What to do seam fistula formed


Ligature fistula after surgical labor is one of the common complications of this operation. It is dangerous in that it is a source of infection and can cause toxic damage to a woman’s body.

Each operation, and delivery by caesarean section is no exception, ends with the imposition of a suture. The purpose of the incision treatment is to stop bleeding, prevent massive blood loss. To do this, use such a suture material as a ligature, which normally does not deliver any complications to patients.

If the body's reaction to an unpredictable ligature, an inflammation center is formed around the filaments, and an abscess is formed with purulent fusion of tissues. The generally accepted requirements for antiseptic surgical material and the surgical field prescribe a thorough treatment of the incision before suturing. If pathogenic bacteria are in the wound, the inflammatory process will inevitably develop, complicated by fistula formation.

Around the ligature tightening the edges of the incision, the tissues are compacted, forming a granuloma. It consists of collagen fibers, suture material, fibroblast. The introduction of pathogenic bacteria into this tissue causes suppuration. Pus finds a way out, and a through hole, or fistula, is formed. Ligature fistula may be the only one, or pus erupts in several parts of the surgical suture.

The time of formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula may spontaneously close for a time, but the final recovery does not occur until the source of suppuration is eliminated.

Causes of

For the appearance of a fistula after a cesarean section, there must be predisposing factors.

Common causes of ligature fistula formation:

Infected suture,

Infection of the surgical field,

Low ligature quality,

Violation of the rules of antiseptics during and after surgery,

Incorrect treatment of the surgical suture,

Stress associated with pregnancy and childbirth, stress factor, weaken the immune system of women. This circumstance significantly increases the risk of an inflammatory process, rejection of foreign material (ligature), the appearance of an allergic reaction to it.

Danger of education

When a fistula is formed on the suture that remains after a cesarean section, it is necessary to take effective measures immediately, because the risk of secondary infection of the body increases. Intense purulent discharge leads to irritation and maceration of the skin, the appearance of dermatitis.

Further development of the inflammatory process leads to intoxication of the body with tissue breakdown products and the activity of pathogenic bacteria. When a fistula is broken, there is a high probability of infection in the blood, which leads to the development of sepsis. This complication can lead to disability and even death.

Complications ligature fistula:

Toxic-resorptive fever - the body's response to the formation of a purulent focus and the accompanying high temperature, negatively affects the functioning of most organs,

The appearance of phlegmon - the spread of inflammation in the subcutaneous fatty tissue,

The prolapse of the abdominal cavity from the molten wound.

To prevent the occurrence of complications can only be timely diagnosis of ligature fistula.

Women who have undergone a cesarean section should know the main symptoms of the onset of pathology, because a ligature fistula can form several months after the operation.

A higher temperature of the skin around the seam compared to the rest of the body,

The separation of pus, suckling from the suture, sometimes it can be minimal, giving the impression that the wound is a little wet.

When a ligature fistula appears, the body temperature always rises. At the early stage of the onset of complications, the temperature values ​​may be close to normal, but still increase. The more the inflammatory process develops, the more pronounced the hyperthermia is.

Diagnostics

Not all women can self-detect the onset of the inflammatory process in time. Usually the patient goes to the doctor when the infection of the wound has gone too far. If a wound after a cesarean section is regularly examined by a specialist, it is possible to detect the pathological process at the earliest stages, to prevent complications.

Palpation of granular tissues,

Anamnesis, patient complaints,

Probing ligature fistula to determine the parameters of the defect,

Ultrasound with contrast

X-ray study with the introduction of a contrast agent.

It is categorically unacceptable to engage in self-treatment of a ligature fistula after a cesarean section at home or to wait until the surgical thread comes out on its own. Only in the conditions of a surgical hospital is it possible to prevent the spread of infection, to open the suppuration and remove the fistula.

Surgical treatment

There are two tactics of surgical treatment of ligature fistula - the doctor removes the thread that caused the inflammation, or excised the whole fistula, which in many cases is preferable. The thread is removed blindly through a small incision in the area of ​​the seam. Suppuration is released from blood and pus, washed with an antiseptic solution. If it was possible to completely get rid of the cause of inflammation, the fistula is finally delayed. If relapses occur, the operation is repeated.

A wide incision is not made, because there is a risk of the formation of cellulitis and the spread of infection to healthy tissue. The surgeon may decide not to make the incision, but to remove the ligature from the fistulous channel with a special tool. After performing the manipulation, the wound is treated with antiseptic preparations, the bandage is regularly changed on it.

In modern clinics, the procedure is carried out under the control of an ultrasound scan, which allows to accurately determine the localization of the ligature that caused the inflammation.

A radical way to get rid of the focus of inflammation - single block fistula excision. This removes both the fistulous canal and the suture material that caused the pathology. The operation is performed under local anesthesia, with careful observance of the antiseptic rules. After removal of the fistula, the wound is sutured, its condition is monitored for 5 days. After healing of the site of excision of the fistula wounds are removed from the wound.

Conservative treatment

In the case when the inflammatory process has not yet gone too far, the use of drug therapy is possible. It consists in treating the inflamed area with antibacterial and antiseptic solutions. The purpose of treatment - the destruction of pathogenic bacteria throughout the wound. Treatments are often carried out to effectively remove pus and disinfect the suture.

If this way it is possible to stop the inflammation, the ligature fistula may be delayed spontaneously. Immunostimulants and vitamin complexes are prescribed to support immunity. A course of antibiotics will help prevent the spread of infection. When the body's defenses increase, the focus of inflammation will decrease or disappear completely.

With this method of treatment, there is always a risk of recurrence, since the suture material remains in the wound. If the appearance of a ligature fistula was provoked by a surgical suture, the process may be repeated.

Prevention

Even with the strictest observance of antiseptic rules during cesarean section, there remains the risk of a ligature fistula. It is impossible to predict in advance whether a woman will have a suture rejection reaction or not. However, preventive measures will help prevent the occurrence of complications.

Rational management of cesarean section,

Compliance with the rules of antiseptics,

Careful preparation of the surgical field,

The use of modern surgical materials.

To prevent the development of inflammation of the suture after cesarean section, you need to carefully monitor its condition for several months after surgery.

Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from an educational and scientific medical center for managing the affairs of the President of the Russian Federation.

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A fistula is a channel that connects the body cavity or hollow organs with the external environment or with each other. Another fistula called fistula. Most often it is represented by a narrow tubule, which is covered with epithelium or young connective tissue from the inside. Fistulas can form on the background of various pathological processes occurring in the body, as well.

A fistula on a tooth gum is a pathological formation, represented by a small stroke through the gum to the lesion. Most often, the fistula comes from the root of the diseased tooth. According to it, serous or purulent exudate is removed from the focus of inflammation. You can see the fistula in the place of the projection of the tooth, in its upper part. It looks like a sore point.

Pararectal fistula occurs as a result of metabolic disturbances in the fiber around the rectal ampulla. Most often, these are the effects of paraproctitis, or proctitis, a symptom of which is fiber abscess. Its main manifestations are purulent or bloody discharge, pain, itching, irritation of the epidermis of the prianal area.

Photo fistula after cesarean




Complication develops within 4 days after a cesarean section, up to several months. When the inflammatory processes go away, the fistula closes for a while, but there will be no recovery until the doctors eliminate the source of suppuration.

Fistula definition

A fistula is a hole in the form of a passage that connects certain openings in the body, a system of organs with each other or with the environment. It has the appearance of a narrow slit, which is lined with fabric. Fistulas are formed as a result of suturing after surgery, as well as as a result of inflammatory processes occurring inside the human body.

Purulent fluid is formed due to the cessation of inflammatory processes. The hole through which this fluid flows out, then heals completely. But if the infection is not finally suppressed, this channel does not grow together and a purulent fistula is formed. Fistulas often form, which directly proves the development of pathological microorganisms inside a person. Any neoplasm is nothing more than an organism’s response to the development and reproduction of these pathogens. When fistulae are detected, you should immediately resort to the help of experienced specialists so that they take the necessary diagnostic measures and recommend how to properly treat this ailment.

Important! It is not recommended to self-medicate, it can be harmful to health. .

Symptoms of fistula after cesarean section

Symptoms of a fistula on the suture after applying caesarean are the following phenomena:

  • in the first days there is a sharp compaction of the suture, its redness. Doctors may observe a slight swelling and a slight increase in body temperature,
  • after 7 days of the seams with a strong pressure and palpation appears fluid, and later purulent connection,
  • a feverish condition appears on day 10, body temperature rises to 38 °,
  • fistulous channels are independently clogged, but when inflammatory processes appear, they reopen,
  • the appearance of a hole in the skin
  • hot area around the seam.

Fistulae are always accompanied by the appearance of a slight temperature. At the earliest stages, this rise is insignificant, but it is impossible to ignore such a condition, it is better to immediately consult a doctor to start treatment on time. Not to notice the fistula is very difficult, all the symptoms quickly appear, to recognize the tumor is quite simple. Usually, after a cesarean section, the doctor often examines the patient and observes how the stitches heal, so he will very quickly detect infection and the development of inflammatory foci.

Treatment of ligature fistula

Before treatment, every woman should understand that it is possible to get rid of a ligature fistula only with the help of surgery. Prolonged treatment can lead to a number of complications. Treatment involves taking the following medications:

  1. Antiseptics with local anesthetic action.
  2. ampicillin group.
  3. Enzymes that are soon able to dissolve dead cells.

These medicines need to be introduced into the fistulous canal and peripheral sites with a certain frequency, because their effect lasts for 5 hours.

It is important to know It is forbidden to treat the incision with oily ointments in case of a strong discharge of purulent fluid from the fistula, because they block the passage of the canal, which contributes to the further spread of infection.

With a strong inflammatory process, you can resort to other methods of treatment - physiotherapy procedures. Experienced experts recommend quartz wound. The procedure helps to reduce edema and improve the condition of the patient. But such events will only be able to stop the development of the disease, to cure it permanently - in any case. Only with the help of surgical intervention can you get rid of the cause of persistent suppuration. At home to treat this ailment is impossible.

Attention! Before taking any drugs, consult your doctor!

Preventive action

Doctors can not guarantee 100% safety during and after surgical intervention. Many infections penetrate quickly and dexterously, so there is no exact preventive measures. But experts advise to adhere to the following rules:

  • need to abandon the use of thick silk thread for stitching the cut,
  • after cesarean section, use only synthetic threads,
  • follow aseptic measures clearly
  • for the fastest healing, take medications prescribed by a doctor.

