Knowledge Center


Use of High-Frequency Electrical Stimulation in Gastrocutaneous Fistula Closure: A Case Report (2024)

Techniques: Complex Wounds and Fistulas

Click here to go to the Complex Wounds and Fistulas website for practical “Here’s how I do it” fistula management techniques.

Webinar: Managing Difficult Stomas and Fistulas: Keys to Success (2023)

Click here for a discussion on managing difficult stomas and fistulas from the Colorectal Surgery Virtual Educational Series (CRS).

Feeding Fistula Patients

Literature:  The Adult Patient's Guide to Managing a Short Bowel

Request a complimentary copy of The Adult Patient's Guide to Managing a Short Bowel by Carol Rees Parrish MS, RDN. Enteric fistula patients frequently suffer from chronic malabsorption due to Short Bowel Syndrome (SBS).  Carol's book is the seminal guide for managing SBS so that fistula patients get proper nutritional support.

Literature: Nutritional Management of Patients With Enterocutaneous Fistulas: Practice and Progression (2020)

Literature: UOAA Short Bowel Syndrome Blog

United Ostomy Associations of America (UOAA) has a series of articles on the importance of recognition and treatment of patients diagnosed with Short Bowel Syndrome (SBS).

Literature: The Art of Fistuloclysis: Nutritional Management of Enterocutaneous Fistulas (2010)

Tools:  Short-Bowel Syndrome Medication Protocol Example for Antimotility Medications

This downloadable Short-Bowel Syndrome medication protocol example for anti-motility medications can be a helpful reference when creating your protocol.

Video:  Nutritionist Interview (2020)

Meet a fistula team nutritionist and learn her approach to assessing fistula patients and Short Bowel Syndrome (SBS) patient management.

Webinars and Videos

Webinar: Treatment of Enterocutaneous Fistula (2022)

Click here to learn about the treatment of enterocutaneous fistula in this recorded event from the Colorectal Surgery Virtual Educational Series (CRS).

Webinar: 2-part Series on Fistula Care (2020)

View the on-demand series on fistula care from the 2020 Northeast Region of the WOCN's virtual conference:

Webinar: Reimagine Solutions for Fistula Management: The Patient, The Fistula, The Skin! (2020)

Click here to view this session from WOCNext 2020 Reimagined, which provides solutions for fistula management with primary focus on effluent containment and perifistular skin protection.

Videos: Fistula Solution YouTube Channel

Find example device application techniques on the Fistula Solution YouTube channel.


Techniques: Decision Framework for Enteric Fistula Management

Click here to download the enteric fistula decision making framework poster presentation from WOCNext 2022. This framework can help providers determine the appropriate therapy when faced with a challenging enteric fistula.

Techniques: Surgical Reconstruction of Peri-fistula/stomal Soft Tissue: Revise, Isolate, Skin Graft, Pouch (RISP)

Click here to download the RISP poster presentation from SAWC Fall 2021.  In some situations, the soft tissue around a fistula or ostomy makes it impossible to apply a pouch and contain effluent. The purpose of RISP (Revise, Isolate, Skin graft, Pouch) is to transition the patient to a standard, easy-to-apply ostomy appliance.

Techniques:  Isolation of Enteric Fistulas to Allow Adjacent Skin Graft Placement

This downloadable case study poster from SAWC 2020 Virtual illustrates a new technique to manage intestinal effluent during the placement of skin grafts or artificial skin substitutes onto nearby wounds.  Skin grafting around enteric fistulas and ostomies may allow providers to transition patients to standard ostomy appliances.

Techniques:  Stop Pouch Attachment Leakage

Leaks can happen at the interface of a pouch appliance and Fistula Solution device. The goal is to direct all effluent into the pouch appliance with no leaks.  These technique tips will help assure success. Visit our "how-to" post or watch this video.

Techniques: Belted Ostomy Pouch with Fistula Solution Devices for Difficult Perifistula

Using a belted ostomy pouch with Fistula Solution devices can be a good effluent management option in cases when perifistula creases or scars make adhesive pouching difficult or when ostomy pouches will not adhere to denuded and weeping peristomal skin. Visit our "how-to" post.

