Fistula after hernia repair. Postoperative fistula on the abdomen treatment

Article prepared by:

Ligature fistula - suppuration in the area of ​​surgical suture. Violation occurs when using non-absorbable threads. Pathology can appear only after surgery. The complication is rare. First, a fistula appears in the area of ​​the suture and then forms. The pathology is characterized by the development of the inflammatory process. It requires urgent treatment and is accompanied by a large number of unpleasant symptoms.

The formation of a fistula is an abnormal reaction of the body. Threads can be of synthetic or natural origin. A violation is usually indicated by the presence of a dark discharge. Deviation becomes a source of infectious diseases. Poses a huge danger to the life and health of the patient. It is absolutely impossible to ignore the existing violation.

In this article you will learn:

General information about the complication

Ligature fistula is a complication caused by a previous surgical intervention. It is the result of suppuration and contamination in the suture area. The pathology is characterized by rapid development. You should consult a doctor when the first signs appear.

Ligature is a thread that is used to ligate blood vessels. A suture using such material is required to stop internal bleeding. Necessary for most surgical procedures.

A ligature fistula is an inflammatory process in the area where the wound is sutured. The tissue begins to rapidly thicken. Violation can lead to the development of an abscess.

During operations, a non-absorbable thread is often used - a ligature.

Root causes of violation formation

The root causes of fistula are varied. Provoking and predisposing factors are listed in the table.

The risk of a disorder will increase with a lack of vitamin and mineral complexes, as well as deviations in metabolic processes. Most often, pathology is formed when the basics of personal hygiene in the wound area are ignored and the doctor’s recommendations are not followed.

Failure to comply with antiseptic rules leads to the entry of pathogenic bacteria. An inflammatory process is formed. The tissues become denser and a fistula appears.

Symptoms of the disorder

Symptoms of a ligature fistula include:

• redness;
• increase in body temperature;
• compaction;
• pain in the suture area;
• bleeding and discharge mixed with pus.

The fistula tract may close for a while. However, it will reopen after some time. If there is a deviation, the temperature rises to a maximum of 38 degrees. The symptoms can be eliminated only by acting on the provoking factor.

Most often, pathology is formed due to the use of synthetic thread. Over time, peculiar compacted bumps appear near the seam. Pus leaks out of them. The quantity may vary. Small-sized formations may not cause discomfort to the patient for a long period of time. Redness, swelling and swelling usually appear near the suture. There may be signs of intoxication in the body. If assistance is not provided in a timely manner, irreversible complications occur. The sick person may become disabled.

A fistula is characterized by the presence of an external opening when the risk of dermatitis is high. In severe cases, body temperature can reach 39 degrees.

Possible complications

Complications of a ligature fistula include:

• phlegmon;

• eventration;
• sepsis;
• toxic-resorptive fever.

When an abscess forms, a large amount of pus accumulates near the suture. It is always a consequence of the inflammatory process. The deviation is accompanied by a significant increase in temperature.

Cellulitis is the development of purulent formations under the skin. The inflammatory process affects connective tissue. The defeat has no clear boundaries. The complication requires timely treatment. The disorder affects the muscles and tendons.

Eventration is a process in which loss of internal organs occurs through a formed tissue defect. Pathology can be external, internal and subcutaneous.

Sepsis is a complication in which an infection enters the blood and spreads throughout the body. Pus enters the cavity of the skull, chest and abdomen. The patient must be hospitalized immediately.

Toxic-resorptive fever is a consequence of the absorption of toxic substances during purulent inflammation and tissue breakdown.

The condition is characterized by a spontaneous deterioration in health, while body temperature indicators can increase to 39-40 degrees.

Diagnostic methods

Primary diagnosis is carried out during dressings using visual inspection. However, it is worth noting that pathology can manifest itself not only immediately after surgery, but also a year after the operation. It is important that the patient pays attention to the signs that are present.

• detect possible complications;
• determine the location of the fistula.

If a patient is suspected of developing a disorder, they may be referred for fistulography. The method is required when a fistula develops in the thickness of the tissue. During the study, a contrast agent is used and radiography is performed. The resulting image clearly shows the deviation.

Therapeutic methods

Treatment should be started as early as possible. The complication is dangerous and can cause secondary infection. Pathology can lead to death. Therapeutic methods are selected by the doctor.

Treatment may be:

• conservative;
• operational.

Most often, patients are recommended surgical treatment. The operation to eliminate a fistula involves removing the infected ligature. Doctors first make a small incision so that all the pus comes out, and then close the defective formation. After the procedure, the patient is prescribed a course of antibacterial therapy. The wound is washed with special solutions. They give a referral for physical therapy.