In order to prevent the appearance of a fistula, you should properly care for the seams, in time to do the dressings, take medicines, lead a healthy lifestyle and eat right. Any deviations from the norm can trigger the development of pathology, even the appearance of diseases that are not connected in any way with gynecology and the urinary system: problems with the heart vessels, the system of the gastrointestinal tract and mucous membranes.

What do doctors think

No doctor can fully guarantee that the operation will not entail adverse effects. Ligature fistulas appear due to penetration of infectious microorganisms into the incision. Experts recommend urgently deal with the pathology, because it can provoke the development of further complications and lead to sepsis. Therefore, it is imperative to consult a doctor for fistulas after cesarean section. To find it is very simple, doctors advise to pay attention if there is a seal and infiltration around the wound.

All seals become hot because it is associated with an infectious process. Near the scar will always be visible redness, at first a slight, then - a huge one. With surgical interventions, the wound often festers, the entire contents of it comes out. It is necessary to follow the fact that these processes can provoke the appearance of edema of peripheral tissues. Experts recommend not to be silent about the development of fistulas, because they require immediate treatment. Surgeons may decide to operate again to completely cure a woman. For this they will use only thin surgical threads made of synthetics.

Conclusion

Fistula after a cesarean section requires mandatory treatment. The patient is obliged to consult a specialist in time to appoint a number of necessary examinations and tests. Only an experienced specialist can prescribe treatment, all preventive and diagnostic measures are carried out only in the hospital. Treatment is conservative and surgical. Most often, fistulas are removed surgically, after a woman antibiotics are prescribed. Behind the wound, special care is always needed. To do this, the compounds are purchased, they help to clean the wound of purulent fluid and to avoid subsequent infection. Doctors recommend the use of hydrogen peroxide and furatsilina.

Conservative therapy helps when the development of the fistula has just begun. Doctors are trying to remove dead tissue around the resulting inflammatory focus, completely wash the pus. Often removed those threads that crawl out and provoke the growth of fistulas. After getting rid of the pathology, the patient is prescribed a course of antibiotic therapy and taking complex vitamins.

To avoid a ligature fistula, it is important to properly lubricate the wound, both before and after suturing. Doctors are required to work only with sterile materials. When the first signs of pathology appear, they should provide timely medical assistance. In most cases, the outcome of the disease is favorable.

Those "two holes" that have formed on your postoperative seam are nothing more than fistulas, which indicate the development of the inflammatory process in the human body after surgery. Fistulas can occur immediately after the imposition of postoperative sutures, and may appear many years after surgical interventions.

Infection and inflammation after surgery can occur for many reasons. If you are talking about the fact that pus is released from there, then the infection took place unequivocally.

By the way, the channel of the fistula can go not only outside, but also inward, therefore, pus goes not only to the surface, but also into the internal cavity. Often this happens if during the operation a foreign body enters the body, which then begins to be rejected by the body, the patient behaved incorrectly after the operation or the infection fell into an open wound. Infection can have a strong effect on a person’s immunity, and over time, the protective functions of the body gradually weaken, and the inflammatory process, accompanied by suppuration, increases.

Fistulas can be divided into certain types and depend on the place of their localization (rectal, gastric, bronchial, etc.). Ligature fistula is the one that appears after the imposition of non-absorbable sutures. If you were stitched, then you have formed precisely ligature fistulas (since there are two holes). Ligature fistulas appear due to violations of the rules of antiseptic treatment of postoperative sutures and wounds after removal of surgical sutures.

The discharge of pus from the holes indicates that an infection is present in the wound. Also, the doctors when removing the threads could leave in the wound part of the thread (ligature), which infected the wound and led to suppuration.Also the ligature could have been infected initially, i.e. at the moment when the seam only overlap. The lack of treatment in this case leads not only to serious inflammatory processes, but also to complete or partial seam divergence.

Methods of treatment of postoperative fistula

If a patient with a fistula has a sufficiently strong body and strong immunity, then therapy passes quickly, and the recovery period is delayed slightly. If inflammation is observed at the suture site, then treatment of ligature fistulas will most likely be carried out by surgical methods.

There must be a diagnosis for the presence of a foreign body in the wound. Today, modern technologies are used for this purpose, which give fast and truthful results. If the doctors suspect a foreign object account is confirmed, the fistula will be opened, and a foreign object and purulent masses will be brought out through a special channel.

Further treatment may be medical, but this, as mentioned earlier, depends on the human immunity, the specificity of infection and inflammation of the suture, as well as the vital activity of pathogenic microorganisms. Sometimes after the manipulations, the fistula disappears, but this does not happen in all cases. In the absence of proper treatment, the disease will begin to actively progress, giving dangerous complications to the work of the whole organism.

  • Methods of conservative therapy are used if there are few fistulas and the amount of pus secreted does not exceed the permissible values. Gradually remove the dead tissue and remove pus, conducting regular antiseptic measures to treat problem areas. In parallel, the patient takes antibacterial drugs and those whose action is aimed at strengthening the immune system.
  • Surgical therapy is prescribed to patients who have a lot of fistulas, and the flow of purulent masses is ample and intense. If the presence of a foreign body or the development of complications is confirmed, then the operation will also be necessary. The operation is the excision of the fistulous canal, cauterization of the affected tissues or their removal. Sometimes the postoperative suture is removed along with fistulas - this is a complex and voluminous operation.

In any case, you need to urgently seek help from a surgeon, who will take the necessary diagnostic measures, and then prescribe an effective treatment.

Sincerely, Natalia.

Each operation, and delivery by caesarean section is no exception, ends with the imposition of a suture. The purpose of the incision treatment is to stop bleeding, prevent massive blood loss. To do this, use such a suture material as a ligature, which normally does not deliver any complications to patients.

If the body's reaction to an unpredictable ligature, an inflammation center is formed around the filaments, and an abscess is formed with purulent fusion of tissues. The generally accepted requirements for antiseptic surgical material and the surgical field prescribe a thorough treatment of the incision before suturing. If pathogenic bacteria are in the wound, the inflammatory process will inevitably develop, complicated by fistula formation.

Around the ligature tightening the edges of the incision, the tissues are compacted, forming a granuloma. It consists of collagen fibers, suture material, fibroblast. The introduction of pathogenic bacteria into this tissue causes suppuration. Pus finds a way out, and a through hole, or fistula, is formed. Ligature fistula may be the only one, or pus erupts in several parts of the surgical suture.

The time of formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula may spontaneously close for a time, but the final recovery does not occur until the source of suppuration is eliminated.

Causes of ligature fistula after surgery

Conducting any surgical intervention is completed by postoperative treatment, which consists in suturing performed by a ligature, a special surgical thread, absorbable or non-absorbable.

The use of non-absorbable, usually silk, threads suggests that they will forever remain at the wound site, undergo an encapsulation process and will not cause any harm to the patient.

However, there are situations when there are all sorts of complications that cause the development of the inflammatory process in the area of ​​the suture, ligature fistulas. This phenomenon is infectious and allergic nature of the rejection and rejection of foreign material to the body.

Appeared ligature course: what is it?

The term “ligature fistula” is used by physicians to denote the pathological course that has formed in the area of ​​the suture material, which, in turn, was used to fasten (stitch) the tissues at the surgical site. Such a violation is accompanied by the development of the inflammatory process and suppuration. Among all possible complications after surgery, a ligature fistula is considered one of the most common - a similar problem is fixed in 5% of patients who have undergone various surgical interventions.

Most often, the ligature stroke appears after manipulations on hollow organs localized in the abdominal cavity or in the pelvic area, since the risk of infection penetration during such operations is highest. The fistula is extremely superficial, but sometimes it forms at a fairly significant depth.

Causes of abscess on the postoperative scar

Doctors claim that the main reason for the formation of a ligature fistula lies in the body's attempt to reject the foreign body, represented by the thread, which the surgeon used to suture the tissue cut during the operation. Most often, pathological processes of this kind occur after the use of silk threads, an order less often the perpetrator becomes mylar or nylon material. There is evidence that an abscess can form when using catgut, although it is an absorbable thread. At the same time, the vicryl or prolene threads are practically incapable of causing the inflammatory process.

With regard to factors that can trigger the formation of a ligature fistula, among them are:

  • The introduction of infection. Such a development is possible if the pathogenic microorganisms penetrate to the suture material due to the inflammation of the wound left after the operation. Infection may spread due to insufficient sterility of the surgical field or used instruments. It can also be provoked by a patient’s inadequate adherence to medical recommendations, the accidental addition of a so-called hospital infection, or a significant decrease in the body’s defenses (exhaustion, etc.). In rare cases, infectious agents enter the body already on the thread, if doctors violate the rules of sterility.
  • The development of immune rejection. The natural activity of immunity can lead to the rejection of a foreign body, which, in fact, is suture material. The risk of such a problem depends solely on the individual characteristics of the patient and it is impossible to predict its appearance.
  • Flashing a hollow organ. This situation can happen if the doctor accidentally seizes the entire wall of the organ, which is accompanied by the penetration of the thread into its lumen. The suture material as a result of contact with the non-sterile filling of the organ and, naturally, is infected. Pathogenic microorganisms gradually spread throughout the thread, activating the inflammatory process.

Regardless of the reason for its formation, the fistula can permanently disrupt the patient’s ability to work, making it heavier for the main disease.

If the seam heals normally, cicatricial connective tissue cells gradually form around the filaments, as if the suture surrounds the capsule. If a purulent-inflammatory process develops, normal healing does not occur. Instead of a capsule, a thread is surrounded by an abscess (abscess). Over time, it increases in size and opens in the postoperative cicatrix - a fistula is formed. Due to the presence of such a course, there is a decrease in the phenomena of an acute inflammatory process, because the contents of the abscess are constantly moving away. In this case, the suture material can be in a normal place or move along a fistulous passage.

Features ligature fistula:

  • They can be formed with equal probability when suturing the surface tissues (for example, on the leg or arm) or in the depth of the wound (during operations on the peritoneum or pelvic organs).
  • Deeply localized ligature passages may involve internal organs in the purulent-inflammatory process.
  • They may appear years, months or weeks after the intervention.
  • Can proceed with various symptomatology.

If the thread goes out on its own or is removed by surgery, the cause of the inflammatory process disappears, and the fistula closes as a result. However, if this does not occur, the inflammation constantly recurs and may be complicated by the addition of a secondary infection. But even with a successful rejection of the thread, wound suppuration may occur.

