What is a fistula on a suture after surgery? Manifestations and treatment of postoperative fistula on the leg

Most serious operations end with the application of a ligature - a special thread that stitches together damaged tissue layer by layer. Typically, during surgery, the wound is thoroughly washed before suturing begins. This is done using resorcinol, chlorhexidine, iodopirone and other solutions. If the thread becomes contaminated with bacteria, or the wound has not been sufficiently treated, then suppuration of the ligature occurs and, as a result, a ligature fistula is formed.

A compaction called granuloma forms around the thread that tightens the edges of the wound.. The suture material itself, collagen fibers, macrophages and fibroblasts enter this compaction. The ligature itself is not encapsulated - it is not limited to the fibrous membrane. After such suppuration is opened, a fistula is formed. Most often, one fistula is formed, but there may be several, depending on where the ligature remains.

Typically, such a complication makes itself felt quite quickly, even during the patient’s stay in a medical facility, therefore, during a routine examination by a doctor, the symptoms of a ligature fistula are identified and treatment occurs in a timely manner. The fistula opens after a few days - a break appears on the skin, through which purulent discharge oozes. Along with this discharge, part of the ligature may also come out. In some cases, the process fades, the fistula closes, but after a short time it opens again. The purulent process can last for several months if you do not consult a doctor in time and do not remove the cause of the suppuration.

Most often, ligature fistulas appear when a postoperative wound is sutured with silk threads. It is worth noting that at the present stage they are trying to use suture material that is absorbable, so as not to remove the sutures later, for example, catgut.

Symptoms of ligature fistula

Usually, a fistula cannot be ignored - its external signs are clearly expressed.

• Firstly, compaction and infiltration occurs around the wound channel. The bumps that appear become hot to the touch.
• Secondly, near the scar left after the operation, you can clearly see inflammation - redness will develop as the ligature is applied.
• Thirdly, the wound begins to quickly fester and purulent contents are separated from the outlet. The volume of discharge may be insignificant, but with a rapidly developing process, noticeable weeping may be observed.
• Fourthly, such processes provoke swelling of nearby tissues and an increase in body temperature to significant levels (39 degrees and above).

Treatment of ligature fistula

Treatment of a ligature fistula must begin as soon as possible, since this is a serious complication that can lead to secondary infection, disability, and in severe, advanced cases, sepsis, which can lead to death for the patient. Only a doctor should prescribe treatment, and if suppuration occurs at home, the patient must be urgently sent to the hospital. Treatment of ligature fistula can be implemented in two ways - surgical and conservative. The most commonly used surgical treatment consists of removing the infected ligature, after which the patient must undergo a course of antibiotic therapy. The patient is given a small incision to allow the pus to drain. This will protect the patient from the development of phlegmon - purulent melting of tissue, as a result of which it will be much more difficult to cure the disease. If the ligature can be removed, the fistula is closed. Otherwise, a second attempt is made after a few days until the ligature is removed.

In severe cases, when the ligatures are multiple and entire fistula tracts are formed, excision of the entire postoperative scar along with the remains of the ligatures is indicated.

The wound surface requires special care - the affected area must be washed with special solutions to rid the wound of pus and avoid further development of the pathological process. Typically, hydrogen peroxide or furacillin is used for this purpose. If excess granulations are present, it is recommended to cauterize them. After primary care has been provided, if necessary, the ligature is applied again.

Conservative treatment is possible only when the process is just beginning and the amount of discharge is minimal. In this case, the patient removes dead tissue around the fistula and thoroughly washes out the pus. If possible, also cut off those threads whose ends come out. Next, the patient is given antibiotics and immunity boosters.

Prevention

To avoid the occurrence of a ligature fistula, it is necessary to properly treat the wound before suturing and use only sterile suture material. Also, when the first signs of this complication appear, it is necessary to provide timely assistance. Usually the outcome is favorable.

The result of an operation not related to the treatment of a purulent wound is the closure of the surgical field by suturing. If the tissues are infected, the surgeon creates the opportunity to remove the pus and reduce the amount of infiltration. Suture material used in surgery can be natural or synthetic. Ligature sutures may dissolve spontaneously some time after surgery, or they will require the help of a doctor to remove them.

