Wound, Ostomy and Continence Nurses Society (WOCN) Practice Exam

Which of the following conditions would classify as a complex fistula?

1. direct skin opening without complications

2. no abscess present

3. direct tract to skin with organ involvement

4. output less than 500ml per 24 hours

The correct answer is: direct tract to skin with organ involvement

A complex fistula is characterized by its direct involvement with underlying organs or structures, creating a more intricate physiological situation than a simple fistula. When a fistula has a direct tract to the skin and involves other organs, it suggests a significant pathology that can lead to complications such as infection, abscess formation, or disruption of organ function. This complexity necessitates a more thorough assessment and often a multidisciplinary approach for management due to the potential for systemic effects and surgical implications involved in treating such conditions. In contrast, direct skin openings without complications, the absence of abscesses, or low output (less than 500ml per 24 hours) would typically indicate simpler fistula types. Simple fistulas might have fewer associated risks and usually do not engage adjacent organs significantly, making them easier to manage. Thus, while other options describe conditions related to fistulas, they lack the defining feature of a complex fistula, which is the involvement of other anatomical structures or organs.