Conservative treatment is only possible if you consult a doctor in a timely manner and there is a small amount of pus. In this case, the doctor removes the dead tissue near the fistula. The patient is prescribed antibacterial drugs and medications to improve protective functions.

Preventive methods

Prevention directly depends not on the patient, but on the surgeon. It is important that the doctor carefully observes antiseptic rules when performing the operation. All suture material must be sterile.

Before the operation begins, the wound must be washed. Before the procedure, the doctor must check the threads. The material must:

• have a valid shelf life;
• hermetically sealed;
• be sterile.

Only if you follow all the doctor’s recommendations can you significantly reduce the risk of developing a deviation. However, it is impossible to completely exclude it. After surgery, the patient must follow all doctor's orders. The wound needs to be treated regularly.

This video explains why postoperative wounds suppurate and how to treat it:

Forecast

The prognosis in the presence of complications is favorable in most cases. The main thing that needs to be done is to consult a doctor in a timely manner. Only in this case will it be possible to quickly get rid of the violation.

The prognosis is less favorable if the patient ignores the presenting signs for a long period of time. In most cases, repeat surgery is effective. A secondary manifestation of deviation is possible only if the basics of hygiene are ignored and there is an individual intolerance to suture material.

The pathology has an unfavorable prognosis if treated independently. Self-medication is strictly contraindicated and ineffective. Can pose a huge danger to health and life.

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

Fistula in the coccyx area

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. 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 fistula

• 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 reason for the development of postoperative fistula is infection

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 can provoke the development of sepsis

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

Treatment of purulent fistula

• 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

Only surgical intervention can help completely get rid of the fistula.

• 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

Folk remedies for the treatment of fistula

It is permissible to treat postoperative ligature fistulas in a trailer. 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.

St. John's wort decoction for the treatment of fistulas

• 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

Ointment with calendula for healing fistulas

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

A prospective study found that more 62,000 surgical wounds are infected. The degree of wound infection varies markedly depending on the degree of contamination of the surgical field. The risk of wound infection in sterile surgical conditions (there is no infection in the operating room, there are no violations in aseptic procedures, the internal organ is not opened) is less than 2%, while in non-sterile conditions it is 40% or more.

Before surgery, the skin surface is treated with hexachlorophene to prevention of infection of surgical wounds, but at the same time, shaving hair at the surgical site increases the risk of infection. Treatment of the surgical field 5 minutes before surgery was as effective as 10 minutes before surgery. The risk of wound infection increased with prolonged hospital stay, as well as with prolonged surgery.

In addition, concomitant appendectomy increases the risk of wound infection in patients after performing “clean” operations. It has been found that the likelihood of wound infections can be reduced by shortening the preoperative hospital stay, treating the surgical site with hexachlorophene, reducing the area of ​​hair shaving, good surgical technique, reducing operative time as much as possible, placing drains outside the surgical wound, and educating surgeons regarding the frequency wound infection. Compliance with these rules led to a sharp decrease in the frequency of wound infections - from 2.5 to 0.6% over 8 years.

Although wound infection with most gynecological operations below 5%, which reflects the “purity” of most of them, the risk of wound infection in patients with malignant neoplasms of the genital organs is higher.

Symptoms of wound infection often present postoperatively, usually after 4 days, and include fever, erythema, tenderness, induration, and purulent discharge from the wound. The cause of wound infections detected on days 1-3 is usually streptococcal and clostridial infections. Treatment of wound infections is usually mechanical: opening the infected wound area above the fascia, cleaning the edges of the wound, if necessary.

Maintaining surgical wound includes sanitation and changing the gauze bandage 2 or 3 times a day, which promotes the growth of granulation tissue at the site of the defect after secondary surgery with gradual scarring. The use of a special vaccine for large wounds speeds up healing and reduces the number of dressings. Cleanliness and granulation of the wound often helps reduce the time required for complete secondary healing.

Delayed method healing of the primary wound can be used to reduce the likelihood of injury. Briefly about this method: before the surgical procedure begins, the surgical wound is left open above the fascia. A vertical interrupted suture is applied through the skin and subcutaneous tissue, 3 cm away from the edge, without connecting the edges of the wound. Immediately after surgery, the wound is monitored until the wound begins to granulate well.

The seam can then be joined nearby skin edges sewn or fastened. Using delayed primary wound healing has been shown to reduce the overall rate of wound infection from 23% to 2.1% in high-risk patients.

Stump infection vagina after hysterectomy it is characterized by erythema, induration and tenderness of the stump. Sometimes there is purulent discharge from the upper part of the vagina. Parametritis is often limited and does not require treatment. Fever, leukocytosis and pain in the pelvic cavity can be associated with severe inflammation of the loose tissue of the vaginal stump, which often extends to the parametrium. In such cases, therapy with broad-spectrum antibiotics against gram-negative, gram-positive and anaerobic microorganisms is indicated.

