The F.R.I.E.N.D.S. mnemonic for fistula provides a framework for identifying factors that may affect healing in complex fistula cases:
- F – Foreign body
- R – Radiation
- I – Infection or inflammation
- E – Epithelialization
- N – Neoplasm
- D – Distal obstruction
- S – Steroids
Applying F.R.I.E.N.D.S. to Fistula Management
Identifying factors that may affect healing is one part of managing a complex fistula. Clinicians must also consider the characteristics of the fistula, drainage, surrounding skin condition, and the ability to maintain effective containment.
These considerations can help guide strategies for isolating enteric effluent, protecting surrounding tissue, and maintaining a dependable seal.
The Wound Crown, Fistula Funnel, and Isolator Strip were developed to support different isolation and containment challenges in complex fistula management.
Using the F.R.I.E.N.D.S. framework alongside assessment of the wound and its management challenges can help support clinical decision making throughout fistula care.