Symptoms of abscess on the seam

An abscess can occur after a patient has been successfully discharged from the hospital, even after several years. The pathological process may be felt by local and general disorders:

  • Painful sensations in the projection of the location of the infected suture material.
  • Weakness, feeling of weakness, an increase in temperature indicators.
  • Formation of painful consolidation in the projection of the postoperative scar.
  • Changes in the color of the skin above the site of inflammation. Most often, the skin becomes purple or bluish.
  • A few days after the development of primary symptoms, a spontaneous abscess breakthrough occurs.
  • A medium-sized stroke is formed, through which a serous-purulent fluid (mass) is emitted in a small volume. If there are surgical sutures on the body, then a typical serous fluid begins to stand out from under them, then pus replaces it.
  • After a breakthrough, unpleasant symptoms disappear, the severity of inflammation decreases.

If the thread remains in the wound, the fistula may periodically close and open. But after the successful removal of the suture, the tissues heal successfully (in the absence of complications).

Complications

Ligature fistula is able to go by itself, but in some situations its formation may result in the occurrence of quite serious complications:

  • Secondary infection, which will be accompanied by the spread of purulent process.
  • Dermatitis of the skin due to leakage of discharge from the ligature course.
  • Hyperpigmentation of the skin at the site of injury.
  • The development of superficial or deep ulcers.
  • The defeat of the adjacent organs as a result of a purulent inflammatory process, and due to unsuccessful extraction of suture material by a surgeon.
  • Eventration (loss) of internal organs through a defect in the peritoneal wall. A similar situation may occur as a result of purulent fusion of tissues.
  • Sepsis.
  • Fatal.

At the slightest suspicion of the development of the inflammatory process in the area of ​​the suture, it is necessary to seek medical help, even if quite a long time has passed after the operation.

How to cure?

Most often, coping with a ligature fistula can only be achieved by surgical intervention. Without the help of surgeons, it is impossible to do if the pathological course exists for a long time. In parallel with the surgical removal of the ligature, drug treatment is carried out. Only sometimes doctors can try to do only methods of conservative therapy.

Conservative treatment

For the treatment of ligature fistula, various groups of drugs can be used:

  • Local antiseptic preparations. Usually, preference is given to water-soluble ointments, for example, Levosin, Levomekol or Trimistan, and also to fine powders, in particular, Baneotsin and Gentaxan. Ointment on the basis of fat (for example, Vishnevsky's known ointment) can impede the outflow of pus, so their use is not recommended, especially if there is a significant amount of purulent discharge.
  • Antibacterial drugs. Preference is given to drugs with a wide spectrum of action: ampicillin or ceftriaxone.
  • Enzymes to eliminate dead tissue. Trypsin is commonly used for this purpose.

Drugs must be injected into the fistulous course, as well as spread through the tissues located near the wound several times a day. In parallel, methods of physiotherapy can be used, in particular: quartz treatment or UHF-therapy.

Surgical intervention

To eliminate a ligature fistula, doctors usually perform a classic intervention consisting of several stages:

  • Treat the surgical field with an antiseptic (iodine tincture is usually used).
  • Anesthetize the problem area with injections of Lidocaine or Novocain.
  • A special dye is introduced into the fistulous passage for a complete examination.
  • Dissect the resulting fistula and eliminate suture material.
  • Perform revision of adjacent tissues.
  • Stop bleeding with electrocoagulation or peroxide.
  • Conduct a thorough wound debridement using antiseptics.
  • Close the wound with sutures and establish active drainage.

Competent surgery with complete sanation of the wound avoids serious complications. Expectant tactics in the case of a ligature fistula is completely unjustified.

In most cases, when forming a ligature fistula, the prognosis is favorable for the patient’s life and relatively favorable for his recovery. As a rule, such a complication ends with a satisfactory cure, although it may require repeated surgery.

However, in about 60–65% of cases, physicians manage to eliminate the suture without surgery. But even in this case, ligature fistula may recur.

Consequences of a fistula

Sometimes suppuration reaches a considerable size and does not pass for a long time. The result of suppuration of the ligature thread may be an abscess. In such cases, ligature fistulas may secondarily infect the postoperative suture or lead to intoxication of the whole organism or even disability. Frequent discharge of pus from a fistula opening can cause dermatitis.

Postoperative ligature fistula may occur several months after surgery.

Treatment of postoperative ligature fistula

Sometimes the ligature filament is festering and goes out with pus by itself. But to wait for such a moment is not worth it, it is better to immediately seek medical help and prescribing treatment.

Such treatment can not be carried out independently at home. It can and should be carried out only by a specialist.
Fistula treatment most often consists in removing the festering ligature thread by surgery. After that, the patient is undergoing a course of drug treatment with antibiotics or anti-inflammatory drugs. In addition, doctors recommend taking vitamin complexes to enhance immunity.For the speedy healing of a wound, its reorganization is done by washing with a solution of furatsilina or hydrogen peroxide, which perfectly neutralize the surface and wash away the pus that is released.

In addition to removing festering ligatures, cauterizing or scraping of excess granulations is also performed.

There is also a more benign method of treating postoperative fistula - by ultrasound.

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

Where does the ligature fistula come from?

Near the thread, which tightens the edges of the wound, there is a seal, this formation is called "postoperative granuloma of the scar". The suture material, fibroblasts and microphages penetrate into the resulting compaction, while the ligature itself is not covered with a fibrous film. When such an abscess is opened, a fistula is formed, in most situations it is one, but their number can vary significantly depending on the place of suture.

Often, such a complication manifests itself within a few days after the operation, in such a case, the surgeon will easily detect the formation of a ligature fistula during daily examination. The formation is revealed in 2-3 days after the beginning of suppuration, through the breakout discharge in the form of pus.

Important! Suppuration most often occurs when the incision is sewn up with silk thread. It cannot be said that this is an unambiguous statement, because at this stage surgeons put self-absorbable sutures, but the fistula did not become a rare manifestation.

Treatment is assigned based on the cause of this process.

Symptoms of education and treatment

The risk of fistula after surgery is always present. The patient should pay attention to the fact that a fistula can be formed after a certain time after surgery. In such a case, you should contact the surgeon for certain manipulations.

Timely to identify the formation of ligature fistula is not difficult, you need to pay attention to the preceding symptoms:

  • redness in the suture area,
  • discomfort, pain at the site of the suture, itching and burning often occur,
  • significant increase in body temperature
  • pus under the skin.

An increase in body temperature indicates a significant inflammatory process in the body, and accumulated pus under the skin indicates the beginning of ligature abscess. The danger of this condition is the possibility of re-spread of the infection.

Diagnosis of this process is not complicated, in most cases the patient complains of pain at the suture site to the surgeon. Depending on the clinical manifestations, necessary examinations are carried out, and treatment is prescribed. Treatment of ligature fistula differs depending on the severity and location of the ligature imposition.

It is not always possible to choose a gentle treatment for this complication. In some situations, surgery is required. The fistulous passages are viewed, the contents are scraped with a special spoon, and purulent ligatures are removed.

Interesting! When re-stitching apply only self-absorbable synthetic yarn.

Other complications after surgery and prognosis for recovery

Infiltrate is called the accumulation of particles of lymph or blood within the tissue, or any organ. It is a kind of seal. By nature, it can be tumor and inflammatory.

Tumor infiltrate is an oncological formation.
Infiltration occurs quite often after carrying out any operations, regardless of their complexity and location. Treatment at the initial stage does not cause difficulties. Late diagnosis is fraught with rupture of the abscess and sepsis.

Inflammatory infiltration is the most common form of these pathologies.It can resolve itself within 1-2 months, and then turn into a scar or go into an abscess. An infiltrate at the site of the postoperative scar may form a couple of years after healing.

Caesarean section is a fairly common operation that helps a woman become a mother. But often there is endometriosis postoperative scar. This complication occurs due to the fact that the cells of the inner layer enter the scar compound. Such education occurs quite often, surgeons and gynecologists deal with this problem.

Sometimes after performing surgical procedures, seroma is formed. It represents the accumulation of fluid from injured lymphatic and venous capillaries. This manifestation most often occurs in obese people. Mostly seroma is formed after plastic surgery in women in the breast, abdomen and thighs. Preventing gray is much easier than curing; it is enough to properly handle the place of suturing.

Due attention is not paid to the treatment of seroma, many surgeons claim that it resolves itself within 4–20 days. Indeed, in most cases this is so, and the liquid is not dangerous to humans. But it should be borne in mind that in some cases seroma is a dangerous manifestation that causes irreversible effects. To get rid of seroma use drainage. Vacuum aspiration is also used to treat gray.

Oleogranuloma of the mammary gland often occurs in women as a result of surgical operations, for example, implants in the breast. Oleogranuloma develops due to the contact of breast tissue with foreign bodies. Painful ulcers and fissures occur on the surface of the breast. Timely access to a doctor and comprehensive treatment will help prevent the development of complications.

Important! In the process of development of oleogranulomas, the cells of the breast tissue die. In their place, cysts and other malignant neoplasms are formed.

Lipogranuloma is a benign lesion in the chest. Such formation often occurs as a result of injury, excessive compression and other mechanical effects.

Any surgical intervention is a risky event, you should pay attention to the condition of the stitches and general well-being in the postoperative period.

Ligature fistula - suppuration in the area of ​​surgical suture. Violation occurs when using non-absorbable sutures. Pathology can occur only after surgery. Complications are rare. First, in the area of ​​the seam occurs, and then a fistula is formed. Pathology is characterized by the development of the inflammatory process. It requires urgent treatment and is accompanied by a large number of unpleasant symptoms.

Ligature fistula is a pathological tissue reaction that interferes with the healing of postoperative sutures.

Fistula formation is an abnormal reaction of the body. Threads may be of synthetic or natural origin. The violation is usually indicated by the presence of dark discharge. Deviation becomes a source of infectious diseases. It represents a great danger to the life and health of the patient. It is strictly impossible to ignore the violation.

In this article you will learn:

General information about the complication

Ligature fistula is a complication caused by previous surgical intervention. It is the result of suppuration and pollution in the area of ​​the seam. Pathology is characterized by rapid development. Call your doctor if you experience the first signs.

Ligature - a thread that is used to bandage blood vessels. A suture using this material is required to stop internal bleeding.Needed for most surgical procedures.

Ligature fistula is an inflammatory process in the area of ​​stitching a wound. The fabric begins to rapidly thicken. Violation can lead to the development of an abscess.

When performing operations often use non-absorbable thread - ligature

Root causes of violation

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

The risk of a violation will increase with a lack of vitamin and mineral complexes, as well as deviations in metabolic processes. Most often, the pathology is formed by ignoring the basics of personal hygiene in the wound area and non-compliance with the recommendations of the doctor.