If in a cult vagina there is extensive suppuration or fluctuating masses are noticed in it, it should be carefully examined, opened with a blunt instrument and left open for drainage.

We are pleased to present to you the first social network of healthy lifestyle supporters on the Russian-language Internet and a full-fledged platform for sharing experience and knowledge in everything related to the words “health” and “medicine”.

Our task is to create an atmosphere of positivity, kindness and health on the site, which will lift your spirits, improve your health and prevent you, because information and thoughts are transformed into material events! ;-)

We strive to create a highly moral portal in which a variety of people will enjoy staying. This is facilitated by the fact that we monitor the actions of all users. At the same time, we want the site to be fairly objective, open and democratic. Here everyone has the right to express a personal opinion, to make their own assessment and comment on any information. In addition, anyone can submit an article, news or any other material to most sections of the site.

Project “To your health!” is positioned as a portal about health, not medicine. In our opinion, medicine is the science of how to recover from a particular disease, and health is the result of a lifestyle in which you do not get sick. The healthier you are, the less likely you are to get sick. Our body is designed in such a way that with the right lifestyle we should not get sick at all. So let's improve our health instead of studying diseases. There are quite a lot of websites about medicine, but in our opinion, they are intended more for medical professionals than for ordinary people. We strive to talk to you about health. We don’t want to write a lot about diseases and methods of treating them - enough has already been written about this. Instead, we'll focus on how to avoid getting sick.

We are interested in a healthy lifestyle, and we want to live happily ever after. We believe that you are also not indifferent to the topic of healthy longevity. Therefore, if you want to be surrounded by healthy people and those who strive for this, this site will help you solve this problem. Our plans include creating an active community of people leading a healthy lifestyle, and in this regard, we are pleased to offer you the following opportunities:

• create your own page with personal photos, blog, forum, calendar and other sections

Do what you like, and we will try to provide you with everything you need for this. We strive to make this site as comfortable as possible for you. There is still a lot of new and interesting things ahead.

Register yourself and invite your colleagues, friends and loved ones to the site for constant contact with them and exchange experiences. Stay in touch, discussing all the news and interesting things in the field of health.

Stay with us!

Every operation is a serious risk for the body. Currently, doctors try to carry out most surgical interventions with minimal suturing to the wound area. However, even with careful adherence to all rules of care for the surgical area, complications such as ligature fistulas may occur. According to statistics, every tenth working-age patient and every fifth pensioner encounter them. That is why it is necessary to know the first symptoms of the onset of the disease, and also pay great attention to the rules of prevention. This way you can protect yourself and your loved ones from developing such a complication.

What is a ligature fistula?

A ligature fistula is an inflammatory cavity formed after surgery, which contains purulent masses. Almost all surgical procedures involve damage to the patient's soft tissue. To close the resulting defect and ensure immobility of the wound edges, doctors use special sutures. The threads that are applied to the damaged area are called ligatures. Unfortunately, such intervention is often complicated by the addition of an inflammatory process.

How long after surgery does the disease appear?

A ligature fistula can develop in the early postoperative period (in the first seven to ten days after surgery). Moreover, its occurrence is associated with infection of the suture material. If a fistula forms in the late postoperative period (on the eleventh day or later), then this is a consequence of defects in care and dressing.

What types of surgical intervention provoke the development of a ligature fistula?

A similar pathology can occur during the following operations:

1. Appendectomy. This is a surgical procedure to remove the appendix of the cecum, which is located in the right side of the abdomen just above the pubis.
2. Caesarean section is a method of removing a child from the mother's body. In this case, the incision is located directly above the pubis, and doctors sequentially dissect the skin, fatty tissue, muscles and uterus. The danger of developing a fistula after this operation is that the pus directly enters the reproductive organs and can cause infertility.
3. Mammoplasty is a surgical procedure aimed at increasing breast size. A silicone implant is inserted through an incision located under the breast, in the area of ​​the nipple or armpit.
4. Episiotomy is an operation to cut the perineum. Used for difficult births (multiple pregnancies, large children).
5. Nephrectomy is a surgical procedure during which a kidney is removed. In this case, the incision is located in the lumbar region, as a result of which the wound is almost always subjected to greater stress.

Photo gallery: location of sutures after various operations

Caesarean section is one of the most difficult operations, which usually involves a large incision.
With mammoplasty, a ligature fistula under the breast is quite often formed. After surgery to remove the appendix, the suture is located to the right of the midline

What is ligature infiltrate and ligature granuloma?

