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

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 the 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.

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

Any, even the simplest, surgical intervention in the human body, as a rule, requires a lot of time for wound healing. Absolutely all operations end with suturing, which should contribute to a faster and better recovery of the patient.

But sometimes it is in the place where the open wound was sutured that a strong inflammatory process begins, which is characterized by reddening of the skin and the formation of pus. All this indicates that a rather serious complication has begun in a person, requiring 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 need another surgical intervention.

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

A fistula formed in the middle of the seam

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

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 an 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 fought for a long time, and it has affected the internal organs, then feces, urine and bile can be released from the formed channel

Fistula in the coccyx

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

Full. It has two exits at once, which contributes to a faster removal of the inflammatory process and healing
Incomplete. It has only one exit, which is usually inside the abdominal cavity. This contributes to the intensive reproduction of pathogenic microflora and the intensification of inflammatory processes.
labial. In this case, the fistula grows together with the dermatological integument and muscle tissue. It can only be removed surgically.
Granulating. This type of fistula is characterized by the formation of granulation tissue, hyperemia and rather severe edema.
Tubular. Fully formed duct that secretes pus, mucus, and feces

Ligature fistula postoperative scar after childbirth, cesarean, 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, an open wound is carefully treated with disinfectants, and only after that they 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 is opened after a few days and, together with pus, the material that was used to sew the wound comes out of it.

Most often, this problem is provoked by silk threads, so recently doctors have begun to use a material that dissolves itself after a minimum time period and does not require removal of sutures and additional processing.

Infection is the main cause of postoperative fistula

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

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

Signs of a fistula:

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

Redness will be clearly visible near the infected scar. Moreover, it will look brightest in the course of applying the ligature.

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

Severe suppuration appears, which, if not properly treated, turns into weeping of a rather large size.

The fistulous opening can be delayed for a while, and then become inflamed with renewed vigor

Consequences that cause fistulas

Postoperative fistula can provoke the development of sepsis

By itself, the postoperative fistula does not pose a threat to life. But if the patient lets everything take its course, then the pathogenic bacteria that are inside the fistulous opening will begin to affect healthy organs and tissues, and this will provoke the appearance of quite serious diseases.

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

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

Abscess. Purulent masses fill the entire internal cavity of the fistulous opening
Phlegmon. In this case, pus, in addition to tissues, also begins to affect fatty tissue.
Sepsis. There is an opening of the fistulous opening inside the human body. Pus at the same time gets on the internal organs of the patient
Fever,provoked by purulent mass. Temperatures can rise to maximum levels. In this case, a person can lose consciousness and have poor orientation in space.

Purulent fistula on the surgical suture - treatment

Treatment of a purulent fistula

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

If the doctor decides to postpone 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 the pathogenic microflora that provokes inflammation.

If the therapy is chosen correctly, then the fistulous opening will close rather quickly and the patient will be able to return to normal life. To treat the inflamed area of the 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 right away I want to say that conservative treatment does not give a 100% guarantee that the fistula will not reopen. Therefore, most doctors suggest not to suffer and immediately perform an operation to remove the purulent focus

Only surgery can help completely get rid of the fistula.

After washing the wound, drainage is usually installed in it. In the postoperative period, 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, dressings can be used, with ointments that will stimulate the healing process. In this case, for example, troxevasin ointment can be prescribed. As soon as the purulent ceases to stand out, the drainage is taken out of the wound and then the patient only has to make sure that the infection does not get into it and periodically change the bandage

Folk remedies for the treatment of fistula

In the trailer, it is permissible to treat ligature postoperative fistulas using folk methods. Some of the methods described below are quite good at removing inflammation and reducing 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 a specialist. After all, if you have started your condition very strongly, then it is likely that you will only aggravate the course of the disease.

So:

Take olive oil and strong vodka in equal parts and mix until smooth. Rub the resulting mixture 3-4 times a day on the inflamed area of the skin. To enhance the therapeutic effect, you can immediately apply a cabbage leaf scalded with boiling water in advance. So 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 mummy and aloe juice. Mummy should be soaked in boiled water, and when it turns dark brown, add aloe juice to it. In this solution, you will need to moisten a sterile bandage and apply it to the sore spot.