If a dark cherry-colored serous fluid or purulent discharge is released at the site of the suture, this is a sign of a developed inflammatory process and the formation of a ligature fistula. The appearance of these symptoms is a sign of ligature rejection and a reason to resume treatment. A fistula that appears after surgery cannot be considered as a normal phenomenon; urgent treatment under the guidance of a surgeon is required.

Causes of ligature fistula:

Infection in the wound due to ignoring antiseptic requirements;

Allergic reaction to suture material.

There are factors that increase the likelihood of a postoperative fistula:

Patient's age;

Immune reactivity (usually higher in young people);

Accession of a chronic infection;

Hospital infection, typical for surgical and therapeutic hospitals;

Content

As a result of an inflammatory process or surgical intervention, a so-called fistula can form - a channel connecting two cavities to each other or an organ to the surface of the body. The inside of the fistula is filled with exudate, so the inflammation progresses over time. This pathology cannot heal on its own; mandatory drug treatment or surgical intervention is required.

What is a fistula

As a result of various pathological processes, purulent fluid accumulates at the site of inflammation - it consists of bacterial cells along with their waste products and dead leukocytes. As the pathology develops, the amount of exudate gradually increases; it does not fit into the cavity, so the body tries to give it a way out. This is how a fistula is formed - a fistula (tube, channel), which connects the affected cavity or organ with the place where the exudate exits (the surface of the skin or another cavity).

A purulent secretion constantly passes through a fistula, the surface of which is covered by an epithelial layer or granulation tissue, multiplying inflammation, so spontaneous healing of such a pathology is problematic, but in some cases possible. In addition, fistulas often have multiple branches, which makes surgical removal of the pathology difficult.

Under certain conditions, microorganisms from purulent fluid can “migrate” to surrounding organs and tissues, provoking the appearance of new foci of inflammation. The composition of the separated substance directly depends on the organ with which the channel is connected; The more aggressive the secretion, the more it damages the skin or nearby tissues. When fistulas occur, fluid loss and intoxication of the body occur, which leads to metabolic disorders and water-salt balance.

Fistulas can exist in the body for a long time and, in the absence of proper treatment, affect several organs. If the inflammation of the original organ is stopped, purulent discharge ceases to flow into the canal, it closes and heals. When the pathological process resumes, the fistula begins to function again, accumulate and release exudate - a relapse occurs.

What does a fistula look like?

There are internal fistulas, which connect cavities inside the body, and external ones. A fistula on the skin looks like an inflamed wound oozing pus, the edges may resemble lips (see photo below). An external fistula occurs on a person’s skin near cavities - for example, in the throat and nose. In some cases, a person may not be aware of the presence of an inflammatory process in the body until a fistula appears on the surface of the skin. In case of severe damage to internal organs, not only purulent exudate, but also fecal, urinary, and bile fluid can be released from the canal.

What does it come from?

Gram-negative, anaerobic bacteria, streptococcus aureus, staphylococci, some types of fungi, etc. can act as an etiological factor. Fistulas form for the following reasons:

• (severe chronic disease of the gastrointestinal tract);
• actinomycosis - chronic diseases resulting from infection with a fungus;
• complications after surgery (for example, a ligature fistula is formed due to suppuration around the sutures on the blood vessels);
• chronic ENT diseases;
• the presence of sequestra - dead areas of bone;
• injuries of peri-intestinal tissue;
• dental pathologies (periodontitis, caries);
• – inflammation in the crypts of the anal canal of the intestine;
• neoplasms (benign and malignant) on the rectum;
• suppuration around foreign bodies inside the body (for example, a bullet or its fragments).