A ligature granuloma is an inflamed area of ​​tissue that is limited from surrounding organs by a protective rampart. Its formation is associated with massive growth of connective tissue substance, which fills the entire space of the defect.

Ligature infiltrate is a cavity within which altered cells and inflammatory fluid are located. And it is also possible the presence of pus, blood and other foreign impurities.

Causes of ligature fistula

A similar pathology develops after bacterial microorganisms enter the wound. Most often it is staphylococcus, streptococcus or Pseudomonas aeruginosa. However, the following factors from the body and the environment also take part in the formation of a ligature fistula:

• hypothermia or overheating in the sun;
• infection of suture material;
• insufficient disinfection of the skin during surgery;
• previous bacterial or viral diseases (colds, acute respiratory viral infections);
• extremely low or too high body weight;
• the presence of malignant or benign formations;
• allergic reaction to the components of the threads;
• old age of the patient;
• condition after childbirth;
• poor diet with insufficient protein or fat;
• other injuries.

How does the formation of such pathology manifest itself?

The symptomatic picture of the development of a ligature fistula is quite typical and does not differ in a particular variety of symptoms. A few days or weeks after the operation, the victim begins to feel pain in the wound area. It is often accompanied by swelling and redness: the seam looks swollen, the threads change color. The skin becomes hot and bright pink, leaving a white imprint when pressed.

After a few days, hemorrhages appear in the area of ​​the injury, similar to large and small bruises. At the same time, the nature of the discharge from the wound changes: from yellowish, colorless or bloody, it becomes purulent. In this case, the color changes to green, and an unpleasant odor occurs, which is provided by existing bacteria. Patients complain of severe pain and an increase in the amount of discharge when pressed. The skin next to the affected area becomes densely swollen, becomes hot and tense, sutures can cut through and injure surrounding tissues.

Chronic and asymptomatic course of such pathology is quite rare. Most often it occurs in older people, which is associated with a violation of the rate of metabolic processes in the body.

With a more severe course of the disease, symptoms of general intoxication gradually increase:

• nausea and vomiting not associated with meals;
• and dizziness;
• loss of appetite;
• rise in body temperature to 37–40 degrees;
• decreased performance;
• increased fatigue;
• sleep disturbances due to pain and frequent awakenings;
• nervousness, irritability and other changes in mental state.

In some cases, the purulent canal ruptures and the wound cleanses itself. This way you can see the formed passage - a fistula. At the last stage, the formation of such a disease can be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and requires immediate resuscitation.

Methods for diagnosing the disease

An experienced doctor will be able to suspect the development of a ligature fistula in a patient at first glance. To do this, he only needs to examine the area of ​​damage and assess the condition of the seams. However, in order to prescribe treatment, it is necessary to obtain more complete information about the size and course of the fistula, as well as find out which microflora caused its development.

What treatment methods help get rid of the disease?

Ligature fistula is a pathology that is prone to frequent recurrence. That is why therapy lasts an extremely long time and requires a responsible attitude not only from the doctor, but also from the patient himself. At the initial stage, doctors prescribe local medications for external treatment of the wound. In this case, the patient must appear for dressing changes every two days or show the stitch to the attending physician at least once a week (when it is not possible to constantly go to the hospital). If the pathological process continues to progress, drugs of a more general effect are prescribed that affect the condition of the whole organism. Surgical intervention is performed in the absence of positive dynamics from conservative treatment within one and a half to two weeks.

Do not forget that with repeated surgery there is also a risk of a ligature fistula. It is necessary to care for the wound according to the same principles as during primary surgery.

Drug therapy of pathology

Treatment of ligature fistula with conservative means involves the use of pharmaceutical drugs with local and general effects. They allow not only to get rid of the symptoms of the disease, but also to completely eliminate the cause that provoked the development of the disease.

Remember that the use of any medications without medical prescription is strictly prohibited. In my practice, I have encountered a patient who independently began taking antibacterial agents without reading the contents of the instructions. He also suffered from cardiovascular disease, for which there is a rather limited list of drugs acceptable for use. In an effort to recover faster, the patient also repeatedly exceeded the dosage of the antibacterial drug. This led to the development of serious complications: the man fell into a comatose state, from which the intensive care unit doctors had to bring him out. The situation ended happily, but the victim acquired a profound disability as a result of his experiments. That is why doctors advise to be very careful when choosing medications.

