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

Most surgical interventions end successfully: after suturing, the tissues gradually heal, 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 appeared: what is it?

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

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

Causes of an abscess on a postoperative scar

Doctors claim 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, an order of magnitude less often, lavsan or nylon material becomes the culprit. There is evidence that an abscess can also form when catgut is used, although 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. Such a development of events is possible if pathogenic microorganisms penetrate to the suture material due to inflammation of the wound left after the operation. The infection can spread due to insufficient sterility of the surgical field or the instruments used. It can also be provoked 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 already on the thread if doctors have violated the rules of sterility.

Development of immune rejection. The natural activity of the immune system can lead to the rejection of a foreign body, which, in fact, is a 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.
Sewing of a hollow organ. A similar situation can happen if the doctor accidentally captures 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 cause of its formation, a fistula can permanently disrupt the patient's ability to work, aggravating the course of the underlying ailment.

Pathogenesis

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

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

Features of ligature fistulas:

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

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

Symptoms of an abscess on the seam

Abscess formation can occur after the patient has been successfully discharged from the hospital, even after several years. 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, a feeling of weakness, an increase in temperature.
The formation of a painful induration in the projection of the postoperative scar.
A change in the color of the skin over the site of inflammation. Most often, the skin becomes purple or cyanotic.
A few days after the development of primary symptoms, a spontaneous breakthrough of the abscess occurs.
A medium-sized passage 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 stand out from under them, and then it is replaced by pus.
After a breakthrough, unpleasant symptoms disappear sharply, the severity of inflammation decreases.

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

Complications

A ligature fistula is able to 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 passage.
Hyperpigmentation of the skin at the site of injury.
The development of superficial or deep ulcers.
The defeat of nearby organs, both as a result of a purulent inflammatory process, and due to unsuccessful extraction of the suture material by a surgeon.
Eventration (prolapse) of internal organs through a defect in the wall of the peritoneum. A similar situation can occur as a result of purulent fusion of tissues.
Sepsis.
Lethal outcome.

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

Diagnostics

Usually, with superficial fistulous passages, there are no difficulties in their diagnosis. For this, only a medical examination in a dressing room is enough. Immediately after examining the fistulous tract, the doctor may even remove the ligature. But if the fistulous tract is tortuous or not typically located, additional research methods may be required.

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

On the stomach

When a fistulous tract is formed in the peritoneal region, it becomes necessary to perform fistulography. Such a study allows us to find out the depth and features of the form of the resulting passage. The specialist injects a contrast agent into the cavity of the fistula, after which he takes several x-rays in various projections. Ultrasound 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 with only methods of conservative therapy.

Conservative treatment

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

Local antiseptic preparations. 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 amount of purulent discharge.
Antibacterial medicines. Preference is given to drugs with a wide spectrum of action: ampicillin or ceftriaxone.
Enzymes to eliminate dead tissue. Trypsin is usually used for this purpose.

Medicines must be injected into the fistulous tract, and also distributed through the tissues near the wound, several times a day. In parallel, methods of physiotherapy can be used, in particular: quartz treatment or UHF therapy.

Surgical intervention

To eliminate the ligature fistula, doctors usually perform a classic intervention, which consists of several stages:

The surgical field is treated with an antiseptic (usually iodine tincture is used).
Anesthetize the problem area with injections of Lidocaine or Novocaine.
A special dye is introduced into the fistula for a complete examination.
The formed fistula is dissected and the suture material is removed.
Carry out an audit of adjacent tissues.
Stop bleeding with electrocoagulation or peroxide.
Carry out a thorough sanitation of the wound with the use of antiseptics.
The wound is closed with sutures and active drainage is established.

Competent operation with full sanitation of the wound avoids serious complications. Expectant tactics in the case of a ligature fistula are completely unjustified.