Symptoms

The signs of a fistula are in most cases similar, depending on the location of the source of inflammation and the affected organ. Fistulas can occur anywhere, for example: on the back, buttocks, groin, chest, heel, toe, abdomen, perineum, etc. With pathology, the patient experiences the following symptoms:

• low-grade body temperature due to the presence of an inflammatory process in the body;
• signs of intoxication - weakness, headaches and muscle pain, sleep disturbances, decreased performance;
• the presence of a characteristic pain syndrome if the fistula affects the nerve endings (for example, a rectal fistula is accompanied by painful sensations in the anus, which intensify during defecation);
• the pain subsides after the bubble breaks through at the end of the canal and releases the secretion onto the skin or into the cavity.

Kinds

There are several classifications of fistulas. Based on their origin, the following types are distinguished:

1. Congenital fistulas are formed due to malformations of the embryo; Some of them (for example, umbilical fistula) are discovered by doctors before or during childbirth.
2. Purchased pathological channels arise as a result of inflammatory processes, injuries or operations (for example, a fistula on a leg or arm can occur due to a fracture or bruise).
3. Created artificially fistulas are designed to drain fluids from the body (purulent, urinary, fecal, bile).

According to their location, fistulas are divided into the following types:

1. Urinary– installed on the ureters, bladder or urethra, may form as a result of injury.
2. Gall fistulas occur due to operations on the gallbladder. The secretion secreted by such a fistula leaves burns on nearby tissues, so treatment must be started immediately.
3. Purulent canals can appear anywhere on the body; they often appear on the gums due to poorly healed teeth. In rare cases, a purulent fistula can heal on its own, but more often a relapse occurs and purulent exudate begins to be released through the canal again.
4. Salivary fistulas are formed as a result of inflammatory processes on the cheek, neck or ear; saliva is released through them.
5. Bronchial– connect the bronchi with the pleural cavity.
6. Gastric fistulas are installed artificially for enteral feeding of the patient after gastrectomy with deviations of the digestive system and gastrointestinal tract.
7. There are fistulas of the upper and lower parts of the small intestine. The first arise due to injuries or operations, often heal on their own with proper care, the second are created by surgeons to drain feces in case of intestinal obstruction or peritonitis (fecal fistula).
8. Channels in the large intestine arise as a result of injuries, operations or are installed artificially. They often heal on their own, but require special care - the use of protective ointments to avoid injury.

Diagnostic methods

To make an accurate diagnosis, the doctor gets acquainted with the patient’s medical history, palpates the inflammatory focus, assesses the amount and appearance of the secreted fluid, and asks the patient about complaints about dysfunction of internal organs. After this, the doctor refers the patient to further diagnostic measures:

• A blood and urine test and blood culture for the presence of pathogenic bacteria can indicate the presence of inflammation and its nature.
• CT (computed tomography), MRI (magnetic resonance imaging) are often used as a means of diagnosing fistulas.
• One of the most effective methods is radiography with the introduction of a contrast agent into the fistula cavity to determine the size, length, and branching of the fistula.
• The probing method is considered no less effective; it is used only in cases of external fistulas, in which the outer edge extends to the surface of the skin.
• Studies of purulent fluid are used to determine the primary organ that gave rise to the pathological canal.
• During fistula surgery, specialists inject dyes (such as methyl blue) to evaluate the entire structure of the canal and accurately identify the original organ.
• Ultrasound is rarely used to diagnose fistulas, because this method is less informative.

Treatment of fistula

In essence, a fistula is a tube with dead remains of bacteria; often its treatment consists of excision of the canal, cleaning it chemically or mechanically and relieving the inflammation of the organ from which the fistula began. For example, when getting rid of a rectal fistula, the most effective method is surgery. Full recovery of the patient occurs in 20-30 days, during which time the patient is advised to take medicinal baths and refrain from physical activity to avoid sphincter injuries.

Local remedies are also used to treat fistulas (baths, ointments, powders, antiseptic rinsing solutions, etc.). In some cases, the doctor prescribes antibiotics to eliminate bacterial infection, painkillers and antipyretics to improve the patient's condition. The following medications are used as drugs used for the treatment of fistulas:

Folk remedies

Treatment of simple fistulas with medicinal herbs is highly effective. In some cases, complete recovery is observed. Ointments and baths based on natural ingredients are used as medicines. Aloe and cabbage have the most effective healing effects; the juice of these plants helps remove pus from the fistula and quickly heal the wound. Before using any medications, the patient should consult a specialist.