Means for local treatment of ligature fistula:

1. Antiseptic solutions are intended for treating the wound surface. They allow you not only to remove residual sebum, blood, ichor and purulent secretions from the skin, but also kill most harmful microbes. For this purpose, Miramistin, Chlorhexidine, hydrogen peroxide, Furacilin, and potassium permanganate are most often used.
2. Healing ointments that improve blood circulation and help accelerate regeneration processes. The most common products: Bepanten, Rescuer, Dexpanthenol, Pantoderm.
3. Anti-inflammatory gels reduce the severity of swelling, combat itching and relieve pain. Most often used: Diclofenac, Nise, Nimesulide, Ibuprofen, Ketorol, Ketorolac.

Photo gallery: preparations for local wound treatment

Chlorhexidine helps disinfect the wound surface
Dexpanthenol accelerates recovery processes Diclofenac is an anti-inflammatory drug with analgesic effect

Medications for general therapy:

1. Antibiotics have pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Claforan, Tetracycline, Vibramycin, Caten, Augmentin, Unazin, Azlocillin, Zinnat, Aztreonam, Imipenem, Vancocin, Rondomycin.
2. Steroidal anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body and relieve redness and swelling of soft tissues. The use of Hydrocortisone, Cortef, Laticort, Dexona is acceptable.
3. Vitamin and mineral complexes accelerate the healing process and restore the body's need for certain substances. Most often used: Complivit, Calcium D3-Nycomed, Aevit, Vitrum, Supradin.

Photo gallery: drugs for systemic effects on the body

Augmentin is a broad-spectrum antibiotic that kills bacteria Cortef helps relieve inflammation Vitrum contains all the mineral elements necessary for the body

Surgical treatment of ligature fistula

Conservative therapy is not always an effective method for such a disease. If the disease progresses steadily, doctors decide on the need for repeated surgery. It is carried out under the following conditions:

• addition of purulent complications;
• a sharp deterioration in the patient's condition;
• lack of effect from conservative therapy;
• cutting through suture material.

Contraindications to surgery:

• the need to stabilize the victim’s condition;
• too old or too young;
• acute allergic reaction to anesthesia components.

The operation is carried out in several stages:

1. Doctors numb the area of ​​intended intervention. The choice of anesthesia technique (general or local) depends on the location of the suture and its size. The surgical field is treated with an alcohol and iodine solution.
2. Using a scalpel and tweezers, the old suture material is removed, while simultaneously expanding the incision area. Next, doctors examine the condition of the wound, the presence of purulent streaks and ulcers, and, if necessary, add a dye (this allows them to determine the course of the fistula).
3. Using vacuum suction, surgeons remove accumulated blood, lymph fluid, and areas of dead tissue. The formed fistula is excised with a scalpel.
4. The wound is closed using another suture material. If necessary, a thin rubber tube is placed in one of its corners - drainage, through which the contents flow out. The sutures are covered with a sterile bandage with healing ointment.

How to properly care for the site of suppuration

To avoid secondary infection and protect your body from the development of purulent complications, you need to keep the wound clean. The first few days after the operation, the dressing and suture treatment is carried out by a nurse under the supervision of a doctor. But in some cases, the patient has to independently care for the surgical wound from the very beginning. That is why the following processing steps must be followed:

1. Wash your hands with soap and then dry them with a paper towel (this will help minimize bacteria). Disinfect your palms and fingers using an antiseptic.
2. Treat the skin around the wound with water and cotton pads. You can use gels without alcohol fragrance. If necessary, also wipe the skin with an antiseptic without touching the seams.
3. Carefully remove the bandage. You need to do this with soft and gentle movements, as jerking can damage surrounding tissue. If soaking in ichor and blood occurs, the bandage can be soaked in antiseptic or plain water.
4. Using a small gauze pad, smooth the surface of the seam evenly. Try to remove dirt and dried blood. Continue rinsing until the wound is clean.
5. Apply a bandage with the ointment prescribed by the doctor and carefully wrap it with an elastic bandage. At the same time, try not to overtighten the soft tissues.

What is strictly prohibited to do during the rehabilitation period:

1. Visit baths or saunas, take a hot bath. Steam helps soften the tissue around the seam, as a result of which the threads cut through and an even deeper fistula is formed. For the same reason, you should not apply a heating pad to the affected area.
2. Swim in public ponds, rivers and quarries. That water does not undergo special treatment and is a source of many harmful bacteria that penetrate even through a bandage. Swimming in pools is limited due to the presence of chlorine, which disrupts the healing processes of soft tissues.
3. Use alcohol-containing solutions to treat wounds without medical prescription. Such drugs not only kill bacteria, but also damage the smallest blood vessels, causing bleeding. That is why their use is strictly limited.

Video: methods of dressing and treating wounds

Features of treatment of ligature fistula after various types of operations

Often, such a complication occurs after natural and artificial childbirth (caesarean section) or episiotomy. During pregnancy, a woman’s body is under the influence of hormones, as a result of which soft tissues lose their former elasticity and undergo mechanical stretching and tearing.

