Ligature fistula of the anterior abdominal wall. Causes of ligature fistula and treatment methods

Most surgical interventions end successfully: after suturing, the tissue gradually heals, and as a result, only a small scar remains on the body. But sometimes something goes wrong in this process, and a ligature fistula may appear.

A ligature move has appeared: what is it?

The term “ligature fistula” is used by physicians to refer to a pathological tract formed in the area of applied suture material, which, in turn, was used to fasten (sew together) tissues at the site of surgery. Such a violation is accompanied by the development of an inflammatory process and suppuration. Among all possible complications after operations, ligature fistula is considered one of the most common - a similar problem is recorded in 5% of patients who have undergone all kinds of surgical interventions.

Most often, a ligature tract appears after manipulation of hollow organs located in the abdominal cavity or in the pelvic area, since the risk of infection during such operations is highest. The fistula can be exclusively superficial, but sometimes it forms at quite a considerable depth.

Causes of an abscess on a postoperative scar

Doctors assure that the main reason for the formation of a ligature fistula lies in the body’s attempt to reject a foreign body, represented by a thread that the surgeon used to suture tissues cut during the operation. Most often, pathological processes of this kind occur after the use of silk threads; much less often, lavsan or nylon material becomes the culprit. There is evidence that an abscess can form when using catgut, even though it is an absorbable thread. At the same time, vicryl or prolene threads are practically unable to cause an inflammatory process.

As for the factors that can provoke the formation of a ligature fistula, among them are:

Introduction of infection. This development of events is possible if pathogenic microorganisms penetrate the suture material due to inflammation of the wound left after surgery. The infection can spread due to insufficient sterility of the surgical field or the instruments used. It can also be triggered by the patient’s insufficient compliance with 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 while already on the thread, if doctors violated the rules of sterility.

Development of immune rejection. The natural activity of the immune system can lead to 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 occurrence.
Stitching a hollow organ. A similar situation can happen if the doctor accidentally grabs the entire wall of the organ, which is accompanied by the penetration of the thread into its lumen. As a result, the suture material comes into contact with the non-sterile filling of the organ and, naturally, becomes infected. Pathogenic microorganisms gradually spread throughout the thread, activating the inflammatory process.

Regardless of the reason for its formation, a fistula can permanently disrupt the patient’s ability to work, aggravating the course of the underlying illness.

Pathogenesis

If the suture heals normally, scar connective tissue cells gradually form around the threads, and the suture material seems to be surrounded by a capsule.

If a purulent-inflammatory process develops, normal healing does not occur. Instead of a capsule, the thread surrounds an abscess (boil). Over time, it increases in size and opens in the area of the postoperative scar - a fistula is formed. Thanks to the presence of such a course, there is a decrease in the phenomena of acute inflammatory process, because the contents of the abscess are constantly drained. In this case, the suture material can be in its normal place or move along the fistula tract.

Features of ligature fistulas:

They can form with equal probability during suturing of superficial tissues (for example, on a leg or arm) or in the depths of the wound (during operations on the peritoneum or pelvic organs).
Deeply localized ligature tracts can involve internal organs in the purulent-inflammatory process.
They may appear years, months or weeks after the intervention.
They can occur with various symptoms.

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

Symptoms of an abscess on a seam

Abscess formation can occur after the patient has been successfully discharged from the hospital, even several years later. The pathological process can make itself felt by local and general disorders:

Painful sensations in the projection of the location of the infected suture material.
Weakness, feeling of weakness, increase in temperature.
Formation of a painful compaction in the projection of the postoperative scar.
Changes in the color of the skin over the site of inflammation. Most often, the skin becomes purple or bluish.
A few days after the development of primary symptoms, a spontaneous breakthrough of the abscess occurs.
A small tract is formed, through which serous-purulent fluid (mass) is released in a small volume. If there are surgical sutures on the body, then a typical serous fluid begins to emerge from under them, which is then replaced by pus.
After the breakthrough, the unpleasant symptoms suddenly disappear and the severity of inflammation decreases.

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

Complications

A ligature fistula can go away on its own, but in some situations its formation can result in quite serious complications:

Secondary infection, which will be accompanied by the spread of a purulent process.
Skin dermatitis due to leakage of secretions from the ligature tract.
Hyperpigmentation of the skin at the site of the lesion.
Development of superficial or deep ulcers.
Damage to nearby organs, both as a result of a purulent inflammatory process, and due to unsuccessful removal of suture material by a surgeon.
Eventration (loss) of internal organs through a defect in the peritoneal wall. A similar situation can occur as a result of purulent melting of tissue.
Sepsis.
Lethal.