Ointment

The following products are used as homemade ointments:

1. Mix vodka and olive oil in a 1:1 ratio, treat the affected area with the mixture several times a day, then apply a cabbage leaf to remove pus. To achieve maximum effect, the product is used for several weeks.

Decoctions

A few examples of tinctures and decoctions for the treatment of fistulas:

1. Mix equal amounts of aloe juice and mummy juice (after soaking it in water), and apply a bandage soaked in the solution to the sore spot for a long time.
2. 2 tablespoons of St. John's wort are poured into 2 glasses of water, the mixture is boiled for 10 minutes, and the resulting solution is filtered. The mixture is laid out on film and the sore spot is wrapped with such a compress, then the inflammation site is washed with the remaining solution. The product is used until the canal begins to release exudate.
3. Prepare a tincture of dandelion flowers in triple cologne to cure external fistulas. The resulting liquid is pipetted directly into the fistula canal to achieve maximum therapeutic effect.

Video

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Postoperative fistula Doctors consider it one of the complications after surgery.

The patient’s first action is to notify the attending physician. A postoperative fistula is easily recognized; it is simply a hole in the skin from which fluid oozes.

Under no circumstances should you wait for the wound to heal on its own.

Causes of postoperative fistula

Doctors will use probes to determine its connection with surrounding organs.

For labiform fistulas, in most cases, surgical treatment is resorted to, since conservative treatment in this case is futile.

Tubular fistula In some cases, it may close on its own, but this will happen only after the discharge stops.

Epithelized fistulas and their treatment

Epithelialized fistulas are already formed, essentially covered inside with skin and cannot close on their own, therefore, treatment of epithelialized fistulas can only be done with the help of surgical intervention, which eliminates the pathological focus that initiated the occurrence of the fistula, in addition, the fistula tract and the epithelium covering its surface are excised .

How is a fistula that appears after surgery treated? We will introduce you to the most effective methods of treating ligature fistulas, and also tell you why they appear.

Any, even the simplest, surgical intervention on the human body, as a rule, requires quite a lot of time for wounds to heal. Absolutely all operations end with sutures, which should contribute to a faster and better recovery of the patient.

But sometimes, precisely in the place where the open wound was sutured, a strong inflammatory process begins, which is characterized by redness of the skin and the formation of pus. All this indicates that the person has developed a rather serious complication that requires immediate and high-quality treatment.

If you do not start fighting the fistula as quickly as possible, then it is likely that the patient may require another surgical intervention.

What is a fistula after surgery, what does it look like?

• Fistula is a hollow channel inside the human body that connects human organs with the external environment. Also, a fistula can connect an internal cavity with a benign or malignant formation. As a rule, this tube is lined with epithelium and is a channel through which pus formed inside the body after surgery is released.

• Outwardly, it looks like an ordinary deep wound, around which the skin has become inflamed. A fistula can appear on almost any part of the body, and not necessarily in the place where the incision was made. There are cases when the inflammatory process occurs inside the body for a long time and a person learns that something is wrong with him only when a characteristic hole appears on his body, releasing purulent masses

• But not only pus can be released from the fistula; if the problem has not been dealt with for a long time, and it has affected the internal organs, then feces, urine and bile can be released from the canal that has formed

In addition, doctors distinguish several other types of postoperative fistulas:

1. Full. It has two exits at once, which contributes to faster relief of the inflammatory process and healing
2. Incomplete. It has only one exit, which is usually located inside the abdominal cavity. This contributes to the intensive proliferation of pathogenic microflora and increased inflammatory processes
3. Lip-shaped. In this case, the fistula fuses with the dermatological tissue and muscle tissue. It can only be removed surgically
4. Granulating. This type of fistula is characterized by the formation of granulation tissue, hyperemia and quite severe swelling
5. Tubular. A fully formed duct that secretes pus, mucus and feces

Ligature fistula of postoperative scar after childbirth, cesarean section, appendicitis: signs, causes

• Ligature- these are special medical threads that doctors use for layer-by-layer stitching of tissues damaged during surgery. Usually, before using them, the open wound is thoroughly treated with disinfectants and only after this proceed to suturing

• But sometimes such actions are not enough and pathogenic bacteria enter the body along with the thread, provoking severe suppuration and the formation of a ligature postoperative fistula. As a rule, it opens after a few days and the material that was used to stitch the wound comes out along with pus.