According to statistics, every third birth ends with stitches being placed on the damaged perineum.

A feature of the treatment of this condition is the impossibility of using many conventional medications, since they pass into breast milk and can be transmitted to a newborn baby, negatively affecting the condition of his body. This is why doctors predominantly use local therapy: the suture must be treated with an antiseptic solution several times a day, and the woman must also keep the surrounding tissue clean. Local medications do not pass into breast milk and do not affect the baby’s condition. If the pathological process progresses, doctors prescribe antibiotics that have minimal effects on the newborn: Amoxicillin, Erythromycin, Cefatoxime.

Treatment prognosis and possible complications of such pathology

Healing of soft tissues is a long and not always predictable process, which can encounter a number of truly serious complications. The duration of the recovery period largely depends on the patient’s age and state of health. In children and young people, a ligature fistula heals in a period of two weeks to three months, while in the elderly population this period can last up to six months. Patients with diabetes mellitus, hypertension, and cardiovascular diseases have a lower rate of soft tissue healing, as a result of which they have a significantly increased risk of developing secondary complications.

Equally important in the treatment of ligature fistula is strict adherence to hygiene and rules for treating postoperative wounds. While working in the department of purulent surgery, I happened to encounter a man who developed a serious complication in the form of bacterial microorganisms attaching to the area of ​​the postoperative incision. As it turned out, the victim did not clean his hands before changing the bandage, and also periodically sealed it with a rough plaster. When it was separated from the skin, tissue traumatization constantly occurred, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly alleviated his condition.

What complications may occur in patients with ligature fistula:

1. Abscess formation. This pathological formation is a massive accumulation of pus in the soft tissues, which is limited to the capsule. The abscess develops gradually: swelling begins to form in the wound area, and pain increases sharply. After a couple of days, a stationary red elevation forms above the surface of the skin, having a dense elastic consistency. When palpated, softening is observed in its middle, the boundaries of which increase over time. Treatment of an abscess is carried out by opening it and excising the capsule. Additionally, doctors prescribe antibacterial therapy.
2. Development of phlegmon. Unlike an abscess, this accumulation of pus has no boundaries in the soft tissues and can spread further along the location of the fatty tissue. Cellulitis melts nearby vessels and nerves, resulting in disruption of the blood supply to the most important organs and systems. Its danger lies in the fact that often the formation lies deep in the tissues and is quite difficult to detect. Swelling and redness can form only 4–7 days from the onset of the disease. You can get rid of phlegmon only through surgery and further use of antibacterial drugs.
3. Blood poisoning. One of the most dangerous complications that all doctors fear is sepsis. When bacteria enter the systemic bloodstream from the area of ​​the ligature fistula, a cascade of pathological inflammatory reactions is formed, during which the microbes enter all internal organs. As a result, their functioning is disrupted: the heart, kidneys and brain suffer the most. And also the leading mechanism of this condition is blood thickening - it cannot pass normally through the vascular bed. Treatment of this pathology is carried out in the intensive care unit with the help of detoxification, antibacterial and anti-inflammatory drugs.
4. Development of a scar at the location of the ligature fistula. Usually the entire defect is filled with connective tissue, which has a structure different from skin and muscles. The scar can be quite rough and even interfere with some activities. To prevent this condition, doctors use physiotherapy and healing ointments and gels.

Photo gallery: possible complications of the disease

Phlegmon of the leg can be located very deep and not give other symptoms other than swelling An abscess is a purulent formation with a capsule A scar is an overgrowth of connective tissue

How to prevent the development of a ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection entering the surgical wound still remains unresolved. In order to prevent this pathological condition at an early stage, recommendations for individual and group prevention are developed annually. As part of the latter, practicing professors from medical universities organize lectures and open seminars dedicated to the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

While studying at the Department of Traumatology, I had the opportunity to participate in an event dedicated to the problem of the occurrence of ligature fistula in the early and late postoperative period. To get the most detailed information, doctors presented illustrative cases from their practice: a selection of patients aged from twenty to eighty years old who were unlucky enough to encounter a similar illness. During the study, all victims were asked to fill out questionnaires containing questions regarding lifestyle, diet, and hygienic measures taken to treat the wound. As it turned out after analyzing the data obtained, about 20% of patients continued to abuse alcohol and did not follow the rules for preparing food, 5% skipped taking the necessary pills, and 40% performed dressings at home, which increased the risk of infection from the environment. Doctors came to the conclusion that the vast majority of patients had violated the rules for managing the recovery period: this affected the formation of a postoperative fistula. Based on the data obtained, we have developed universal recommendations for preventing the development of such a disease, the use of which helps reduce the risk of its occurrence several times.