St. John's wort for the treatment of fistulas

If you need to draw out the pus as quickly as possible, then use the familiar herb St. John's wort for this. In this case, it will be possible to use both decoction and leaves. First, tear off the leaves of St. John's wort, fill them with water, and then simmer over low heat for 10-15 minutes. When the broth cools down a bit, soak a bandage in it and put the leaves on it in one layer. Fix this bandage on the fistula and leave it applied 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 the fistula from the inside. If you prepare a decoction of this plant and take it regularly for a month, then the substances that are in its composition will kill the infection in the fistula and help relieve inflammation. But since this decoction thickens the blood very much, it will be better if the doctor determines the dosage.

You can try to get rid of the fistula with ordinary black bread. Take the pulp and lightly sprinkle it with water. When the top layer softens a little, apply the bread to the sore spot and fix it 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 right, then approximately on the third day you will see that the fistula is completely cleared of pus and begins to tighten

Ointment for the treatment of postoperative fistula

Ointment with calendula for healing fistulas

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

It is necessary to protect yourself from re-infection of the fistulous opening. After all, if you apply non-sterile dressings and use a product of dubious quality, then you are unlikely to improve your condition.

The most popular ointments:

At home, you can also use an ointment that will have both 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 must be applied to pre-disinfected skin areas.

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

As mentioned a little higher, 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 is she who will protect you from the development of complications such as sepsis and phlegmon.

Stages of the operation:

First, the fistulous opening and all the skin around it are treated with antiseptic agents.
An anesthetic is 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.
Vessels in this case are not sutured as this can lead to the formation of another fistula

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

Video: Ligature fistula of the perineum

A fistula after surgery is always a postoperative complication. The fistula occurs as a result of suppuration, infiltration of the scar. 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 blood vessels during surgery. Some patients are surprised by the name of the disease: they think that the wound after the operation can whistle. In fact, the fistula occurs due to suppuration of the thread. A ligature suture is always necessary; without it, wound healing and stopping bleeding, which always occurs as a result of surgical intervention, cannot occur. Without a surgical thread, it is impossible to achieve wound healing.

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

Reasons for the 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, the recognition of such a disease is not difficult.

Often fistulas result from the use of silk thread. The main reason for this phenomenon is the infection of the thread with bacteria. Sometimes it is not large and passes quickly. Sometimes a fistula occurs a few months after the intervention. In rare 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 during the operation a foreign body enters the body, it causes infection of the wound. The reason for this inflammation is a violation of the processes of removing purulent contents from the fistulous canal due to a large amount of fluid. If an infection gets into an open wound, 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

The fistula at the seam has such pronounced symptoms:

Diagnosis and treatment

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

Primary medical examination. During such actions, the fistula canal is assessed, the granulomatous formation is palpated.
Study of patient complaints. There is a careful study of the medical history.
Sounding the channel (to assess its size and depth).
Examination of the fistula channel using X-ray, ultrasound, dyes.

All patients should remember that the treatment of fistula with folk remedies is strictly prohibited. It is not only useless, but also life-threatening. Treatment of the disease takes place only in the condition of the clinic. Before treating a fistula, the doctor conducts 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 a festering 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 a cure for many pathologies. Elimination of formation is impossible without regular sanitation of the cavity. A solution of furacillin or hydrogen peroxide is used as a washing liquid, they remove pus and disinfect the edges of the wound. An antibacterial agent should be administered only according to the testimony of a doctor.

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

Postoperative fistula in some cases can be created artificially. So, for example, it can be created for artificial feeding or excretion of feces.

How to get rid of a fistula?

You don't have to wait for healing to happen. Lack of treatment can provoke an increase in suppuration and its spread throughout the body. The doctor can use the following techniques and steps to remove the fistula:

dissection of tissue in the affected area to remove pus;
excision of the fistula, cleaning the wound of 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 tools (this is done through the fistula canal 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 fistulous canal, the wound is treated with an antiseptic).

