Rejection of the internal seam. Clinical manifestations of seroma of large sutures

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.

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

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

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

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

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

A fistula has formed in the middle of the seam

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

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

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

Fistula in the coccyx area

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

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

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

Ligature fistula

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

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

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

The main reason for the development of postoperative fistula is infection

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

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

Signs of a fistula:

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

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

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

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

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

Consequences that cause fistulas

Postoperative fistula can provoke the development of sepsis

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

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

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

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

Purulent fistula on a surgical suture - treatment

Treatment of purulent fistula

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

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

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

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

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

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

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

Folk remedies for the treatment of fistula

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

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

So:

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

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

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

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

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

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

Ointment for the treatment of postoperative fistula

Ointment with calendula for healing fistulas

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

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

The most popular ointments:

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

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

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

Stages of the operation:

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

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

Video: Ligature fistula of the perineum

Fistula after surgery is always a postoperative complication. The fistula occurs as a result of suppuration and infiltration of the scar. Let's consider the main causes of fistula, its manifestations, complications and methods of treatment.

What is a fistula

A ligature is a thread used to tie off blood vessels during surgery. Some patients are surprised by the name of the disease: they think that the wound after surgery may whistle. In fact, a fistula occurs due to suppuration of the thread. A ligature suture is always necessary; without it, wound healing and bleeding cannot be stopped, which always occurs as a result of surgery. Without surgical thread, it is impossible to achieve wound healing.

Ligature fistula is the most common complication after surgery. Looks like a normal wound. It means an inflammatory process that develops at the site of the suture. An obligatory factor in the development of a fistula is suppuration of the suture as a result of contamination of the thread with pathogenic bacteria. A granuloma, that is, a compaction, appears around such a place. The compaction contains the festering thread itself, damaged cells, macrophages, fibroblasts, fibrous fragments, plasma cells, and collagen fibers. The progressive development of suppuration ultimately leads to the development of an abscess.

Reasons for formation

As already mentioned, it is the festering suture that contributes to the progression of the purulent process. A fistula always forms where there is a surgical thread. As a rule, recognizing such a disease is not difficult.

Often fistulas occur as a result of the use of silk thread. The main reason for this phenomenon is infection of the thread by bacteria. Sometimes it is not large and goes away quickly. Sometimes a fistula occurs several months after the intervention. In the rarest cases, the fistula appeared even after years. Most often they occur after operations on the abdominal organs. If a fistula occurs at the site of the surgical wound, this indicates that an inflammatory process is taking place in the body.

If a foreign body enters the body during surgery, it causes infection of the wound. The reason for this inflammation is a disruption in the processes of removing purulent contents from the fistula canal due to the large amount of fluid. If an open wound gets infected, this can be an additional danger, as it contributes to the formation of a fistula.

When a foreign body enters the human body, the immune system begins to weaken. Thus, the body resists viruses longer. Prolonged presence of a foreign body causes suppuration and subsequent release of pus from the postoperative cavity to the outside. Infection of the ligature thread often contributes to the formation of a large amount of pus in the postoperative cavity.

Main symptoms

A fistula at the suture has the following severe symptoms:

Diagnosis and treatment

The correct diagnosis can be made by a surgeon only after a complete diagnosis. It includes the following measures:

Primary medical examination. During such actions, the fistula canal is assessed and the granulomatous formation is palpated.
Study of patient complaints. A thorough examination of the medical history takes place.
Sounding of the canal (to assess its size and depth).
Examination of the fistula canal using x-rays, ultrasound, dyes.

All patients should remember that treating fistula with folk remedies is strictly prohibited. It is not only useless, but also life-threatening. Treatment of the disease takes place only in a clinic setting. Before treating a fistula, the doctor performs a detailed diagnostic examination. It helps to establish the extent of the fistulous lesion and its causes. The main principles of therapy are the removal of the suppurating ligature. It is necessary to take a course of anti-inflammatory drugs and antibiotics.

It is necessary to strengthen the immune system. A strong immune system is the key to recovery from many pathologies. Elimination of formation is impossible without regular sanitation of the cavity. A solution of furacillin or hydrogen peroxide is used as a rinsing liquid; they remove pus and disinfect the edges of the wound. Antibacterial agents should be administered only as directed by a doctor.

In case of ineffective treatment of the fistula, surgery is indicated. It involves removing ligatures, scraping, and cauterization. The most gentle way to remove suppurating ligatures is under the influence of ultrasound. With timely and high-quality treatment, the likelihood of fistula complications is minimal. The occurrence of inflammatory reactions in other tissues of the human body is minimal.

In some cases, a postoperative fistula can be created artificially. For example, it can be created for artificial feeding or excretion of feces.

How to get rid of a fistula?

There is no need to wait for healing to occur. Lack of treatment can provoke increased suppuration and its spread throughout the body. The doctor can use the following techniques and stages of fistula removal:

cutting tissue in the affected area to remove pus;
excision of the fistula, cleaning the wound from pus and its subsequent washing;
removal of suture material blindly (if possible);
if it is impossible to remove the suture material blindly, the doctor makes a second attempt (further dissection of the zone is carried out last, since this measure can provoke further infection);
the ligature can be removed using special instruments (this is done through the fistula channel without additional dissection, which reduces the risk of further secondary infection);
Surgical treatment of the wound is performed (in case of unsuccessful removal of the fistula canal, the wound is treated with an antiseptic).