At the slightest suspicion of the development of an inflammatory process in the suture area, you should seek medical help, even if quite a lot of time has passed since the operation.

Diagnostics

Usually, with superficial fistula tracts, there are no difficulties in diagnosing them. To do this, all you need is a medical examination in a dressing room. Immediately after examining the fistula tract, the doctor may even remove the ligature. But if the fistula tract is tortuous or not typically located, additional research techniques may be required.

To determine the precise localization of the fistula and the presence or absence of complications, ultrasound is performed.

On the stomach

When a fistula tract forms in the peritoneum, it becomes necessary to perform fistulography. Such a study makes it possible to find out the depth and features of the shape of the formed passage. The specialist injects a contrast agent into the cavity of the fistula, after which he takes several x-ray images in different projections. Ultrasound techniques can also be used for this purpose.

How to cure?

Most often, it is possible to cope with a ligature fistula only through surgical intervention. You definitely cannot do without the help of surgeons 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 get by only with conservative therapy methods.

Conservative treatment

Various groups of medications can be used to treat ligature fistula:

Local antiseptic drugs. Usually, preference is given to water-soluble ointments, for example, Levosin, Levomekol or Trimistan, as well as fine powders, in particular Baneocin and Gentaxan. Fat-based ointments (for example, the well-known Vishnevsky ointment) can impede the outflow of pus, so their use is not recommended, especially if there is a significant volume of purulent discharge.
Antibacterial medications. Preference is given to drugs with a broad spectrum of action: ampicillin or ceftriaxone.
Enzymes to eliminate dead tissue. Trypsin is usually used for this purpose.

Medicines must be administered inside the fistula tract, and also distributed throughout the tissues located near the wound several times a day. In parallel, physiotherapeutic techniques 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 (usually iodine tincture is used).
The problem area is numbed with injections of Lidocaine or Novocaine.
A special dye is injected into the fistula tract for a full examination.
The resulting fistula is dissected and the suture material is removed.
An inspection of adjacent tissues is carried out.
Stop bleeding using electrocoagulation or peroxide.
Carry out thorough sanitation of the wound using antiseptics.
The wound is closed with sutures and active drainage is installed.

A competent operation with complete sanitation of the wound allows you to avoid serious complications. A wait-and-see approach in the case of a ligature fistula is completely unjustified.

Forecast

In most cases, when a ligature fistula forms, the prognosis is favorable for the patient’s life and relatively favorable for his recovery. As a rule, such a complication ends in a successful cure, although it may require repeated surgical intervention.

However, in approximately 60-65% of cases, doctors are able to remove the suture material without surgery. But even in this case, the ligature fistula can recur.

Prevention

The main measures to prevent ligature fistula are:

Competent and thorough organization of sterility during surgical interventions.
Proper preparation of suture material.
The use of suture material that rarely causes complications.
Performing adequate antibiotic therapy after surgical intervention.
Patients comply with all doctor’s recommendations and timely visit the hospital for examinations after surgery.

Doctors assure that there are no 100% effective methods for preventing the appearance of ligature fistulas, because even with absolute sterility there is a risk of infectious agents getting into the surgical wound. And it is completely impossible to predict and prevent possible rejection of suture material.

The appearance of a fistula on the body of a person who has recently undergone surgery is a kind of complication of the process of restoring damaged epithelial tissues, when the regeneration of their cells does not occur or occurs at a slow pace. Many factors influence such a pathological state of the operated area of the body, but in most cases it is the entry of infectious microorganisms into the wound that provoke a purulent-inflammatory process, as well as a severely weakened immune system of the patient.

A postoperative fistula is a through channel that is hollow inside and connects organs located in the peritoneum with the environment. Based on its etiology and symptoms, the pathology is considered extremely dangerous, as it prevents stable wound healing. This increases the likelihood that microbes, viruses and fungal infections will penetrate the internal organs, which can cause many secondary diseases of varying severity. After the operation, its formation is associated with the lack of normal dynamics of healing of the strip suture.

The very nature of the formation of a fistula is such that it is formed during the acute phase of inflammation, when purulent masses accumulated in the subcutaneous layer break through the epithelium, naturally drain and come out, creating a hole in the abdominal cavity or on any other part of the body. The most common fistula lesions in the abdominal cavity and lower extremities occur in medical practice. This is due to the physiological and anatomical structure of the human body.