If the patient has strong immunity, then the fistula can heal quickly, and inflammatory complications are not observed. It can self-destruct in very rare cases. Only with an inflammatory process of a slight degree of intensity, the patient is prescribed conservative treatment. Surgical removal of the fistula is indicated when a large number of fistulas appear, and also if the outflow of pus is very intense.

Remember that a healing antiseptic only temporarily stops inflammation. To permanently cure the 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, the pleura or internal organs. They occur in the postoperative period as a result of the insolvency of the bronchus stump, necrosis. This type of bronchial fistula is a frequent consequence of pneumoectomy due to lung cancer and other resections.

Common symptoms of bronchial fistula are:

If water gets into such a hole, then a person has a sharp paroxysmal cough and suffocation. Removal of the pressure bandage provokes the appearance of the above symptoms, including loss of voice. Dry barking cough - sometimes a small amount of viscous sputum can 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, pronounced suffocation. Air is released from the drain. Possible development of subcutaneous emphysema. As complications, the patient may have hemoptysis, bleeding from the lung, 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 refers to a high risk of complications, including pneumonia, blood poisoning, internal bleeding, and amyloidosis.

Urogenital and intestinal fistulas

Genitourinary fistula appears as a complication of operations on the genitals. Most often, messages are formed between the urethra and the vagina, the vagina and the bladder.

Symptoms of urogenital fistulas are very bright, and it is unlikely that a woman will be able not to detect them. With the development of the disease, urine is excreted from the genital tract. Moreover, urine can be excreted both immediately after urination, and all the time through the vagina. In the latter case, a person does not have voluntary urination. If a unilateral fistula is formed, then women most often have urinary incontinence, while arbitrary urination persists.

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

Postoperative fistulas of the rectum are also possible. The patient is concerned about the presence of a wound in the anus and the release of pus, sanious fluid from it. When the outlet is blocked with pus, a significant increase in the inflammatory process occurs. During the increase in inflammation, patients complain of severe pain, sometimes making it difficult to move.

The fistula seriously worsens the general condition of the patient. Prolonged inflammation disrupts sleep, appetite, a person's performance decreases, and weight decreases. Due to inflammation, deformation of the anus can occur. The 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 does not depend on the patient, but on the doctor who performed the operation. The most important preventive measure is the strict observance of the rules of disinfection during the operation. The material must be sterile. Before suturing, the wound is always washed with an aseptic solution.

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

What is a ligature fistula

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

1 - vessel lumen; 2 - muscles of the anterior abdominal wall; 3 - skin of the anterior abdominal wall; 4 - lumen of a 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 the surgical intervention). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then these are the consequences of defects in care and dressing.

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

Such a pathology may occur against the background of the following operations:

Appendectomy. This is a surgical procedure to remove the appendix of the caecum, which is located in the right side of the abdomen just above the pubis.
A caesarean section is a procedure for removing a baby 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 intervention aimed at increasing the size of the breast. Through the incision, which is located under the breast, in the area of the nipple or armpit, a silicone implant is inserted.
Episiotomy is an operation to cut the perineum. Used in difficult childbirth (multiple pregnancy, large child).
Nephrectomy is a surgical procedure in which the kidney is removed. In this case, the incision is located in the lumbar region, as a result of which the wound is almost always subjected to a greater load.

Photo gallery: the location of the seams after various operations

A caesarean section is one of the most difficult operations in which a large incision is usually made.
With mammoplasty, a ligature fistula is often formed under the breast. 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 the surrounding organs by a protective shaft. Its formation is associated with a massive growth of the connective tissue substance, which fills the entire space of the defect.

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

Causes of the appearance of a 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 organism and the environment also take part in the formation of the ligature fistula:

hypothermia or overheating in the sun;
infection of the suture material;
insufficient disinfection of the skin during the operation;
transferred bacterial or viral diseases (colds, SARS);
extremely low or too high body weight;
the presence of malignant or benign formations;
an allergic reaction to the components of the threads;
advanced age of the patient;
condition after childbirth;
malnutrition with a lack of proteins or fats;
other injuries.