• Most often, this problem is caused by silk threads, so recently doctors have begun to use a material that dissolves on its own after a minimum period of time and does not require the removal of sutures or additional processing

The main reasons for the appearance of a fistula after surgery:

• Orgasm perceives the material that was used to stitch the wound as a foreign body and begins to reject it
• The wound itself, as well as the ligature, becomes infected
• Untimely and poor-quality processing of the postoperative suture
• The patient is too old
• Excess weight
• Reduced immunity

Signs of a fistula:

• A seal appears around the cut in the skin, which begins to hurt noticeably when pressed. In some cases, pronounced tubercles appear that secrete infiltrate

• Redness will be clearly visible near the infected scar. Moreover, it will look brightest as the ligature is applied

• The temperature may rise very sharply. And since the inflammatory process in the body will intensify all the time, it will not go astray to normal levels

• Severe suppuration appears, which, if not treated correctly, turns into a weeping quite large size

• The fistula opening may heal for a while and then become inflamed with renewed vigor.

Consequences that cause fistulas

Postoperative fistula itself is not life-threatening. But if the patient lets everything take its course, then the pathogenic bacteria that are inside the fistula opening will begin to infect healthy organs and tissues, and this will provoke the appearance of quite serious diseases.

In addition, the body may refuse to respond correctly to medical therapy, which in turn can also cause quite serious complications.

The most common complications in the treatment of fistula after surgery:

• Abscess. Purulent masses fill the entire internal cavity of the fistula opening
• Phlegmon. In this case, the pus, in addition to tissues, also begins to affect fatty tissue.
• Sepsis. A fistula opening occurs inside the human body. The pus ends up on the patient’s internal organs.
• Fever,provoked by a purulent mass. Temperatures can rise to maximum levels. In this case, a person may lose consciousness and have difficulty oriented in space.

Purulent fistula on a surgical suture - treatment

• As you probably already understood, a purulent fistula is not a death sentence and, with proper treatment, almost always responds quite well to treatment. But still, in most cases, surgery is usually required for a favorable outcome.

• If the doctor decides to delay the intervention, the patient will be prescribed conservative treatment. But it should also be carried out under the strict supervision of a specialist and preferably in a hospital setting. Typically, such treatment is aimed at eliminating pathogenic microflora that provokes inflammation

• If the therapy is chosen correctly, the fistula opening will heal fairly quickly and the patient will be able to return to normal life. To treat an inflamed area of ​​skin, drugs that have antiseptic, antibacterial and bactericidal effects are usually used

• In addition, the patient must be prescribed antibiotics and vitamins, which help maintain the body’s defenses at a normal level. But I would like to immediately say that conservative treatment does not provide a 100% guarantee that the fistula will not reopen. Therefore, most doctors suggest not to suffer and immediately perform surgery to remove the purulent focus

• After washing the wound, drainage is usually installed in it. In the postoperative period, the drainage is washed daily and sterile dressings are changed. If after a few days the amount of purulent masses does not begin to decrease, then the patient is additionally prescribed anti-inflammatory drugs, antibiotics and vitamin E

• In addition, bandages and ointments can be used to stimulate the healing process. In this case, for example, troxevasin ointment may be prescribed. As soon as the purulent ceases to be released, the drainage is removed from the wound and then the patient can only make sure that no infection gets into it and periodically change the bandage

In a trailer, it is permissible to treat ligature postoperative fistulas using traditional methods. Some of the methods described below remove inflammation quite well and reduce the amount of pus.