Forecast

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

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

Prevention

The main measures for the prevention of ligature fistula are:

Competent and careful organization of sterility during surgical interventions.
Proper preparation of suture material.
The use of the suture material, which rarely causes complications.
Performing adequate antibiotic therapy after the intervention of surgeons.
Compliance by patients with all the recommendations of the doctor and timely visits to 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 entering the surgical wound. And it is completely impossible to predict and prevent the possible rejection of the suture material.

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

A postoperative fistula is a through canal that is hollow inside and connects the organs located in the peritoneum with the environment. According to 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 enter 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 the band suture healing.

The very nature of fistula formation is such that it is formed during the acute phase of inflammation, when purulent masses accumulated in the subcutaneous layer break through the epithelium, drain naturally and go outside, creating a hole in the abdominal cavity or on any other part of the body. The most common in medical practice are fistulous lesions of the abdominal cavity and lower extremities. 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 medical, and sometimes even surgical treatment. For it to be effective, it is extremely important to establish a factor contributing to the development of the pathological condition of the suture. The following causes of postoperative fistulas of various localization and severity are distinguished:

improper wound care, lack of antiseptic treatment with specially designed solutions (Chlorhexidine, Miramistin, Hydrogen Peroxide, Iodocerin), rare replacement of the dressing material;
the 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 their functional duty and the entry of even non-dangerous strains of microorganisms into the wound leads to a purulent lesion of the epithelium with the formation of a hollow drainage channel (fistula);
excess body weight, when a thick layer of adipose tissue excludes the normal regeneration of epithelial cells (the cut part of the body simply cannot physically grow together, since fat exerts constant static pressure on the wound);
the senile age of the patient (patients who are already 80 years old and older, very poorly tolerate not only the surgical intervention itself, but also the recovery period of the body, because the cells responsible for the formation of fibrous tissue, from which the suture scar is formed, divide at a too slow pace) ;
medical negligence and leaving surgical instruments in the abdominal cavity (such cases occur periodically in various countries of the world, and their occurrence is associated with insufficient care of medical personnel immediately at the time of the operation).

Timely elimination of these causative factors can ensure a stable recovery of the human body in the postoperative period, as well as avoid the development of inflammatory processes.

How to treat a fistula after surgery?

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

Antibiotics

Flushing the seam

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

Surgical debridement

Quite often, the fistula forms a scar, consisting of fibrous tissue that is not able to grow together. As a result, a hole appears, which by itself is no longer capable of healing. To eliminate this pathology, the surgeon cuts off the edges of the fistula in order to start a new process of regeneration of open tissues.

Before surgery with the help of antibiotics, the complete elimination of infectious inflammation is ensured. Otherwise, the operation will only lead to the expansion of the diameter of the fistula. The described complex treatment of a non-healing wound provides a gradual overgrowth of the inflamed wound with the relief of the drainage channel.

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Ligature fistula - suppuration in the area of imposition of a surgical suture. Violation occurs when using non-absorbable threads. Pathology can manifest itself only after surgery. The complication is rare. First, a fistula appears in the area of the seam, and then a fistula is formed. Pathology is characterized by the development of the inflammatory process. Needs 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. Represents a huge danger to the life and health of the patient. The present violation cannot be categorically ignored.

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 area of the seam. Pathology is characterized by rapid development. You need to see a doctor at the first signs.

A ligature is a thread used to tie off blood vessels. A suture using such material is required to stop internal bleeding. Required for most surgeries.

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

When carrying out operations, a non-absorbable thread is often used - a ligature.

The root causes of the formation of a violation

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

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

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

Symptoms of the violation

Symptoms of a ligature fistula include:

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

The seam should be even, if redness or induration is observed, it should be shown to the doctor

The fistulous passage may be closed for a while. However, it will open again after a while. The temperature in the presence of a deviation rises to a maximum of 38 degrees. It is possible to eliminate signs only when exposed to a provoking factor.