If the patient has a strong immune system, then the fistula can heal quickly, and no inflammatory complications are observed. It can self-destruct in very rare cases. Only with an inflammatory process of minor intensity, the patient is prescribed conservative treatment. Surgical removal of the fistula is indicated when a large number of fistulas appear, as well as if the leakage of pus occurs very intensely.

Remember that a healing antiseptic only temporarily stops inflammation. To permanently cure a fistula, you need to remove the ligature. If the fistula is not removed in time, this leads to a chronic course of the pathological process.

Why are bronchial fistulas dangerous?

Bronchial fistula is a pathological condition of the bronchial tree, in which it communicates with the external environment, pleura or internal organs. They occur in the postoperative period as a consequence of bronchial stump failure and necrosis. This type of bronchial fistula is a common consequence of pneumoectomy due to lung cancer and other resections.

General symptoms of bronchial fistula are:

If water gets into such a hole, the person experiences a sharp paroxysmal cough and suffocation. Removal of the pressure bandage provokes the appearance of the above symptoms, including loss of voice. Dry, barky cough—sometimes a small amount of sticky sputum may be coughed up.

If the fistula develops against the background of purulent inflammation of the pleura, then other symptoms come first: secretion of mucus with pus, with an unpleasant fetid odor, severe suffocation. Air is released from the drain. Subcutaneous emphysema may develop. Complications may include hemoptysis, bleeding from the lung, or aspiration pneumonia.

The connection of the bronchus with other organs causes the following symptoms:

coughing up food or stomach contents;
cough;
asphyxia.

The danger of bronchial fistulas involves a high risk of complications, including pneumonia, blood poisoning, internal bleeding, and amyloidosis.

Genitourinary and intestinal fistulas

Urogenital fistula appears as a complication of genital surgery. The most common communications are between the urethra and the vagina, the vagina and the bladder.

The symptoms of genitourinary fistulas are very clear, and it is unlikely that a woman will fail to detect them. As the disease develops, urine is released from the genital tract. Moreover, urine can be released either immediately after urination or all the time through the vagina. In the latter case, a person does not experience voluntary urination. If a unilateral fistula is formed, then women most often experience urinary incontinence, but voluntary urination persists.

Patients feel severe discomfort in the genital area. During active movements, this discomfort intensifies even more. Sexual intercourse becomes almost completely impossible. Due to the fact that urine is constantly and uncontrollably released from the vagina, a persistent and unpleasant odor emanates from patients.

Postoperative rectal fistulas are also possible. The patient is concerned about the presence of a wound in the anal area and the discharge of pus and sanguineous fluid from it. When the outlet is blocked with pus, the inflammatory process significantly intensifies. When inflammation increases, patients complain of severe pain, sometimes making movement difficult.

The fistula seriously worsens the general condition of the patient. Long-term inflammation disrupts sleep and appetite, a person’s performance decreases, and weight decreases. Due to inflammatory phenomena, deformation of the anus may occur. A long course of the pathological process can contribute to the transition of the fistula into a malignant tumor - cancer.

Disease Prevention

Preventing the development of a fistula depends not on the patient, but on the doctor who performed the operation. The most important preventive measure is strict adherence to the rules of disinfection during the operation. The material must be sterile. Before suturing, the wound is always washed with an aseptic solution.

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

What is a ligature fistula?

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

1 - lumen of the vessel; 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 surgery does the disease appear?

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

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

A similar pathology can occur during the following operations:

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

Photo gallery: location of sutures after various operations

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

What is ligature infiltrate and ligature granuloma?

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

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

Causes of ligature fistula

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

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

How does the formation of such pathology manifest itself?

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

Redness of the suture after surgery is considered an unfavorable sign.

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

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

With further progression, the wound becomes purulent.

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

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

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

Methods for diagnosing the disease

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

What treatment methods help get rid of the disease?

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

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

Drug therapy of pathology

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

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

Means for local treatment of ligature fistula:

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

Photo gallery: preparations for local wound treatment

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

Medications for general therapy:

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

Photo gallery: drugs for systemic effects on the body

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

Surgical treatment of ligature fistula

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

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

Contraindications to surgery:

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

Excision of tissue is necessary to prevent recurrence of the fistula

The operation is carried out in several stages:

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

How to properly care for the site of suppuration

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

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

Be extremely careful: some actions may cause deterioration of the seam

What is strictly prohibited to do during the rehabilitation period:

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

Video: methods of dressing and treating wounds

Features of treatment of ligature fistula after various types of operations

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

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

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

Treatment prognosis and possible complications of such pathology

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

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

What complications may occur in patients with ligature fistula:

