Enteric fistulae are a relatively common complication of bowel surgery or in surgery where the bowel has been exposed. Fistulae can present a significant threat to patients' well-being. Changes in surgical techniques and in particular the rise in damage control surgery for emergency patients have led to an increase in open abdominal wounds. The presence of an enteroatmospheric fistula on the surface of a wound can cause a number of distressing symptoms/issues for the patient whilst providing a significant challenge for the clinician. The loss of fluid, proteins and electrolytes will place the patient in danger of becoming hypokalaemic and malnourished. A variety of techniques are available, most refer to a method of isolating the fistula using stoma rings or washers and ostomy paste. The role of negative pressure in the management of wounds with fistula is in its infancy; however, there is evidence to suggest that isolation techniques can be advantageous in managing wounds with fistulae.

Fifty patients underwent a variety of hand operations and were randomized for wound closure either with tissue adhesive (Indermil) or sutures. The two treatment groups had similar demographic characteristics and similar outcomes at the 2 and 6 week postoperative assessments which were performed by a designated tissue viability nurse blinded to the method of closure. Five minor wound dehiscences occurred: three in the adhesive group and two in the suture group. No infection occurred in either group. In conclusion, the study demonstrates tissue adhesive is as effective as suture in this type of hand surgery.

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Wound clinics are seeing an increase in the number of 'complex' wounds, which arise as the result of the interaction between multiple coexisting systemic pathologies, environmental factors and local wound factors. These complex wounds require an approach to diagnosis and management that can encapsulate all these factors. Unified wound assessment approaches such as HEIDI (History, Examination, Investigations, Diagnosis and management plan), wound bed preparation and applied wound management systems are essential to reach a definitive diagnosis and to ensure that management is agreed between the various clinical specialities that may be involved. A series of case histories is presented that illustrate the benefits of a unified approach to wound management. Results of a study into the cost-effectiveness of an improved foam dressing are presented, and the problems of demonstrating the ability to make long-term savings through short-term expenditure are discussed.