Most often, pathology is formed against the background of the use of a synthetic thread. Over time, peculiar compacted cones appear near the seam. Pus flows out of them. The quantity may vary. Small formations may not cause discomfort to the patient for a long period of time. Near the seam, as a rule, redness, swelling and swelling appear. There may be signs of intoxication of the body. With untimely assistance, irreversible complications are formed. The patient 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;

eventrations;
sepsis;
toxic-resorptive fever.

Inflammation of the suture can turn into an abscess

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

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

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

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

With 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 well-being, while body temperature indicators can increase to 39-40 degrees.

Diagnostic methods

Primary diagnosis is carried out during dressings using a visual examination. However, it is worth noting that the 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 present.

detect possible complications;
determine the location of the fistula.

A patient with suspected development of a disorder may be given a referral for fistulography. The method is required for the development of a fistula in the thickness of the tissues. During the study, a contrast agent is used and x-rays are taken. The resulting picture clearly shows the deviation.

The doctor can notice the signs of the problem already in the first days after the operation.

Therapeutic methods

Treatment should be started as soon 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 patients are recommended surgical treatment. The operation to eliminate the fistula is to remove the infected ligature. Beforehand, doctors make a small incision so that all the pus comes out, and then they close the defective formation. After the procedure, the patient is prescribed a course of antibiotic therapy. The wound is washed with special solutions. Referral to physical therapy.

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

Treatment always involves antibiotics to kill the infection.

Preventive methods

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

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

have an acceptable expiration date;
hermetically sealed;
be sterile.

Only if all the recommendations of the doctor are followed can the risk of developing a deviation be significantly reduced. However, it is impossible to exclude it completely. After the operation, the patient must comply with all doctor's prescriptions. The wound needs to be treated regularly.

This video talks about why suppuration of postoperative wounds occurs and how to treat it:

Forecast

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

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

Pathology has an unfavorable prognosis with self-treatment. Self-medication is categorically contraindicated and ineffective. It can pose a huge danger to health and life.

Almost every surgical intervention ends with closing the wound with surgical sutures, with the exception of only operations performed for purulent wounds, where, on the contrary, conditions are created for a 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 a pronounced inflammatory process occurs at the site of their application, serous (cherry color), 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 the postoperative fistula is a manifestation of the abnormal course of this period and requires further treatment.

Causes of the appearance of a ligature fistula after surgical interventions

Accession of an infection that has entered the wound through the sutures (insufficient observance of the cleanliness of the wound, failure to observe sufficient antiseptics during the operation);
Rejection by the body due to an allergic reaction to the thread material.

Also, the following factors influence the occurrence of a 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);
Do not depend on the time frame (occur 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);
Occur regardless of the material of the surgical thread;

Manifestations

The first days in the projection of the surgical wound there is a thickening, redness, slight swelling, soreness and an increase in local temperature.
After one week, serous fluid begins to come out from under the sutures, especially when pressed, and later pus.
In parallel with this, the body temperature rises to (37.5-38);
Sometimes the inflamed fistulous passage closes on its own, but reopens after a while;
A complete cure occurs only after a subsequent operation and elimination of the cause.

Complications arising from ligature fistula

Abscess - cavity with pus
Phlegmon - the spread of pus through the subcutaneous fat
Eventration - prolapse of internal organs due to purulent fusion of the surgical wound
Sepsis - with a breakthrough of purulent contents into the cavity of the abdomen, chest, skull
Toxic-resorptive fever- a severe temperature reaction of the body to the presence of a purulent focus in the body.

Diagnostics

It is possible to diagnose a ligature fistula during a clinical examination of the wound in the dressing room. It is also a prerequisite to perform an ultrasound examination of the surgical wound, which is done to identify possible purulent streaks or abscesses.

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 fistulous tract, followed by radiography. The picture clearly shows the location of the fistula.

Treatment

Before treating a fistula, it is necessary to understand that in most cases there will be no cure without surgical intervention and its long existence will only aggravate the course of the disease. Also, with a ligature fistula, treatment should be comprehensive, with the obligatory 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 injected both into the fistulous tract itself and into the local tissues surrounding it several times a day, since their activity lasts no more than 4 hours.