How to protect your body from the formation of pathology in the postoperative period:

1. Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for the presence of an allergic reaction to the components of the suture material. This can be done in the same hospital where the operation will be performed. To do this, ask the surgeon for samples of the proposed threads and take them to the allergy laboratory. There, the doctor will use cutaneous or intradermal tests to determine the presence of a pathological reaction. If there is redness, swelling and swelling of the skin, it is better to avoid using this type of material. Currently, there are a huge number of suture threads: one of them will definitely suit you.
   The patch test detects the allergen
2. Try to avoid stress and mental shock. During the period of recovery of the body after surgery, even minor anxiety can cause a deterioration in the condition. It has been proven that during times of tension and stress, the human internal glands secrete hormones that slow down the processes of rehabilitation and tissue healing.
3. Maintain good hygiene. Most opportunistic bacteria live on the skin of even a healthy person. Under normal conditions, with intact tissue integrity, they cannot penetrate the bloodstream and cause an infectious process. But in the postoperative period, the body becomes especially vulnerable, and the wound is an entry point for bacteria. This is why it is so important to keep the surrounding tissues clean. It is recommended to wear loose clothing made from natural materials that will not cover the postoperative incision site or injure it in any way. In the morning and evening, it is necessary to treat the skin with water and detergents, without touching the bandage.
   Antiseptic gel removes germs from the surface of the skin
4. Avoid physical activity. Prolonged lifting and carrying of heavy objects or exercise in the gym can cause the suture material to cut through the soft tissue, causing the wound to open. This will not only increase the risk of infection, but may also be a reason for repeat surgery. This is why doctors prohibit playing sports and lifting weights of more than one kilogram for several months after surgery. Once a permanent scar has formed, you can return to unrestricted training.
5. In the period before and after surgery, try to adhere to proper nutrition. Popular vegetarian and vegan diets with a complete absence of animal protein reduce the rate of healing of soft tissues and prolong recovery processes. During the rehabilitation period, the body needs to receive fats and carbohydrates in large quantities, and the caloric content of the diet should not be less than 2500–2700 units. Doctors recommend giving up fast food, fast food, carbonated drinks and packaged juices, as well as sweets. These foods slow down the body's metabolism and can have a negative impact on wound healing. Give preference to vegetables, fruits, berries, lean meat and fish, as well as cereals and cereals. You can restore the amount of protein and calcium in the body with the help of dairy products and special vitamin and mineral complexes.
   Dairy products are necessary for feeding patients during the postoperative period

Postoperative ligature fistula is a common situation in surgical practice. If you discover such a defect, there is no need to worry and worry again: the modern system of medical care has long foreseen the occurrence of such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to accurately determine the cause of the ligature fistula and offer effective ways to combat this problem.

It often happens that an infection that progresses inside seeks a way out. This especially happens after surgery. Let's look at why this happens and how the resulting fistula is treated after surgery.

Fistula - what is it?

A fistula is a canal that connects body cavities or hollow organs to each other or to the external environment. It is lined with epithelium, and through it pus comes out, or the canal is lined with granulation tissue. If this does not happen, then a purulent fistula forms.

Such a process may be the result of some inflammatory process in the body or a consequence of surgery.

Types of fistulas

Depending on where the fistula is located, they are divided into:

• Gastric fistula.
• Rectal.
• Rectovaginal fistula.
• Duodenal.
• Bronchial.

The fistula can be complete or incomplete. A complete one has two holes and is treated faster, since it has a way out; an incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labiform or tubular. Labial can only be treated with surgery.

If we consider the process of formation, then a granulating fistula is one that is not yet fully formed, while a tubular one is already lined with epithelium and is fully formed.

What are the causes of a fistula after surgery?

There are several reasons for this phenomenon:

The last point is the most common reason why a fistula appears after surgery. There are also several explanations for this:

• Non-sterile suture material.
• The body's reaction to a foreign body.

A fistula at the suture after surgery forms a compaction of the suture thread itself, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is not difficult to recognize a fistula after surgery based on its characteristic symptoms. They are:

If you experience such symptoms, you need to see a doctor immediately, otherwise the infectious process may spread to your organs or cause blood poisoning.

Diagnosis of fistula

Diagnosing a fistula after surgery is not difficult, since it can be seen visually if it is external. The doctor, after listening to the patient and examining him, pays attention first of all to:

• Quantity and quality of discharge.
• The size of the fistula, its color.
• If the fistula is interorgan, then pay attention to the work of neighboring organs, especially if there are changes.

In order to find out the length and direction of the fistula canal, probing and radiography are used.

