience.

Using an adhesive

Adhesive use is best understood as part of a broader system rather than an isolated product choice. Adhesives perform most reliably when applied to skin that is clean, dry, and intact. When moisture or mucus becomes trapped beneath the adhesive, or when the outer skin barrier is compromised, adhesion may become less predictable. When a seal comes loose after a short amount of time, this can then lead to more frequent adhesive changes, increasing mechanical stress on the skin. Supporting skin health and good habits helps stabilize this cycle and promotes more consistent adhesive performance over time.

Understanding skin and skin health

To better understand how to support skin health, we first must understand the skin itself. The skin consists of three primary layers: the epidermis, the dermis, and the subcutaneous tissue. Adhesive-related considerations primarily involve the outer portion of the epidermis, where the skin’s protective barrier resides. This barrier helps regulate moisture and protect against friction, but it can be disrupted by repeated adhesive removal, prolonged occlusion, or harsh cleansing practices. When the epidermal barrier remains intact, adhesives are more likely to bond comfortably and predictably.

Skin changes associated with adhesive use are commonly described as Medical Adhesive–Related Skin Injury (MARSI), a term used to encompass a range of skin responses. These may include irritation, skin stripping related to improper removal, maceration from prolonged moisture exposure, or sensitivity during application or removal. Mild MARSI is not uncommon, particularly early in the postoperative period as patients establish routines and gain confidence with daily care. The literature suggests that many of these skin changes can be minimized through consistent habits that protect the skin while supporting adhesive performance.

Certain factors may increase susceptibility to skin sensitivity. Patients early in recovery, individuals with deeper stomas, and those who use TE speech, especially hands-free speech, often place higher mechanical demands on adhesives. Prior radiation, age-related changes in skin quality, perspiration, and other comorbidities may also influence how the skin responds over time. Awareness of these variables allows clinicians to guide patients toward stable routines and proactive strategies rather than responding only after problems arise.

Supporting healthy peristomal skin is largely about reinforcing practical, repeatable behaviors. The following strategies, drawn from published guidance and clinical experience summarized in the whitepaper, can help reduce the risk of MARSI while promoting consistent adhesive wear.

Top 10 tips to help reduce the risk of MARSI:

• Choose the most skin-friendly adhesive based on the patient’s skin condition, anatomy, and stage of recovery
• Use proper application techniques to promote even contact and reduce unnecessary tension
• Avoid leaving non-permeable adhesives on for extended periods
• Use proper adhesive removal techniques, peeling slowly at a low angle to minimize friction on the skin
• Avoid repeated and unpredictable adhesive changes, which increase mechanical stress on the outer skin layer
• Allow the adhesive to set for 15–60 minutes before speaking with a voice prosthesis, particularly for TE speakers
• Immediately clear mucus that may become trapped beneath the adhesive to support skin integrity and seal reliability
• Encourage gentle voicing without excessive speaking pressure
• Support the adhesive when removing the HME to reduce tension on the skin and baseplate
• Avoid touching the adhesive layer during application to preserve bonding strength and consistency

Healthy peristomal skin supports consistent HME use, reliable attachment performance, and effective communication. When skin health is maintained through thoughtful routines and awareness, adhesives can function predictably and comfortably as part of everyday life after total laryngectomy. As patients progress in their recovery, adhesive needs may change as skin condition, activity level, and voicing demands vary in everyday life. Creating space for patients to explore different adhesive options while monitoring skin response and wear experience reinforces that finding the right solution is an expected and individualized part of optimal laryngectomy care and management. The considerations outlined above are explored in greater detail in a 2023 whitepaper developed by Atos Medical, which brings together published literature and clinical experience related to peristomal skin health and adhesive performance in laryngectomy care.