Reasons for education

In modern surgery, it is generally accepted that prolonged non-healing of the wound surface formed after surgery is a complication that requires medication and sometimes even surgical treatment. For it to be effective, it is extremely important to establish the factor contributing to the development of the pathological condition of the suture. The following causes of postoperative fistulas of varying localization and severity are identified:

improper care of the wound, lack of antiseptic treatment with solutions specially designed for this (Chlorhexidine, Miramistin, Hydrogen Peroxide, Iodocerin), rare replacement of dressing material;
entry of pathogenic microflora directly at the time of the operation, if surgical instruments and threads that have undergone insufficient sterilization are used, or infection occurs during the rehabilitation process;
low-quality suture threads were used, which led to a negative reaction of the body and their rejection began with extensive inflammation and the formation of purulent masses;
reduced immune status of the patient, when the cells responsible for suppressing the activity of pathogenic microflora are not able to cope with the functional responsibility assigned to them and even non-dangerous strains of microorganisms enter the wound, leading to purulent damage to the epithelium with the formation of a hollow drainage channel (fistula);
excess body weight, when a thick layer of adipose tissue excludes normal regeneration of epithelial cells (the cut area of the body simply physically cannot heal, since the fat exerts constant static pressure on the wound);
senile age of the patient (patients who are already 80 years of age and older tolerate very poorly not only the surgical intervention itself, but also the period of recovery of the body, because the cells responsible for the formation of fibrous tissue, from which the suture scar is formed, divide at too slow a pace) ;
medical negligence and leaving surgical instruments in the abdominal cavity (such cases periodically occur in different countries of the world, and their occurrence is associated with insufficient care of medical personnel directly at the time of the operation).

By promptly eliminating these causative factors, it is possible to ensure stable recovery of the human body in the postoperative period, as well as to avoid the development of inflammatory processes.

How to treat a fistula after surgery?

The appearance of a postoperative channel through which purulent contents flow is not a death sentence for the patient. The main thing is to start treatment of the pathology in a timely manner so that the fistula does not cause the occurrence of concomitant diseases of an infectious nature. To do this, the patient is prescribed the following treatment measures.

Antibiotics

Washing the seam

The entire strip wound and the resulting fistula are subjected to daily cleansing with antiseptic solutions. Most often attributed to Hydrogen Peroxide with a concentration of 3%, Chlorhexidine, Miramistin, Iodocerin, manganese water. The procedure is performed 2-3 times a day to cleanse the tissues of purulent secretions and microbes.

Surgical debridement

Quite often, a fistula forms a scar consisting of fibrous tissue that is unable to grow together. This results in a hole that is no longer capable of healing on its own. To eliminate this pathology, the surgeon cuts off the edges of the fistula in order to start a new process of regeneration of exposed tissues.

Before surgery, antibiotics are used to ensure complete elimination of infectious inflammation. Otherwise, the operation will only lead to an expansion of the diameter of the fistula. The described complex treatment of a non-healing wound ensures gradual healing of the inflamed wound with relief of the drainage channel.

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

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

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

In this article you will learn:

General information about the complication

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

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

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

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

Root causes of violation formation

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

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

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

Symptoms of the disorder

Symptoms of a ligature fistula include:

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

The seam should be smooth, if redness or thickening is observed, you should show it to a doctor

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

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

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

Possible complications

Complications of a ligature fistula include:

phlegmon;

eventration;
sepsis;
toxic-resorptive fever.

Inflammation of the suture can develop into an abscess

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

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

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

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

In case of serious complications, the temperature can rise to 40 degrees

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

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

Diagnostic methods

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

detect possible complications;
determine the location of the fistula.

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

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

Therapeutic methods

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

Treatment may be:

conservative;
operational.

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

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

Treatment always involves prescribing antibiotics to kill the infection

Preventive methods

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

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

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

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

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

Forecast

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

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

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

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

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

Sometimes it happens that at the site of their application a pronounced inflammatory process occurs, serous (cherry-colored), and then purulent discharge, and this is a reliable indicator that a fistula has formed after the operation and its rejection by the body has begun. It is important to understand that a postoperative fistula is a manifestation of an abnormal course of this period and requires further treatment.

Causes of ligature fistula after surgery

Attachment of an infection that entered the wound through the sutures (insufficient cleanliness of the wound, failure to maintain sufficient antiseptics during surgery);
Rejection by the body due to an allergic reaction to the thread material.