Failure to comply with antiseptic rules leads to the ingress of pathogenic bacteria. An inflammatory process is formed. Fabrics are compacted, and a fistula appears.

Symptoms of the violation

The symptoms of ligature fistula include:

  • redness,
  • increase in body temperature
  • compaction
  • pain in the seam area,
  • bleeding and discharge with an admixture of pus.

The suture should be flat, if redness or compaction is observed, it should be shown to the doctor

The fistula is temporarily closed. However, after a while it will open again. The temperature in the presence of deviation rises to a maximum of 38 degrees. Eliminate the symptoms is possible only when exposed to a provoking factor.

Most often, the pathology is formed on the background of the use of synthetic thread. Over time, a kind of compacted cones appear around the seam. From them pus follows. The quantity may be different. Small education may not cause discomfort to the patient for a long period of time. Redness, swelling and bloating usually appear around the seam. There may be signs of intoxication. In case of untimely assistance, irreversible complications are formed. Ill can become disabled.

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

Possible complications

The complications of ligature fistula include:

  • phlegmon,
  • events,
  • sepsis,
  • toxic resorptive fever.

Inflammation of the suture can go into an abscess

When an abscess is formed, a large amount of pus accumulates around the suture. It is always a consequence of the inflammatory process. Deviation is accompanied by a significant increase in temperature.

Phlegmon - the development of purulent formations under the skin. The inflammatory process affects connective tissue. Defeat has no clear boundaries. Complication needs timely treatment. Violation affects muscles and tendons.

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

Sepsis is a complication in which the infection penetrates the bloodstream and spreads throughout the body. Pus falls into the cavity of the skull, chest and abdomen. The patient should be hospitalized promptly.

With serious complications, temperatures can rise to 40 degrees.

Toxic-resorptive fever - a consequence of the absorption of toxic substances with purulent inflammation and decay of tissues.

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

Diagnostic methods

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

  • detect possible complications present,
  • determine the location of the fistula.

A patient with suspected developmental disorders may be referred for fistulography. The method is required for the development of fistula in the thickness of the tissue. In the study, a contrast agent is used and radiography is performed. On the received picture the deviation is accurately traced.

The doctor may notice signs of a problem already in the first days after surgery.

Ligature fistula after surgical delivery

Any surgery involves the risk of complications. Surgical delivery is no exception. Common complications include the appearance of a ligature fistula after cesarean.

Fistula is dangerous because it is a source of infection. If time does not pay attention to the pathological phenomenon, then an intoxication of the organism may occur.

What to do if a fistula appears? To seek qualified assistance, it is the only way to avoid the risks associated with the inflammatory process.

In order to avoid complications after an operative generic process, all recommendations of doctors should be followed.

Concept definition

A caesarean, like any other surgical intervention, ends with a postoperative treatment of the incision site. The final stage of surgical delivery is suturing. For this, a ligature is used - a surgical thread. With its help stop the bleeding. The thread prevents subsequent blood loss. Surgical material should not give care to the patient.

However, during the birth of an operational nature, there is a high probability that the filaments will decay, resulting in an abscess in the tissues.
An incision in the abdominal cavity, which is mandatory for caesarean, is always treated before suturing. If bacteria or pathogenic microorganisms end up in a wound on a thread, suppuration occurs.

This ultimately leads to complications.

The thread tightening the edges of the incision “overgrows” with granuloma - compaction of tissues. Suture material, fibroplasts, collagen fibers can get into the seal. Under the influence of microbes, suture suppuration occurs. After breakthrough purulent discharge oozes out.

With him can go and part of the surgical thread. The place where the suppuration is opened begins to “whistle”, because a through hole appears - a fistula. Usually suppuration breaks in one place, however there are breakthroughs in several areas.

It all depends on the cause and characteristics of the inflammatory process.

A complication may appear after a couple of days after surgery, that is, when the patient is still in hospital. Fistula may appear after discharge. Sometimes the inflammation subsides, the breakthrough closes, but after a while, everything repeats. This happens when appropriate therapeutic measures are not taken and suppuration factors are not eliminated.

Causes of complications

Fistula formation after cesarean due to several reasons. Complications arise when:

  • initial infection of the suture,
  • infection of surgical material with wound contents,
  • using poor quality thread,
  • violation of hygiene procedures during and after cesarean,
  • insufficient suture machining.

Risks of development of the inflammatory process increase, if the immune system is weakened. In pregnant women, the functions of the immune system are reduced, due to the process of gestation, generic stress. Sometimes this leads to rejection by the cells of a foreign body (filament) or provokes the appearance of an allergic reaction to the surgical material.

What is dangerous fistula

Timely diagnosis of pathology - the key to rapid recovery

Fistula is a dangerous phenomenon requiring immediate action. With large purulent accumulations, the likelihood of secondary infection is high. When the purulent discharge is intense, skin irritation occurs.

This leads to the occurrence of dermatitis.If the pathological process is ignored and allowed to develop, then a strong intoxication of the organism can occur - with a breakthrough, the probability of bacteria that cause inflammation in the blood is high. Because of this, the patient may become disabled.

Fix and deaths.

Fistulas are dangerous and their complications. The presence of purulent focus can trigger a severe reaction of the body, expressed by extremely high temperature. A severe temperature reaction is called toxic-resorptive fever.

It affects all organs and systems. By fistulous complications include phlegmon. So called the process of distribution of purulent sediments subcutaneously. Pus flows into the fatty tissue.

If purulent discharge melts the wound after a caesarean, organ loss may occur.

To reduce the risks is possible only by timely detection of a fistula. After the pathological process is diagnosed, treatment is necessary, including measures to prevent complications.

Symptoms of the pathological phenomenon

Determine ligature fistula can be on a number of symptoms. Identify the pathology is easy, because it is accompanied by clear signs. To notice the fistula at the site of the incision from a caesarean woman can at home.

This is important, because the complication does not always manifest itself immediately after surgery, sometimes it occurs after a couple of months.

What are the signs determine the complication? Need to pay attention to:

  • seals around the wound,
  • hot to the touch area of ​​the wound channel
  • redness near the scar (often goes along the stitching),
  • swelling of the tissue around the wound,
  • pus (sometimes the purulent contents are separated in a minimum quantity: the wound that has been sewn up gets a little wet).

Almost always, the formation of fistulous openings is accompanied by a significant increase in temperature. In the early stages, temperature deviations from the norm may be minimal, but you should not ignore them.

Conservative therapy

If a fistulous opening occurs after the CS, the doctor determines the exact location of the infected area, finds the cause of the inflammation, assesses the degree of pathology and possible risks.

Only after that the doctor determines the method of treatment.
If the case is not running, it is possible to appeal to conservative therapy.

This method is to remove the infection with various antibacterial solutions, antiseptic agents.

The site of inflammation is treated daily with special drugs that kill bacteria. Frequent washing of the wound is necessary to remove the pus and disinfect the suture itself. This contributes to the rapid healing of the incision site.

When the infection can be stopped, the fistula closes on its own. If the infection has spread, the doctor may prescribe a course of antibiotics. Additionally, the patient is prescribed vitamin complexes, the action of which is aimed at improving immunity.

When the protective functions of the body return to normal, the process of dealing with complications after CS is accelerated naturally.

Conservative treatment is not always possible. After such therapy, the likelihood of recurrence remains, because the surgical thread remains intact. If the causes of the complications were directly related to the thread, and the doctor could not determine this, then the development of fistulas may recur.

Operational methods

In some cases, immediate medical attention is required.

Treatment of fistula often involves surgery. Especially if the pathological process was not fixed immediately. The operational method has two options:

Surgical thread extraction is carried out through a small incision. First, the surgeon releases pus, cleans the cavity, thoroughly washes the wound. The thread is removed by a blind method.This is not always the case from the first time; therefore, exacerbations are possible, during which the extraction of the filament is again carried out.

If the surgical material can be obtained the first time, then the fistula is permanently tightened. Why not make a wide incision? This would provide an absolute result, because the ligature thread that led to the inflammation could be seen.

The use of such a cut is dangerous infection of "healthy" threads, increases the risk of developing cellulitis.

After evaluating the fistulous canal, the doctor may decide not to make an incision at all, but use a thin tool, for example, to extract a thin instrument. It is introduced into the fistulous opening. The tool penetrates the canal and removes the surgical material. After removal of the thread, which was the cause of the complication, the wound is treated with antiseptics, dressings are made.

Postoperative ligature fistula: symptoms, causes, treatment, prognosis

Almost every surgical intervention ends with wound closure using surgical sutures, with the exception of operations performed for purulent wounds, where, on the contrary, conditions are created for the normal outflow of purulent contents and reduction of infiltration (inflammation) around the wound.

Surgical sutures can be of both synthetic and natural origin, as well as those that are absorbed and not absorbed in the body after some time.

Sometimes it happens that a pronounced inflammatory process, serous (cherry color), and then purulent discharge occurs in the place of their imposition, and this is a reliable indicator that a fistula formed after the operation and its rejection began. It is important to understand that postoperative fistula is a manifestation of an abnormal course of this period and requires further treatment.

Manifestations

  • The first days in the projection of the wound, there is a thickening, redness, slight swelling, tenderness and an increase in local temperature.
  • After one week, serous fluid begins to protrude from under the sutures, especially with pressure, and later pus.
  • In parallel with this, the body temperature rises to subfibril numbers (37.5-38),
  • Sometimes an inflamed fistulous passage closes on its own, but after a while it opens again,
  • Full cure occurs only after a subsequent operation and the elimination of the cause.

Prognosis after surgery and prevention

In many cases, surgical treatment of a ligature fistula is effective, but there are cases when the human body in every way rejects all surgical sutures, even after multiple repeated operations. With self-treatment of the fistula, the prognosis is not favorable.

Prevention of fistula in most cases is not possible, since the infection can penetrate the seam even under the most aseptic conditions, not to mention the rejection reaction.

Fistula after cesarean section, fistula on the neck


A fistula is a narrow, unnatural canal that forms in the tissues as a result of the ulcerative process and connects the hollow cavities and organs.

There are two types of fistula: appearing after surgery or formed as a result of certain pathological processes occurring in the body.

Consider the first type of fistula on the example of creating a suture after a cesarean section. As with any surgical procedure, this procedure can have some unpleasant consequences and complications. One of them is the appearance of fistulas on the postoperative suture.

This fistula is called ligature.