Techniques:  Contain High-output Fistula and Ostomy Effluent

Managing effluent from a high-output fistula or ostomy can be a challenge.  This technique can be helpful for managing high volumes of effluent. Visit our "how-to" post.


Literature: New Technique to Protect Perineal Skin Grafts Without A Diverting Ostomy (2021)

Literature: Management of Open Abdominal Wounds With Intestinal Fistula Formation Using a Combination of Negative Pressure Wound Therapy With Instillation and Dwell Time and New Generation Fistula Devices (2020)

Literature: New Compressible Barrier Devices for Enteric Fistula and Ostomy Effluent Isolation (2020)

Literature: “Floating” stoma en enteroatmosferische fistels: een uitdaging! (2020)

Read the Dutch Journal of Surgery article: “Floating” stoma en enteroatmosferische fistels: een uitdaging!

Literature:  Atlas of Critical Care Procedures (2018)

Find excellent guidance on the Local Management of Enteroatmospheric Fistulae in Chapter 34 of the Atlas of Critical Care Procedures, Editors: Demetrios Demetriades, Kenji Inaba, and Philip D. Lumb.

This atlas is a standard reference for surgeons, critical care physicians, nurses and all critical care professionals who manage enteric fistulas and complex wounds.

Literature:  Collapsible Enteroatmospheric Fistula Isolation Device: A Novel, Simple Solution to a Complex Problem (2015)

Literature: Novel technique for stomal isolation after extensive abdominal wall soft tissue loss (2018)

Literature: Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing (2017)

Read the Journal of Wound, Ostomy and Continence Nursing article: Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing

Literature: SNAP protocol for fistula care (Skin and Sepsis, Nutrition, definition of fistula Anatomy, and proposing a Procedure to address the fistula)

snap wide

Read the Clinics in Colon and Rectal Surgery article: Management of Enterocutaneous Fistulas  (2004)

Read the Clinics in Colon and Rectal Surgery article: Enterocutaneous Fistula: Proven Strategies and Updates  (2016)

Literature:  Enteric Fistulas: Principles of Management (2009)

Read the Journal of the American College of Surgeons article: Enteric Fistulas: Principles of Management

Literature:  Management of Enterocutaneous Fistulas (2011)

Read the Surgical Clinics article:  Management of Enterocutaneous Fistulas

Literature: Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study (2016)

Literature: Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden (2020)

Literature: Long-Term Teduglutide for the Treatment of Patients With Intestinal Failure Associated With Short Bowel Syndrome (2016)


Tools:  Fistula Dressing Change Checklist

Click here to download an example Dressing Change Checklist which may be a helpful reference when creating your own protocol.

Tools:  CeDAR App

Download the free CeDAR app to facilitate conversations with patients about their fistula repair surgery risk profile.  Users simply answer eight questions about themselves, including height and weight. A percentage chance of developing specific postoperative complications requiring treatment is calculated, along with the corresponding cost of this treatment. These results can then be used to discuss a patient’s risk for wound problems after surgery and what changes they can make to improve the odds for a good result.

Inventing a New Device?

University of Minnesota Value Proposition Design Online

This free program earns participants a Certificate in Value Proposition Design from the Holmes Center for Entrepreneurship at the University of Minnesota. Participants utilize Lean Startup tools and receive feedback from instructors deeply experienced in science/technology entrepreneurship. In addition, industry experts and entrepreneur mentors offer insights, advice and connections.

gBETA Medtech

gBETA Medtech is a free, seven-week accelerator that works with medical device, healthcare-related software, biotech and diagnostics startups. Each program is capped at five teams, and requires no fees and no equity.


MakerNurse is a community of inventive nurses who are creating solutions to improve patient care every day. MakerNurses are making the next generation of health technology.

Video: The Frank & Lizzie Show (2021)

Watch the pilot episode of The Frank & Lizzie Show highlighting the development of Fistula Solution devices.  This morning talk-show style channel features clinicians and products within the wound care community.