It is necessary to know that with abundant discharge of pus from the fistula, it is strictly forbidden to use fatty ointments (Vishnevsky, synthomycin), as they clog its channel and thereby disrupt the outflow of pus.

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

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

The course of the operation for the ligature fistula

Treatment of the surgical field with antiseptics (alcoholic solution of iodine) three times;
An anesthetic is injected into the projection of the surgical wound and under it (2% lidocaine solution, 0.5-5% novocaine);
For the convenience of the search, a dye (brilliant green and hydrogen peroxide) is introduced into the fistula;
The wound is incised with the removal of all suture material;
The cause that caused the fistula is located and removed with the tissues surrounding it;
Bleeding stops only with the help of an electrocoagulator or 3% hydrogen peroxide, flashing the vessel is strictly prohibited, as this can re-cause a fistula;
After bleeding stops, the wound is washed with antiseptic solutions (chlorhexidine, 70% alcohol, decasan) and closed with secondary sutures with its obligatory active drainage.

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

antibiotics
anti-inflammatory drugs (- dicloberl, )
ointments that stimulate healing processes (methyluracil, troxevasin)
along the way, you can also use herbal preparations, especially those that are rich in vitamin E (, aloe).

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

It should also be noted that self-treatment in the case of a ligature fistula of a postoperative scar is not permissible, since everything will still end with surgery 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 in every possible way rejects all surgical threads, even after multiple repeated operations. With self-treatment of a fistula, the prognosis is not favorable.

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

Most serious operations end with the application of a ligature - a special thread that sews together damaged tissues in layers. Usually during the operation, the wound is thoroughly washed before sewing up. This is done using resorcinol, chlorhexidine, iodopyrone 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.

Around the thread that tightens the edges of the wound, a seal is formed, called a granuloma.. The suture itself, collagen fibers, macrophages and fibroblasts get into this seal. The ligature itself is not encapsulated - it is not limited to the fibrous sheath. 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.

Usually, such a complication makes itself felt quite quickly, even during the patient's stay in a medical institution, therefore, during a routine examination by a doctor, the symptoms of a ligature fistula are detected and treatment occurs in a timely manner. A fistula is opened after a few days - a breakthrough appears on the skin, through which a purulent discharge oozes. Together with this detachable 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 remove the cause of suppuration.

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

Symptoms of a ligature fistula

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

First, around the wound channel there is a seal and infiltration. The bumps that appear are hot to the touch.
Secondly, near the scar left after the operation, you can clearly see the inflammation - redness will go in the course of applying the ligature.
Thirdly, the wound begins to fester quickly and purulent contents are separated from the outlet. The volumes of discharge may be insignificant, but with a rapidly developing process, a 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 should be started as soon as possible, since this is a serious complication that can lead to secondary infection, disability, and in severe, advanced cases, to sepsis, which threatens the patient with death. Only a doctor should prescribe treatment, and if suppuration occurs at home, the patient must be urgently sent to the hospital. Treatment of a ligature fistula can be implemented in two ways - surgical and conservative. Surgical treatment is most often used - it consists in removing the infected ligature, after which the patient must undergo a course of antibiotic therapy. The patient is made a small incision to allow the pus to drain out. This will protect the patient from the development of phlegmon - purulent fusion of tissues, as a result of which it will be much more difficult to cure the disease. If the ligature can be removed, then the fistula is closed. Otherwise, a second attempt is made after a few days until the ligature is removed.

In severe cases, when ligatures are multiple and whole fistulous tracts are formed, excision of the entire postoperative scar along with the remnants of 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. Usually, hydrogen peroxide or furacillin is used for this purpose. If there are excessive granulations, they are recommended to be cauterized. After the primary care is 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 dead tissue around the fistula is removed from the patient, the pus is thoroughly washed out. If possible, also cut off those threads, the endings of which go out. Next, the patient is given antibiotics and drugs that increase immunity.

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.