It is the result of the introduction of infection into the suture, as well as the body's response to foreign material - a surgical thread. (Hence the name: ligature - thread). It may appear at different times after surgery: from a few days to months and even years.Onset is infectious as well as allergic.

First, the bacteria get on the surgical thread. They cause suppuration of tissues and further compaction. Not one but several fistulas may be formed. The latter depends on the circumstances and individual characteristics of the patient.

Fistula on the neck

It is the result of impaired fetal development. However, such a fistula can also form as a result of a previous illness or neck injury, i.e. to be acquired. Diagnosed mainly in children.

One of the causes of congenital pathology is the abnormal development of the gill arches at the embryo stage.

Consolidation on a seam after Cesarean section

A cesarean section often backfires. Like any surgical procedure, it can lead to postoperative complications. The most common problem with which women give birth is a seal on the suture after a cesarean section.

For example, compaction, redness, pus formation, inflammation may occur. All this is a threat to the life and health of the young mother. Many women worry about the ugly scar, which easily spoils even a very beautiful figure.

In addition to the fact that the scar has an unattractive look, it also sometimes causes painful sensations.

There are several causes of postoperative complications. The most common of these is infection of the scar. In advanced cases, the inflammatory process may end in sepsis.

Some complications can go away on their own without the intervention of doctors.

How to understand what it costs to see a specialist? What are the causes and types of complications? Details can be found by reading the article further.

Ligature fistula after surgery may develop:

  • When infected, the actual ligatures
  • If non-compliance or violation of the asepsis rules during the operation
  • When ligature is infected with wound contents
  • With imperfect treatment of the postoperative site and the penetration of infection in the suture area

The development of the inflammatory process is influenced by the state of the patient's immune system, aggressiveness, the infectious ability of the microorganism causing it, and the allergic reaction of the organism.

The formation of ligature fistula is characterized by:

  • Various localization in the postoperative area, in any tissue layer
  • Delayed temporary manifestation, from several days, weeks, months, years after suturing
  • Different degree of severity of the inflammatory process - from the local area with the rejection of suture material and the healing of the fistula to the long-non-healing inflamed areas throughout the suture
  • Independence from the material from which non-absorbable ligature is made (silk, kapron, polyester)
  • Different consequences for the patient - from quickly healing, and practically not causing anxiety to a permanent source of infection, causing intoxication of the organism, capable of leading the patient to disability

Postoperative complications in the form of ligature fistulae are inflammatory processes caused by infection in the areas of overlapping sutures.

Visually-vaginal-rectal fistula presented on this video.

Symptoms and diagnosis

The formation of a ligature fistula is accompanied by the occurrence of certain events:

  • The formation of local seals, granulomas, in the area of ​​the surgical suture, hyperemic, often hot to the touch
  • With a deep location of the fistula granuloma is not palpable palpation
  • As a rule, the size of the inflamed area has limited dimensions.
  • Formations of compacted sites may be accompanied by painful sensations.
  • Formation on the reddened compacted part of the opening, the fistulous canal, through which the pus is separated, is abundant or insignificant
  • In some cases, in the opening of the fistulous passage, you can notice the end of the ligature that is larger or smaller.
  • The fistula can close after some time reopen
  • Complete closure of the opening of the fistula occurs after removal of the infected ligature

The formation of a ligature fistula may be accompanied by a significant increase in body temperature, up to 39 degrees.

Detection of fistula, as a rule, does not cause difficulties.

To confirm the diagnosis of a ligature fistula after surgery, the following measures should be performed by a surgeon.

Ligature fistula: treatment

Fistula treatment is performed on a mandatory basis in a medical institution by a qualified surgeon. Self-treatment and treatment of the inflamed area in non-sterile conditions are fraught with additional infection and complication of the condition.

Waiting for the release of the thread and the breakthrough of pus without medical intervention is also dangerous, since they can lead to the development of cellulitis, suppuration of neighboring areas.

Therapeutic measures can be carried out as conservative methods, as well as more radical, surgical.

In the course of conservative treatment, measures are taken to eliminate the infection in the inflamed area, resulting in the closure of the fistula opening.

Antiseptics, antibacterial drugs, and solutions of bactericidal indiscriminate action are used to treat the site of the fistula.

The treatment is accompanied by the prescription of antibiotics, anti-inflammatory drugs, drugs-immunomodulators, vitamins.

Unfortunately, there are frequent cases of reopening of the fistula, if the ligature remains unresolved.

Methods of surgical treatment are aimed at the removal of infected non-absorbable suture material from the fistula.

Removing it is as follows:

  • Under operating conditions, the surgeon cuts tissue in the fistula in order to release pus.
  • Cleaning and washing the wound
  • Steps are being taken to blindly remove the suture.
  • In case of success, this will lead to the final closure of the fistula.
  • If the attempt is unsuccessful, it will be repeated after a time, until successful removal of the thread.
  • The extension of the dissection zone is fraught with infection and its spread to neighboring areas
  • Sometimes attempts are made to remove the ligature using special surgical instruments without performing tissue dissection, through the fistulous canal.
  • And in case of successful removal of the thread, and in case of failure, the wound is treated with antiseptic preparations, the wound is tied up, the treatment is carried out for the required period while monitoring the condition of the wound

Developed methods for removing filaments carried out using ultrasonic methods of control. The advantages of such modern techniques are the directed actions of the surgeon and a more gentle procedure for the patient.

If there are several fistulas during the postoperative suture, an operation is performed to excise the affected area and remove the ligature.

A prerequisite for the effective treatment of ligature fistula is full patient awareness of the steps taken and the treatment methods used.

Prevention measures:

  • Strict adherence to the principles of asepsis and antisepsis
  • Checking the suture before using it - tightness of the package, expiration date, confirmation of sterility
  • Thorough preparation of the wound with antiseptic treatment before stitching
  • The use of modern suture materials at the final stage of surgical intervention, if possible, the rejection of the use of non-absorbable silk sutures

The implementation of preventive measures by the surgeon to prevent postoperative complications will reduce the percentage of inflammatory diseases in patients.

Awareness of patients about possible complications after surgery will allow them to detect their symptoms in time if they appear and promptly seek medical help.

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1 week 5 hours ago

How is a fistula that appears after surgery?

After surgery, a fistula can occur for many reasons. It usually appears after abdominal and tubular surgery. Fistula may not heal for a long time, leading to the defeat of many parts of the body and in some cases to the formation of malignant tumors. The formation of a non-healing wound suggests that an inflammatory process occurs in the body.

Causes of fistula after surgery

If during the surgical intervention a foreign body that caused inflammation and infection got into the body, postoperative complications may begin. There are many reasons for this. One of them is a violation of excretion of purulent masses from the fistula canal. The occurrence of the inflammatory process may be due to the difficulty of the release of purulent masses due to the narrowness of the channel, the presence in the drainage fluid of the products of the body undergoing surgery. In addition, the reasons for the formation of non-healing postoperative wounds can be improper operation and getting into an open wound of infections.

A foreign body that has entered the human body begins to be rejected. The result is a weakening of the immune system, the body ceases to resist infections. All this delays the recovery period after surgery and causes encapsulation - infection of the operated organ. In addition, a foreign body in the body causes suppuration, which serves as an additional factor interfering with the healing of the suture. Such cases include bullet wounds, closed fractures and other injuries to the body. Ligature fistula occurs when the body rejects the threads that hold the wound edges together.

The appearance of a fistula at the suture can occur both in the first days after the operation, and after many years. It depends on the severity of the inflammatory process and the depth of the tissue incision. The fistula can be either external (coming out to the surface and in contact with the external environment) or internal (the fistula channel then goes into the organ cavity).

Postoperative fistula can be created artificially. It is introduced into the digestive system for artificial feeding of the patient. Artificial fistula of the rectum is formed for the smooth removal of fecal masses.

Fistulas in the human body can be formed in various chronic or acute diseases that require urgent surgical intervention.

When an organ, bone or muscle tissue of a cyst or an abscess (with the further appearance of the fistulous canal) occurs in the cavity, doctors re-excise the suture. If the inflammation is not eliminated, the infection becomes more severe and leads to the emergence of new fistulas.

Types of postoperative fistula

Ligature fistula is formed after the imposition of non-absorbable sutures and with further suppuration of the seams. They exist until complete removal of the surgical sutures and are able not to heal for a sufficiently long time. Fistula resulting from infection of tissues is a consequence of non-compliance with the rules of antiseptic treatment of the seam or subsequent divergence of the seams.

Fistulas of the rectum or urogenital system lead to a deterioration of the general condition of the body. Excretion of feces and urine is accompanied by an unpleasant odor, which gives a person many inconveniences. Bronchial fistula is a complication of surgery to remove part of the lung.While there are no more perfect ways of suturing the bronchi.

Treatment of fistula folk remedies

In the early stages of the disease, treatment with folk methods can be quite effective. Good results are obtained by treatment with a mixture of vodka and olive oil. The mixture should be used to treat affected areas. After performing this procedure, put a cabbage leaf, helping to pull the pus. The course of treatment lasts for several weeks, after which the fistulous canal disappears.

Fistula on the skin can be cured with a mixture of aloe and mummy juice. Mumiyo need to soak in warm water, mix the resulting solution with aloe juice. This medicine is used in the form of gauze compresses. Good results are given and compresses with decoction of Hypericum. 2 tbsp. spoon dry herbs poured a glass of water and bring to a boil. After this, the broth is filtered and used for compresses. For the treatment can be applied and fresh leaves of Hypericum. They are placed on the film, which is superimposed on the affected area. The course of treatment lasts until complete healing of the wound.

Fistula of the rectum can also be cured by folk methods. Mix a small amount of flax flowers, water pepper leaves and oak bark. The mixture must be cooked over low heat in a brass oven. Finished ointment with a cotton swab smeared the affected areas. The course of treatment lasts about 3 weeks. The same method can be used in the treatment of vaginal fistula. This ointment can be prepared using onions.

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Fistula - what is it?

A fistula is a channel that connects body cavities or hollow organs between themselves or with the external environment. It is lined with epithelium, and through it pus comes out, or the channel is lined with granulation tissue. If this does not happen, then a purulent fistula is formed.

Such a process may be the result of any inflammatory process in the body or a consequence of surgical intervention.

Types of fistula

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

Fistula may be complete and incomplete. Full has two holes and is faster treated, as it has a way out, incomplete, having one hole, develops further the inflammatory process, the number of bacteria increases.

The fistula may be labial or tubular. Guboid is treated only with the help of surgical intervention.