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

Photo gallery: possible complications of the disease

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

How to prevent the development of a ligature fistula

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

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

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

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

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

anonymously

Hello! Three years ago I had surgery for an incisional hernia. A month and a half ago, after, as I believe, mechanical irritation of the postoperative scar (rubbed with a rough seam of clothing), a wound of several mm in size appeared along the scar. Approximately 10 cm above the wound along the scar, superficial pain arose. I didn’t go to the doctor, I treated the wound with hydrogen peroxide and covered it with a gauze pad. Three weeks later, on February 14, 2013, the temperature rose to 38 degrees, the pain along the scar intensified. I turned to surgeons, on February 16, my phlegmon was opened (a small puncture), 150 ml of pus was removed, then treatment was injections of antibiotics, dressings, treatment with hydrogen peroxide, a tampon with chlorhexidine, drainage. They explained to me that this was thread rejection. The thread was not found when opening the phlegmon. After 12 days, she was discharged for outpatient treatment, both wounds are still open. Dressings with the same solutions. On tampons when dressing, as they explain to me, there is ichor, there is no pure pus. Yesterday there was a sharp burning sensation and pain at the puncture site, and the temperature rose a little. Today, while dressing, the surgeon probed the wound, said that it had started to leak (it was closed and had accumulated), and again inserted a rubber band into the hole. They don’t give me information: how long will the thread rejection last, if this is exactly the case? Weeks or months? For me, being on sick leave for a long time is problematic. How long to wait, doing only dressings?

Hello. The situation is typical and it is not entirely clear what difficulties did your doctors have with removing the ligatures? After all, the main problem is the ligature (one or more). If they are not removed, the process can continue indefinitely.

anonymously

Dear Alexey Vasilievich! As they explain to me, the difficulty in finding ligatures is the deep cavity. 7 days ago I was consulted by the curator of our district hospital, a surgeon from the republican hospital. I “cleaned” the cavity with a “spoon”, got pus and necrotic masses, but did not find any threads. He placed a drainage tube and prescribed daily rinsing with dioxidine. The attending physician at the clinic carries out these appointments, but does not explain anything further; the only answer is “we’ll see.” Over the course of a day, the dressing material becomes saturated with ichor and something like white mucus. For 2 days after the “cleaning” I felt bad - severe chills and a temperature of up to 39, now it’s normal. Please tell me, should I insist on some other actions to speed up the solution to the problem?

1) It makes no sense to drain your existing cavity. It needs to be tamponed. 2) It is necessary to carry out a tank culture from the cavity for flora and sensitivity, and taking this into account, carry out complex antibacterial therapy. 3) Ultrasound monitoring of both the anterior abdominal wall and abdominal organs is required. And it is completely pointless to treat with the volume that is given to you.

anonymously

Dear Alexey Vasilievich! At the beginning of April, I was operated on in the surgical department of the Republic of Belarus of Karelia (excision of a purulent fistula), I’ll write right away - the operation site healed by primary intention. But three days after the operation, infiltration arose, as the surgeon said, unrelated to the site of the operation (in the left lower abdomen, there was a drainage tube there 6 years ago after resection of the sigmoid, that is, again in the area of old scar tissue). The surgeon made a “notch” of the infiltrate and was surprised to receive not pus, but serous fluid. At this moment, the surgeon could not explain to me the reasons for this phenomenon. She suspected paniculitis or systemic connective tissue disease. She is sure that in the first case, from the onset of the disease, there was actually no phlegmon clinic, but something similar took place. After some thought, I was prescribed rheumatology tests - normal, blood test for sterility three times, echinococcus, paratyphoid - normal. Consultation with a rheumatologist - there is not enough evidence for paniculitis, there is some kind of inflammation of the subcutaneous tissue, the reasons are unclear. Amoxiclav and indomethacin were prescribed for 3 weeks, taken as prescribed - on an outpatient basis. On May 7, I had a consultation with the surgeon who operated, because... The place of the “notch” does not heal and since January the first opened hole along the scar (below the site of the operation) has not healed. There is no pus, within 24 hours there is a little bit of blood or ichor on both bandages, a few drops. At the consultation, the surgeon couldn’t answer me anything about why it wasn’t healing... She prescribed cauterization with iodine a little and covering it with a sterile bandage. Today the situation is the same, that is, it has not changed for several weeks - two small holes and a little bleeding, there is a small seal around the place of the notch. I went to work, the bandages don’t bother me and there’s almost no pain, but why isn’t it healing? And I don’t know the reasons and I don’t know if there could be an exacerbation and how to avoid it?

anonymously

Thank you, Alexey Vasilievich! Shortly before the operation for a “purulent fistula,” a bacterial culture was done, but only once, the result was Enterobacter agglomerans, but was it really from the fistula or from the skin by chance?? It would be necessary, of course, in dynamics at the same time. Before the operation in the Republic of Belarus, they also did an ultrasound of the abdominal organs (nothing special) and the wound cavity. They didn’t do fistulography then; they used contrast during surgery. They did histology of what was removed during surgery - normal. Oncology tests are normal. Upon discharge, it was indicated that a biopsy would be necessary in case of recurrence of infiltrates. Everything you mentioned can be done at the proper level only on the basis of the Republic of Belarus, except for bacterial sowing. Thanks again for the advice, I’ll think about how best to implement this.