But still, if you decide to get rid of the problem in this way, then before starting treatment, be sure to consult with a specialist. After all, if you have neglected your condition very much, then it is likely that you will only aggravate the course of the disease.

So:

• Take equal parts olive oil and strong vodka and mix until smooth. Wipe the inflamed area of ​​skin with the resulting mixture 3-4 times a day. To enhance the therapeutic effect, you can immediately apply a cabbage leaf previously scalded with boiling water. This way you will not only kill pathogenic microflora, but also contribute to a faster discharge of pus

• To prepare the next miracle remedy, you will need mumiyo and aloe juice. The mummy should be soaked in boiled water, and when it turns it dark brown, add aloe juice to it. You will need to moisten a sterile bandage in this solution and apply it to the sore spot.

• If you need to draw out pus as quickly as possible, then use the familiar herb St. John's wort for this. In this case, you can use both the decoction and the leaves. First, tear off the St. John's wort leaves, fill them with water, and then simmer over low heat for 10-15 minutes. When the broth has cooled a little, soak a bandage in it and place the leaves on it in one layer. Fix this bandage on the fistula and leave it there for 4 hours. After this time, the bandage must be removed, the sore spot treated with hydrogen peroxide, and then a fresh one applied.

• A decoction of celandine will help you fight fistula from the inside. If you prepare a decoction from this plant and take it regularly for a month, the substances that it contains will kill the infection located in the fistula opening and help relieve inflammation. But since this decoction thickens the blood very much, it will be better if the dosage is determined by a doctor

• You can try to get rid of a fistula with regular black bread. Take the pulp and lightly sprinkle it with water. When the top layer softens a little, apply the bread to the sore spot and secure with a sterile bandage. This procedure must be carried out once a day. Before each znamenny bread, be sure to treat the wound with hydrogen peroxide. If you do everything correctly, then approximately on the third day you will see that the fistula is completely cleared of pus and begins to heal

Ointment for the treatment of postoperative fistula

Home-made ointments have also proven themselves quite well. They eliminate the cause of the infection quite well and contribute to a faster restoration of the dermatological integument. But even in this case, it is extremely important to be very careful when applying the ointment, as well as pre-treatment of the wound.

You need to protect yourself from re-infection of the fistula opening. After all, if you apply unsterile dressings and use a product of questionable quality, you are unlikely to improve your condition.

The most popular ointments:

• At home, you can also use an ointment that will have anti-inflammatory and healing properties. To prepare it, you will need pine resin, natural honey, butter, aloe pulp and medical tar. All ingredients are mixed in equal parts and brought to homogeneity in a water bath. The resulting product should be applied to previously disinfected areas of the skin.

• Another effective remedy is ointment made from fresh calendula flowers. They need to be tightly folded into a half-liter jar and filled with melted pork fat or butter. Leave the product in a dark place to brew for 10-12 hours. Then transfer it to a clay pot and simmer for 48 hours in the oven at 70 degrees. After the ointment has cooled, transfer it to a container with an airtight lid and store in a cool, dark place. You can simply lubricate the fistula opening with the resulting product or make medicinal dressings from it.

As mentioned a little above, the best way to get rid of a postoperative fistula is to completely excise it. Although this procedure is quite painful and has a fairly long recovery period, it will protect you from the development of complications such as sepsis and phlegmon.

Stages of the operation:

1. First, the fistula opening and all the skin around it are treated with antiseptic agents.
2. Anesthetic substances are then injected into the wound area
3. At the next stage, the wound is carefully dissected and all pus and remnants of the ligature are removed from it.
4. After this, everything is washed well, drainage is installed and closed with a secondary suture.
5. In this case, the vessels are not sutured, as this can lead to the formation of another fistula

After surgery, the affected area of ​​skin will require special care. The wound will definitely need to be treated with disinfecting solutions (for example, furatsilin) ​​and ensure that it is clean and dry at all times. If, even after surgery, excessive granulation is noticeable at the site of the fistula, it must be cauterized immediately.

Video: Ligature fistula of the perineum