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

What causes fistula after surgery?

There are several reasons for this phenomenon:

  1. Not completely eliminated the focus of infection.
  2. With chronic prolonged inflammatory process.
  3. As the consequences of a blind gunshot wound. Small particles in the body, fragments are perceived by the body as a foreign body, and the process of festering begins.
  4. Denial by the body of the threads used in surgical operations, as a result - stitches fester.

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 reaction of the body to a foreign body.

The fistula on the seam after the operation forms a seal of the most suture thread, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is easy to recognize the fistula after the operation according to its characteristic symptoms. They are:

  1. A compaction, reddening, and hillocks are observed around the suture in the infected place, and here the body temperature is much higher.
  2. As a rule, at the initial stage, not all of the postoperative suture is inflamed.
  3. Observed purulent discharge. The less, the number of them more.
  4. The affected area becomes red, swollen and painfully touched.
  5. The stitching becomes red.
  6. The general condition of the patient may deteriorate, the body temperature rises to 38 degrees and above.

If you have such symptoms, you should urgently see a doctor, otherwise the infection process may spread to the organs or cause blood poisoning.

Diagnosing a fistula

It is easy to diagnose a fistula after the operation, as it can be seen visually if it is external. The doctor, after listening to the patient, examining, draws attention primarily to:

  • The 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 fistulous canal, sounding and radiography are used.

It is also necessary to make a series of tests that confirm the type of fistula. Gastric acid will show the presence of hydrochloric acid, and urinary - the presence of urate salts.

It sometimes happens that the suture can begin to fester after a long period after surgery, so you need to find out the cause of this phenomenon.

If you still have a fistula after surgery, how to treat?

Fistula treatment

For successful therapy, first of all it is necessary:

  1. Eliminate the source of the inflammatory process. If it is a thread, then it is removed.
  2. The doctor must conduct an examination, make fistulography. This will show whether the fistula has a connection with the internal organs.
  3. Then prescribed a mandatory course of antibiotics or anti-inflammatory drugs, depending on the depth of the inflammatory process.
  4. To maintain the body, the doctor may prescribe a vitamin complex to have more strength to fight the germs.
  5. The wound is washed with a syringe with hydrogen peroxide or furatsilina solution, as these tools perfectly disinfect and promote rapid healing. The procedure is carried out daily, and if there is a lot of pus, then several times a day.

As a rule, the wound begins to tighten. If this does not happen, then a surgical intervention is possible, in which excess granulations are removed, and cauterization of the areas is possible.

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

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

Postoperative intervention

If you still could not cure the fistula and had to resort to operative methods, then after the operation to remove the fistula, healing will take place within a few weeks. The wound will heal faster if you provide it with complete peace and proper care.

After surgery, rectal fistula, the doctor usually prescribes a diet so that the wound heals faster. After such operations, the appointment of painkillers and antibiotics is mandatory. The wound heals within a month, any physical activities are excluded.

The treatment prognosis is usually good, and the patient recovers completely.

Traditional methods of treatment

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

  1. It is necessary to take vodka and olive oil in equal proportions. Wet this mixture bandage and apply to the inflamed area. At night, attach the cabbage leaf. Such procedures need at least ten.
  2. Well pulls pus from the wound a mixture of aloe juice and mummy. Mumiye diluted with water to the consistency of strong tea. The dressing should be left for a long time.
  3. Wash the wounds advised decoction of hypericum. You can apply a bandage on top, and then wrap with oilcloth. If the solution is hot, then its effect will be greater.
  4. There is a recipe for ointment that treats not only fistulas, but also non-healing wounds. It is necessary to take equal amounts of flower honey, pine resin, medical tar, butter, aloe leaf pulp, mix the ingredients and heat in a water bath. Dilute with vodka to the desired consistency. Apply ointment around the fistula, then cover with polyethylene and apply a bandage or plaster. Fistula heal literally on the eyes.
  5. Well applied softened sap. It pulls pus well and tightens wounds.
  6. To enhance the patient's immunity, it is recommended to drink aloe juice with honey. The recipe of preparation is as follows: you need to take 12 leaves from a three-year-old plant and leave in the fridge for 10 days. Then finely chop, put in a glass dish and pour liquid honey so that it is completely covered. Stir every day and insist for 6 days. Infusion strain and use 1 teaspoon 3 times a day before meals. After such a remedy, forces appear to fight the disease, and wounds will heal faster.

It is worth noting that if a fistula formed after the operation, the treatment should be supervised by doctors, and folk remedies are an addition to the main course.

What is postoperative fistula

We immediately say that the fistula that forms in the patient's body after surgery can be attributed to the classic complication after surgery. Note that the reasons that lead to the formation of a fistula are:

  • Suppuration in the area of ​​operation.
  • EVENTATION
  • Infiltration in the field of operating sutures.

The basis in any case lies in the fact that the suture after the operation remains contaminated. Under suture tissue refers ligatures, or ligature thread. On them remain pathogenic microorganisms, which lead to the formation of compaction, granulomas.

The granuloma, in turn, consists of a ligature thread and cells with fibrous tissue. Macrophages and collagen fibers can also be present here, which then, after complete healing of all the stitches, can lead to the formation of scars.

In this case, we emphasize that the fistula does not have to be pronounced and brings inconvenience or pain. Small-sized fistulas are also diagnosed that do not manifest themselves at all and the patient does not even feel them.

And yet, most often it can be stated that fistulae are formed after applying a special thread of silk.

Symptoms of postoperative fistula

If the fistula is represented by a large size, then its development always takes place against the background of pronounced manifestations and symptoms. We define the main ones:

  • The inflammatory process begins around the wound. Small tubercles are formed, hot to the touch granulation of mushroom shape.
  • The inflammatory process does not affect the entire postoperative suture, but only a part.
  • From the wound, the area of ​​the affected inflammation begins to stand out pus. Sometimes it can be represented by a small number, new overwhelming number of cases, pus is allocated a lot.
  • The place of suturing begins to change color, turns red.
  • In the area of ​​fistula formation, edema and the first signs of pain, which may increase, begin to appear.
  • You can diagnose fever up to 39 degrees.

Fistula and its consequences

If the fistula does not pass for a long time, its main consequence may be suppuration of the ligature thread, which develops into an abscess.

It is worth noting here that ligature fistulas may re-cause infection of the postoperative suture. In addition, there is the likelihood of intoxication of the whole body, which can bring the patient to disability.

Important! Frequent discharge of pus from the fistula opening can lead to the onset of dermatitis, which can turn into chronicles.

Interestingly, the occurrence of a fistula does not necessarily occur in a short time after surgery, it is often possible to diagnose its development and several months after a successful surgical intervention.

Treatment of postoperative fistula

In principle, the ligature thread can independently come out with pus after the suppuration reaches a critical point, so to speak. However, this happens in rare cases, and just watching the development of a fistula, without turning to doctors for help, would be a completely wrong move.

You just need to immediately, at the first symptoms, consult a doctor. And independently to carry out treatment of the fistula, and even at home, it is extremely dangerous and contraindicated.

First of all, the treatment lies in the fact that the festering ligature thread is removed again by surgery. After prescribed a course of antibiotics and anti-inflammatory drugs.

Be sure to add to the course of treatment reception, which are designed to help restore immunity and maintain it at the right level.

With regard to wound healing after removal of the festering filament, here are used rehabilitation, which are performed by washing with a solution of furatsilin. Hydrogen peroxide can also be used. Both of these tools not only perfectly disinfect the wound surface, but also relieve pus that is excreted.

Along with the removal of a festering ligature, cauterization and curettage of granulations can be carried out, which, in inflammation of the fistula, appear in excess form.

In addition to these activities, there is a more benign method of treatment of postoperative fistula, which is concluded in the use of ultrasound.

When several channels are formed at once, the doctor makes a decision on the surgical excision of the scar, and the fabric is completely removed together with the ligature thread, and a new stitch is applied to the site of the operation. Recall earlier we wrote about.

Therapeutic methods

Treatment should be started as early as possible. Complications are dangerous and can cause secondary infections. Pathology can be fatal. Therapeutic methods are selected by the doctor.

Treatment may be:

More often patients are recommended surgical treatment. The operation to remove the fistula is to remove the infected ligature. Previously, doctors make a small incision so that all the pus comes out and then close the defective mass. After the procedure, the patient is prescribed a course of antibiotic therapy. The wound is washed with special solutions. Give direction to physiotherapy.

Conservative treatment is possible only with timely treatment to the doctor and the presence of a small amount of pus. In this case, the doctor removes dead tissue near the fistula. The patient is prescribed antibacterial drugs and drugs to improve the protective functions.

Treatment always involves prescribing antibiotics to kill the infection.

Preventive methods

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

Before the operation, the wound should be washed. Before the procedure, the doctor must check the thread. The material must:

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

Only if all recommendations are followed by a doctor can the risk of deviation formation be significantly reduced. However, it is completely impossible to exclude it. After surgery, the patient must fulfill all the doctor's appointments. Regularly required to handle the wound.

Fistula after cesarean section is one of the most common problems, which is directly related to the operation and is dangerous because it provokes various pathological microorganisms entering the female body, which stimulate the development of infectious processes.

After any operation, special stitches are applied to promote rapid healing. Doctors treat the incision in order to stop the bleeding in time and prevent massive blood loss. The material of all seams is a ligature. She does not give women any further complications.

Before stitching the cut, experienced specialists process it in a high-quality way so that bacteria do not get inside. If you do not do this, inflammatory processes that trigger the appearance of a fistula will develop. Any penetration into the suture causes pus to form. It subsequently flows out, the passage is called a fistula. Fluid can break through into one hole or into several holes, so many ligature fistulas can appear simultaneously.

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

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

  1. Full. It has two options at once, which contributes to a more rapid removal of the inflammatory process and healing
  2. Incomplete. It has only one outlet, which is usually located inside the abdominal cavity. This contributes to the intensive reproduction of pathogenic microflora and the strengthening of inflammatory processes.
  3. Spongy. In this case, the fistula grows together with dermatological integuments 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 strong edema.
  5. Tubular. Fully formed canal that releases pus, mucus and feces

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

The main causes of fistula after surgery:

  • The orgasm perceives the material that was used to sew up the wound, as an alien body and begins to reject it.
  • The wound itself is infected as well as the ligature
  • Untimely and poor quality treatment of postoperative suture
  • Patient is too old
  • Excess weight
  • Reduced immunity

  • A compaction appears around the cut in the skin, which, when pressed, begins to noticeably hurt. In some cases, pronounced tubercles appear that emit infiltration
  • Near the infected scar will be clearly noticeable redness. And brightest of all it will look in the course of the imposition of ligatures
  • The temperature may rise very sharply. And since in the body the inflammatory process will intensify all the time, it will not get off to normal levels
  • There is a strong suppuration, which, if not properly treated, turns into a rather large weeping.
  • The fistula hole may for some time be tightened and then inflamed with new force.

