In today's medical arena, complex medical situations are being treated more aggressively than ever before, resulting in some very complex ostomy and skin care issues for the WOC nurse. The patient is also spending less time in the inpatient setting resulting in a need to utilize resources in the community setting. This poster will highlight a modification of the troughing technique that is able to manage difficult fistulas/wounds, and also allow the patient independence in the outpatient setting.