The following factors also influence the occurrence of ligature fistula in the postoperative period:

It is interesting that ligature fistulas:

Occur in any part of the body;
In different layers of the surgical wound (skin, fascia, muscle, internal organ);
Does not depend on the time frame (occurs in a week, month, year);
They have different clinical manifestations (rejection of sutures by the body with further healing or prolonged inflammation with suppuration of the wound without healing);
They occur regardless of the material of the surgical thread;

Manifestations

The first days in the projection of the surgical wound there is compaction, redness, slight swelling, pain and an increase in local temperature.
After one week, serous fluid begins to emerge from under the sutures, especially when pressed, and later pus.
In parallel with this, body temperature rises to (37.5-38);
Sometimes the inflamed fistula closes on its own, but after some time it opens again;
Complete cure occurs only after subsequent surgery and elimination of the cause.

Complications arising from ligature fistula

Abscess - a cavity filled with pus
Cellulitis - the spread of pus through the subcutaneous fatty tissue
Eventration - loss of internal organs due to purulent melting of the surgical wound
Sepsis - when purulent contents break into the cavity of the abdomen, chest, skull
Toxic-resorptive fever- severe temperature reaction of the body to the presence of a purulent focus in the body.

Diagnostics

A ligature fistula can be diagnosed during a clinical examination of the wound in the dressing room. It will also be necessary to perform an ultrasound examination of the surgical wound, which is done to identify possible purulent leaks or an abscess.

If diagnosis is difficult due to the deep location of the fistula, fistulography is used. The essence of the latter is the introduction of a contrast agent into the fistula tract followed by radiography. The image will clearly show the location of the fistula tract.

Treatment

Before treating a fistula, it is necessary to understand that in most cases there will be no cure without surgical intervention and its prolonged existence will only worsen the course of the disease. Also, for ligature fistula, treatment should be comprehensive, with the mandatory use of:

local antiseptics:
- water-soluble ointments: levomikol, trimistin, levosin
— finely dispersed powders: tyrosur, baneocin, gentaxan
broad-spectrum antibiotics - ceftriaxone, norfloxacin, levofloxacin, ampicillin
enzymes that dissolve dead tissue - trypsin and chymotrypsin.

These antiseptics and enzymes must be administered both into the fistula tract itself and into the local tissues surrounding it several times a day, since their activity lasts no more than 4 hours.

You need to know that if there is abundant discharge of pus from the fistula, it is strictly forbidden to use fatty ointments (Vishnevsky, syntomycin), since they clog its canal and thereby disrupt the outflow of pus.

Also, during the inflammation phase, physiotherapeutic procedures can be actively used, namely wound quartz treatment and UHF therapy. The latter significantly reduce swelling and the spread of infection due to improved microcirculation of blood, lymph and detrimental effects on microorganisms. Such measures do not guarantee complete recovery, but can only cause stable remission.

To the question: “what to do if a fistula does not close?” we can only answer that this is a guaranteed indication for surgical intervention. Treatment of a ligature fistula by surgery is the “gold standard”, because only through surgical treatment can the cause of constant suppuration be eliminated.

Progress of surgery for ligature fistula

Treatment of the surgical field with antiseptics (alcohol solution of iodine) three times;
An anesthetic substance (2% lidocaine solution, 0.5-5% novocaine) is injected into the projection of the surgical wound and under it;
To make searching easier, a dye (diamond green and hydrogen peroxide) is injected into the fistula tract;
The wound is incised and all suture material is removed;
The cause that caused the fistula is found and removed along with the surrounding tissues;
Bleeding is stopped only with the help of an electric coagulator or 3% hydrogen peroxide; suturing the vessel is strictly prohibited, as this can repeatedly cause a fistula;
After stopping the bleeding, the wound is washed with antiseptic solutions (chlorhexidine, 70% alcohol, decasan) and closed with secondary sutures with mandatory active drainage.

In the postoperative period, periodic dressings are carried out with washing of the drainage, which, in the absence of purulent discharge, is removed. If there are indications (extensive phlegmon, multiple purulent leaks), the patient receives:

antibiotics
anti-inflammatory drugs (- dikloberl, )
ointments that stimulate healing processes (methyluracil, troxevasin)
At the same time, you can use herbal preparations, especially those rich in vitamin E (, aloe).

It is important to note that surgery for a ligature fistula is most effective in its classic form, namely with a wide dissection and adequate revision. All minimally invasive techniques (using ultrasound) in this case do not show high effectiveness in the fight against this disease.

It should also be noted that self-medication in the case of a ligature fistula of a postoperative scar is not permissible, since everything will still end with surgical intervention followed by surgical treatment, but time will be lost and life-threatening complications may develop.

Prognosis after surgery and prevention

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

Preventing the appearance of a fistula in most cases is not possible, since infection can penetrate the suture even under the most aseptic conditions, not to mention the rejection reaction.

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

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

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

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

Symptoms of ligature fistula

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

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

Treatment of ligature fistula

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

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

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

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

Prevention

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