Consequences that cause fistula

By itself, postoperative fistula does not carry a threat to life. But if the patient leaves everything to chance, then the pathogenic bacteria that are inside the fistulous opening start to infect healthy organs and tissues and this will provoke the appearance of quite serious diseases.

In addition, the body can 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 fistulous opening.
  • Phlegmon. In this case, the pus, in addition to tissue, also begins to infect fatty tissue.
  • Sepsis. The opening of the fistulous opening inside the human body. The pus enters the internal organs of the patient.
  • Fever , provoked by purulent mass. Temperature indicators can rise to maximum levels. At the same time, a person may lose consciousness and be poorly oriented in space.

Purulent fistula on the surgical suture - treatment

In the trailer, it is permissible to treat ligature postoperative fistula by folk methods. Some of the methods described below remove inflammation reasonably well and reduce the amount of pus.

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

  • Take olive oil and strong vodka and equal parts and mix until smooth. The resulting mixture 3-4 times a day, wipe the inflamed area of ​​skin. To enhance the therapeutic effect, you can immediately apply the cabbage leaf, which is scalded with boiling water beforehand. So you will not only kill pathogens, but also contribute to a more rapid discharge of pus.
  • For cooking, the next miracle means you need mummy and aloe juice. Mummies need to be soaked in boiled water, and when it turns it dark brown, add aloe juice to it. In this solution, it will be necessary to moisten a sterile bandage and apply it to the sore spot.


Decoction Hypericum for the treatment of fistula
  • If you need to quickly extract pus, then use the St. John's wort herb for all of us. In this case, you can use and decoction, and leaves. First, cut off the leaves of Hypericum, fill them with water, and then protomite on a small fire for 10-15 minutes. When the broth has cooled down 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 applied for 4 hours. After this time, the dressing should be removed, the sore spot should be treated with hydrogen peroxide, and then apply fresh
  • Broth celandine will help you fight the fistula from the inside. If you prepare a decoction from this plant and take it regularly for a month, then the substances that are in its composition will kill the infection in the fistula opening and contribute to the removal of inflammation. But since this broth thickens blood very much, it will be better if the doctor determines the dosage.
  • You can try to get rid of the fistula with ordinary black bread. Take the pulp and lightly sprinkle it with water. When the top layer softens a little, attach the bread to the sore spot and fix with a sterile bandage. It is necessary to carry out this procedure once a day. Before each znamenny bread, be sure to treat the wound with hydrogen peroxide. If you do everything right, then for about the third day you will see that the fistula was completely purged of pus and began to drag on.

Ointment for the treatment of postoperative fistula

Quite well themselves also recommended homemade ointment. They are quite good at eliminating the cause of the infection and contributing to a more rapid recovery of dermatological covers. But in this case it is extremely important to treat the application of the ointment very carefully, as well as the pretreatment of the wound.

You need to protect yourself from re-infection of the fistulous opening. After all, if you apply non-sterile dressings and use a means of doubtful quality, you are unlikely to improve your condition.

Most popular ointments:

  • At home, you can also use the ointment, which will have both anti-inflammatory and healing properties. For its preparation, 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 pre-disinfected skin.
  • Another effective tool is an ointment from fresh calendula flowers. They should be firmly folded floor liter jar and pour with melted pork fat or butter. Leave the agent in a dark place for 10-12 hours to infuse. Then shift his clay pot and stew for 48 hours in the oven, at a temperature of 70 degrees. After the ointment has cooled, transfer it to a container with an airtight lid and store it in a cool dark place. The resulting tool can simply lubricate the fistulous opening or make it medical dressings



As mentioned above, the best way to get rid of postoperative fistula is to completely exclude it. Although this procedure is quite unhealthy and has a rather large recovery period, it is it that will protect you from the development of such complications as sepsis and phlegmon.

Stages of the operation:

  1. First, the fistulous opening and all the skin around it are treated with antiseptic agents.
  2. Anesthetic agents are then injected into the wound area.
  3. At the next stage, the wound is carefully dissected and all pus and remnants of ligature will be removed from it.
  4. After that, all is well washed, install drainage and close the secondary suture.
  5. The vessels in this case are not sewn as this may lead to the formation of another fistula.

After surgery, the affected skin area will require special care. The wound should be treated with disinfecting solutions (for example, furatsilinom) and ensure that it was clean and dry all the time. If even after surgery at the site of fistula formation, excessive granulation is noticeable, then it should immediately be cauterized.

Video: Ligament fistula perineum

Each operation is a serious risk to the body. Currently, doctors are trying to carry out most surgical interventions with minimal suturing of the wound area. However, even with careful observance of all the rules for the care of the operating area, complications such as ligature fistulas may arise. According to statistics, every tenth patient of working age and every fifth pensioner is facing them. That is why it is necessary to know the first symptoms of the appearance of the disease, as well as to pay great attention to the rules of prevention. So you can protect yourself and your loved ones from the development of such complications.

What is a ligature fistula

Ligature fistula is an inflammatory cavity that formed after surgery, in which there are purulent masses. Almost all surgical procedures are performed with damage to the soft tissues of the patient. To close the defect and ensure the immobility of the wound edges, doctors use special stitches. The threads that are superimposed on the damaged area, are called ligatures. Unfortunately, often such an intervention is complicated by the addition of the inflammatory process.

1 - vessel lumen, 2 - muscles of the anterior abdominal wall, 3 - skin of the anterior abdominal wall, 4 - lumen of the tubular fistula, 5 - wall of the small intestine

How long after the operation is the disease manifested

Ligature fistula can develop in the early postoperative period (in the first seven to ten days from the surgical intervention). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then this is the consequence of defects in the care and ligation.

What types of surgery provoke the development of ligature fistula

Similar pathology may occur on the background of the following operations:

  1. Appendectomy. This is a surgical procedure to remove the appendix of the caecum, which is located in the right side of the abdomen just above the pubis.
  2. Caesarean section - a method of removing the baby from the mother's body. In this case, the incision is located directly above the pubis, and doctors consistently cut through the skin, fatty tissue, muscles and uterus. The danger of fistula development after this operation is that the pus directly enters the reproductive organs and can cause infertility.
  3. Mammoplasty - surgical intervention aimed at increasing the size of the breast. A silicone implant is inserted through an incision that is located under the breast, in the area of ​​the nipple or axilla.
  4. Episiotomy - an operation to cut the perineum.Used in difficult childbirth (multiple pregnancy, large child).
  5. Nephrectomy is a surgical procedure in 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 a greater load.

Photo gallery: the location of the seams after various operations

A caesarean section is one of the hardest operations that usually involves a large incision.
When mammoplasty is often formed ligature fistula under the breast. After surgery to remove the appendix, the suture is located to the right of the midline.

What is ligature infiltration and ligature granuloma

The ligature granuloma is an inflamed area of ​​tissue that is bounded by a protective shaft from surrounding organs. Its formation is associated with a massive growth of a connective tissue substance that fills the entire space of a defect.

Ligature infiltration is a cavity inside which altered cells and inflammatory fluid are located. And the presence of pus, blood and other foreign matter is also possible.

How does the formation of a similar pathology

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

Redness of the suture after surgery is considered an adverse symptom

A few days later, hemorrhages of the type of large and small bruises appear in the area of ​​damage. Along with this, the nature of the discharge from the wound changes: from yellowish, colorless or bloody, it becomes purulent. At the same time, the color changes to green, and an unpleasant odor arises, which is provided by existing bacteria. Patients complain of severe pain and an increase in the amount of discharge when pressed. The skin near the affected area acquires dense edema, becomes hot and tense, the seams can erupt and injure the surrounding tissue.

Chronic and asymptomatic course of this 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 related to meals,
  • and dizziness,
  • loss of appetite,
  • body temperature rise up to 37–40 degrees
  • reduced performance
  • increased fatigue
  • sleep disturbances due to pain and frequent awakenings,
  • nervousness, irritability and other changes in the mental state.

In some cases, a purulent canal tears and self-cleaning wounds. So you can see the formed passage - a fistula. At the last stage, the formation of such a disease may be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and needs immediate resuscitation.

Methods of diagnosing the disease

An experienced doctor will be able at first glance to suspect the development of a patient's ligature fistula. To do this, it only needs to inspect 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 has caused its development.

What methods of treatment help to get rid of the disease?

Ligature fistula is a pathology that is prone to frequent recurrence.That is why therapy lasts for 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 drugs for external treatment of the wound. In this case, the patient must appear every two days on dressings or at least once a week show a suture to the attending physician (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 state of the whole organism. Surgical intervention is carried out in the absence of positive dynamics from conservative treatment within one and a half to two weeks.

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

Drug therapy pathology

Treatment of a ligature fistula with conservative means is the use of pharmaceutical preparations of local and general effects. They can not only get rid of the symptoms of the disease, but also completely eliminate the cause that provoked the development of the disease.

Remember that without medical prescriptions, the use of any medication is strictly prohibited. In my practice, I have come across a patient who independently began taking antibacterial agents without familiarizing himself with the content of the instructions. He also suffered from cardiovascular disease, in which there is a rather limited list of drugs that can be used. 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 doctors of the intensive care unit had to withdraw it. The situation ended well, but the victim acquired a deep disability as a result of his experiments. That is why doctors advise very carefully to the choice of drugs.

Means for the local treatment of ligature fistula:

  1. Antiseptic solutions are designed to treat the wound surface. They allow not only to remove the remnants of fat, blood, ichor and purulent secretions from the skin, but also to kill most of the harmful microbes. For this purpose, Miramistin, Chlorhexidine, hydrogen peroxide, Furacilin, manganese are most often used.
  2. Healing ointments that improve blood circulation and accelerate regeneration processes. The most common means: Bepanten, Rescuer, Dexpanthenol, Pantoderm.
  3. Anti-inflammatory gels reduce the severity of edema, allow you to fight itching and relieve pain. The most commonly used: Diclofenac, Nise, Nimesulide, Ibuprofen, Ketorol, Ketorolac.