It is also necessary to do a series of tests that will confirm the type of fistula. The gastric one will show the presence of hydrochloric acid, and the uric one will show the presence of uric acid salts.

It happens that the suture may begin to fester a long time after the operation, so you need to find out the reason for this phenomenon.

If a fistula does appear after surgery, how to treat it?

Treatment of fistulas

For successful therapy, it is first necessary to:

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulation is removed, and the areas can be cauterized.

The newest method is the treatment of fistula after surgery using ultrasound. This method is considered the most gentle, but it is not fast.

In severe cases, if several fistulas have formed, complete excision of the postoperative scar is indicated. The infected suture material is removed and a new suture is placed.

Postoperative intervention

If you still failed to cure the fistula and had to resort to surgical methods, then after the operation to remove the fistula, healing will take place within several weeks. The wound will heal faster if you provide it with complete rest and proper care.

After surgery for a rectal fistula, the doctor, as a rule, prescribes a diet so that the wound heals faster. After such operations, painkillers and antibiotics are required. The wound heals within a month; any physical activity is avoided.

The prognosis for treatment is usually good and the patient makes a full recovery.

Traditional methods of treatment

Of course, people always try to cure the disease at home. There are several recipes for treating fistulas with folk remedies. Here are some of them.

It is worth noting that if a fistula has formed after surgery, then treatment should be carried out under the supervision of doctors, and folk remedies are an addition to the main course.

Prevention of fistulas

In order to prevent fistulas from appearing after surgery, it is necessary:

• First of all, observe the rules of asepsis during surgery.
• All instruments and suture material must be sterile.
• It is necessary to treat the wound before suturing it.
• Vessel doping should occur with little tissue involvement.
• Prescribe antibacterial drugs to prevent infections.
• It is necessary to treat all infectious diseases, preventing the development of fistulas.

A fistula, or fistula (from Latin - “tube”) is a channel connecting hollow organs to each other or to the external environment, or connecting a cavity or surface of the body with a tumor. The fistula looks like a narrow canal, covered with the top layer of skin - the epithelium.

There are fistulas that are the consequences of pathological processes and fistulas that are the consequences of a surgical operation performed to drain the contents of a hollow organ.

It is considered a complication after surgery. Typically, a fistula occurs as a result of suppuration, eventration or infiltrates of surgical scars. The main reason for the occurrence of a postoperative fistula is contamination of the suture material (ligature, or ligature thread) by pathogenic microorganisms. A compaction (granuloma) forms around the fistula, which consists of the ligature thread itself and cells with fibrous tissue, macrophages, collagen fibers, etc. The fistula can be small in size and not cause any inconvenience.
Fistulas most often occur as a result of the use of a special silk thread.

Symptoms

The development of a fistula has its own distinct symptoms.

• Seals and mushroom-shaped granulations (tubercles) that are hot to the touch form around the infected area of ​​the sutured wound.
• A limited area of ​​the postoperative scar becomes inflamed.
• A small (less often large) amount of pus is discharged from the wound.
• The place is redder.
• Swelling and pain appear in the area of ​​the fistula.
• Body temperature rises to 39 degrees.

Consequences of fistula

Sometimes the suppuration reaches a significant size and does not go away for a long time. The result of suppuration of the ligature thread can be an abscess. In such cases, ligature fistulas can secondarily infect a postoperative suture or lead to intoxication of the entire body, including disability. Frequent discharge of pus from the opening of the fistula can cause dermatitis.

Postoperative ligature fistula can occur several months after surgery.

Treatment of postoperative ligature fistula

Sometimes the ligature thread festeres and comes out with pus on its own. But you should not wait for such a moment; it is better to immediately seek medical help and treatment.

This treatment cannot be carried out independently at home. It can and should only be carried out by a specialist.
Treatment of a fistula most often involves surgical removal of the suppurating ligature thread. After this, the patient undergoes a course of drug treatment with antibiotics or anti-inflammatory drugs. In addition, doctors recommend taking vitamin complexes to strengthen the immune system. To speed up the healing of the wound, its sanitation is done by washing it with a solution of furatsilin or hydrogen peroxide, which perfectly neutralize the surface and wash away the released pus.

In addition to removing suppurating ligatures, excess granulations are also cauterized or scraped out.

There is also a more gentle way to treat postoperative fistula - ultrasound.

If several fistulas have formed, complete excision of the postoperative scar, removal of the infected ligature thread and re-suturing are prescribed.

Prevention of fistula after surgery

Such prevention depends on the surgeon, who must carefully observe all aseptic measures during the operation. The suture material must be sterile, and the wound must be washed before suturing. It is better to use modern absorbable threads - such as Vicryl, Dexon.