Photo gallery: preparations for local wound treatment

Chlorhexidine helps to disinfect the wound surface
Dexpanthenol accelerates recovery processes Diclofenac is an anti-inflammatory with anesthetic effect.

Medications for general therapy:

  1. Antibiotics have a pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Claforan, Tetracycline, Vibramitsin, Keiten, Augmentin, Unazin, Azlocillin, Zinnat, Aztreonam, Imipenem, Vankotsin, Rondomitsin.
  2. Steroidal anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body, relieve redness and puffiness of soft tissues. Acceptable use Hydrocortisone, Cortef, Latikorta, Deksona.
  3. Vitamin and mineral complexes accelerate the healing process and restore the body's need for certain substances.Most often used: Complivit, Calcium D3-Nikomed, Aevit, Vitrum, Supradin.

Photo gallery: drugs for systemic effects on the body

Augmentin - a broad-spectrum antibiotic that kills bacteria. Vitrum contains all the mineral elements the body needs.

Surgical treatment of ligature fistula

Conservative therapy is not always an effective method for such a disease. If the disease progresses steadily, the doctors decide on the need for re-surgical intervention. It is conducted under the following conditions:

  • addition of purulent complications
  • a sharp deterioration in the patient’s condition
  • lack of effect from conservative therapy,
  • eruption of suture material.

Contraindications to surgery:

  • the need to stabilize the victim,
  • too old or too young age
  • acute allergic reaction to the components of anesthesia.

Tissue excision is necessary to prevent recurrence of fistula.

The operation is carried out in several stages:

  1. Doctors anesthetize the area of ​​the 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. With the help of a scalpel and forceps, remove the old suture material, in parallel with this, expanding the incision area. Next, the doctors study the condition of the wound, the presence of purulent hemorrhages and ulcers, if necessary, add coloring matter (this allows you to determine the course of the fistula).
  3. Using vacuum suction, surgeons remove accumulations of blood, lymphatic fluid and patches of dead tissue. Scalpel excised formed fistula.
  4. Using another suture, the wound is closed. If necessary, a thin rubber tube is placed in one of its corners — a drainage through which the contents flow. The seams are closed with a sterile dressing with a healing ointment.

How to care for a suppuration site

To avoid the attachment of a secondary infection and protect your body from the development of purulent complications, it is necessary to monitor the cleanliness of the wound. For the first few days after surgery, a nurse under the supervision of a doctor deals with dressing and suture treatment. But in some cases, the patient has to take care of the surgical wound from the very beginning. That is why it is necessary to observe the following processing steps:

  1. Wash your hands with soap and water, then dry them with a paper towel (this will help minimize the number of bacteria). Disinfect the palms and fingers with an antiseptic.
  2. Treat the skin around the wound with water and cotton discs. You can use gels without alcohol fragrance. If necessary, also wipe the skin with an antiseptic without touching the seams.
  3. Carefully remove bandage. It should be done with soft and unsharp movements, since jerks can damage the surrounding tissues. If suckling and blood become soaked, it is allowed to soak the dressing in an antiseptic or in plain water.
  4. Use a small gauze pad to evenly clean the seam surface. Try to remove the dirt and dried blood. Continue washing until the wound is clean.
  5. Apply a bandage with the ointment prescribed by the doctor and gently wrap it with an elastic bandage. At the same time try not to overstretch the soft tissue.

Be extremely careful: some actions can cause the seam to deteriorate.

What is strictly forbidden to do during the rehabilitation period:

  1. Visit the baths or saunas, swim in the hot tub. Steam contributes to the softening of the tissues around the seam, with the result that the threads erupt and an even deeper fistula forms. For the same reason, do 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 the source of many harmful bacteria that even penetrate through the bandage. Swimming in pools is limited due to the presence of bleach, which disrupts the healing processes of soft tissues.
  3. Use alcohol-containing solutions for the treatment of wounds without medical appointments. Such drugs not only kill bacteria, but also damage the smallest blood vessels, causing bleeding. That is why their use is strictly limited.

Features of treatment of ligature fistula after various types of operations

Often, this complication occurs after natural and artificial labor (cesarean section) or episiotomy. During pregnancy, the 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 childbirth ends with the imposition of sutures on the damaged perineum.

A feature of the therapy of such a condition is the inability to use many of the usual medications, as they enter the breast milk and can be transmitted to the newborn child, negatively affecting the state of his body. That is why doctors mainly use local therapy: the suture should be treated several times a day with an antiseptic solution, and the woman must maintain clean surrounding tissues. Local preparations do not penetrate into breast milk and do not affect the condition of the child. If the pathological process progresses, doctors prescribe antibiotics with minimal effect on the newborn: Amoxicillin, Erythromycin, Cefotaxime.

Treatment predictions and possible complications of a similar pathology.

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

Important in the treatment of ligature fistula is strict hygiene and rules for the treatment of 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 attaching bacterial microorganisms to the postoperative incision area. As it turned out, the victim did not handle his hands before changing the dressing, and also periodically sealed it with a rough plaster. When it was separated from the skin, tissue trauma was constantly occurring, which complicated the healing process. The man was operated on and removed all the elements of pus, which made his condition much easier.

What complications can occur in patients with a ligature fistula:

  1. Formation of an abscess. This pathological formation is a massive accumulation of pus in soft tissues, which is limited to the capsule. An abscess develops gradually: edema begins to form in the wound area, soreness increases dramatically. After a couple of days, an immobile red eminence is formed above the skin surface, having a dense-elastic consistency. When probing, there is a softening in its middle, the boundaries of which increase with time. Treatment of an abscess is carried out with the help of its opening and excision of the capsule. Additionally, doctors prescribe antibiotic therapy.
  2. The development of phlegmon.Unlike an abscess, this accumulation of pus has no boundaries in soft tissues and may spread further along the location of fatty tissue. Cellulitis melts nearby vessels and nerves, as a result of which the blood supply to the most important organs and systems is disturbed. Its danger lies in the fact that often the formation lies deep in the tissues, and it is quite difficult to detect it. Edema and redness can form only 4–7 days after the onset of the disease. It is possible to get rid of phlegmon only by means of surgical intervention and further intake of antibacterial drugs.
  3. Blood poisoning. One of the most dangerous complications that all doctors fear is sepsis. When bacteria from the area of ​​a ligature fistula enters the systemic circulation, a cascade of pathological inflammatory reactions is formed, during which microbes enter all internal organs. As a result, their functioning is impaired: the heart, kidneys and brain suffer the most. As well as the leading mechanism of this condition is blood thickening - it cannot normally pass through the vascular bed. Treatment of this pathology is carried out in the intensive care unit and intensive care with the help of detoxification, antibacterial and anti-inflammatory drugs.
  4. Development of the scar at the location of the ligature fistula. Usually, the entire defect is filled with connective tissue, which has a structure different from that of the skin and muscles. A scar can be quite rude and even interfere with the implementation of certain actions. In order to prevent this condition, physicians use physiotherapy and healing ointments and gels.

Photo gallery: possible complications of the disease

The phlegmon of the foot can be very deep and does not give other symptoms besides edema. An abscess is a purulent formation with a capsule. Scar is a proliferation of connective tissue

How to prevent the development of ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection penetration into the surgical wound is still unsolved. In order to prevent this pathological condition, recommendations on individual and group prophylaxis are developed annually at the earliest. As part of the latter, practicing professors at medical universities organize lectures and open seminars on the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

During my studies at the Department of Traumatology, I had to participate in an event dedicated to the problem of the emergence of a ligature fistula in the early and late postoperative period. To obtain the most detailed information, doctors presented illustrative cases from their practice: a selection of patients between the ages of twenty and eighty years who were not fortunate enough to encounter a similar ailment. During the study, all the victims were asked to fill out questionnaires containing questions regarding lifestyle, diet and hygiene measures taken to treat the wound. As it turned out after analyzing the data, about 20% of patients continued to abuse alcohol and did not follow the rules of cooking, 5% missed taking the necessary pills, and 40% performed dressing at home, which increased the risk of infection from the environment. Doctors concluded that the overwhelming majority of patients violated the rules for the management of the recovery period: this influenced the formation of postoperative fistula. Based on the data obtained, we have developed universal recommendations for the prevention of the development of this disease, the use of which helps to 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 the planning of a surgical intervention (if it is not an emergency), it is necessary to check 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 intended threads and take them to the allergy laboratory. There, the doctor using skin or intradermal tests will detect the presence of a pathological reaction. When redness, swelling and swelling of the skin from the use of this type of material should be abandoned. Currently, there are a huge number of suture threads: one of them will definitely suit you.
    Application test allows to detect allergen
  2. Try to avoid stress and neuropsychic shocks. During the period of recovery of the body after surgery, even minor anxiety can cause deterioration. It is proved that during stress and stress, the internal glands of a person secrete hormones that slow down the processes of rehabilitation and tissue healing.
  3. Take care of hygiene. Most opportunistic bacteria live on the skin, even in 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 the entrance gate for bacteria. That is why it is so important to monitor the clean surrounding tissues. It is recommended to wear spacious clothing made of natural materials that will not cover the site of the postoperative incision or injure it in any way. In the morning and in the evening it is necessary to treat the skin with the help of water and detergents, while not touching the bandage.
    The antiseptic gel removes germs from the skin.
  4. Give up physical activity. Prolonged lifting and carrying over of weights or exercises in the gymnasium can cause the eruption of soft tissues with suture material, causing the wound to spread. This will not only increase the risk of developing an infection, but may also give rise to a second operation. That is why doctors forbid to engage in sports and lift loads of more than one kilogram for several months after surgery. Once a stable scar is formed, you can return to unlimited training again.
  5. In the period before and after the operation, try to adhere to proper nutrition. Popular vegetarian and vegan diets with a complete lack of animal protein reduce the healing rate of soft tissues and lengthen recovery processes. During the rehabilitation period, the body needs to receive fats and carbohydrates in large quantities, and the caloric intake should not be less than 2500–2700 units. Doctors recommend abandoning fast food, fast food, carbonated drinks and packaged juices, as well as sweets. These products slow down the body's metabolism and can have a bad effect on wound healing. Prefer vegetables, fruits, berries, lean meat and fish, as well as cereals and cereals. It is possible to restore the amount of protein and calcium in the body with the help of dairy products and special vitamin-mineral complexes.
    Dairy products are necessary for the nutrition of patients in the postoperative period.

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, you should not worry and worry once again: the modern system of medical care has long provided for such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more efficient and safer to consult the doctor who performed the operation.He will be able to accurately determine the cause of the ligature fistula and suggest effective ways to combat this problem.

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