How does the formation of such a pathology manifest itself?

The symptomatic picture of the development of a ligature fistula is quite typical and does not differ in a special variety of signs. A few days or weeks after the operation, the victim begins to feel pain in the wound area. Often it is accompanied by swelling and redness: the seam looks swollen, the threads change color. The skin becomes hot and bright pink, 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 damage in the form of large and small bruises. Along with this, 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 arises, which is provided by existing bacteria. Patients complain of severe soreness and an increase in the amount of discharge with pressure. The skin near the affected area acquires a dense edema, becomes hot and tense, the sutures can erupt and injure the surrounding tissues.

Chronic and asymptomatic course of such a 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, the 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;
decrease in working capacity;
increased fatigue;
sleep disturbances due to pain and frequent awakenings;
nervousness, irritability and other changes in mental state.

In some cases, there is a tear of the purulent channel and self-cleansing of the wound. So you can see the formed passage - fistula. At the last stage, the formation of such an ailment can be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and needs immediate resuscitation.

Methods for diagnosing a disease

An experienced doctor will be able to suspect the development of a ligature fistula in a patient at a 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 treatments 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 wound treatment. In this case, the patient needs to appear every two days for dressings or show the suture to the attending physician at least once a week (when it is not possible to constantly travel to the hospital). If the pathological process continues to progress, more general drugs are prescribed that affect the state 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 a second operation there is also a risk of a ligature fistula. It is necessary to care for the wound according to the same principles as for the primary surgical intervention.

Medical therapy for pathology

Treatment of a ligature fistula with conservative means consists in the use of local and general pharmaceutical preparations. 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 without medical prescriptions, the use of any medication is strictly prohibited. In my practice, I have encountered a patient who independently began to take 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 that can be used. In an effort to recover faster, the patient also repeatedly exceeded the dosage of the antibacterial drug. This led to the development of serious complications: the man fell into a coma, from which he had to be taken out by the doctors of the intensive care unit. The situation ended happily, but the victim became deeply disabled as a result of his experiments. That is why doctors advise very carefully approaching the choice of drugs.

Means for local treatment of ligature fistula:

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

Photo gallery: preparations for local wound treatment

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

Medications for general therapy:

Antibiotics have a pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Klaforan, Tetracycline, Vibramycin, Keiten, Augmentin, Unazine, Azlocillin, Zinnat, Aztreonam, Imipenem, Vancocin, Rondomycin.
Steroid anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body, relieve redness and swelling of soft tissues. It is permissible to use Hydrocortisone, Cortef, Laticort, Dexons.
Vitamin and mineral complexes accelerate healing processes 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 technique for such a disease. If the disease progresses steadily, doctors decide on the need for repeated surgical intervention. It is carried out under the following conditions:

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

Contraindications for surgery:

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

Excision of tissues is necessary to prevent the recurrence of the fistula

The operation is carried out in several stages:

Doctors anesthetize the area of the proposed 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 alcohol and iodine solution.
Using a scalpel and tweezers, the old suture material is removed, while expanding the incision area. Next, doctors study the condition of the wound, the presence of purulent streaks and sores, if necessary, adds a dye (this allows you to determine the course of the fistula).
Using vacuum suction, surgeons remove accumulations of blood, lymph fluid, and areas of dead tissue. The formed fistula is excised with a scalpel.
Using another suture material, the formed wound is closed. If necessary, a thin rubber tube is placed in one of its corners - drainage, through which the contents flow. The sutures are closed with a sterile dressing with a healing ointment.

How to properly care for the place of suppuration

To avoid the attachment of a secondary infection and protect your body from the development of purulent complications, it is necessary to monitor the cleanliness of the wound. The first few days after the operation, the dressing and processing of the suture is done by a nurse under the supervision of a doctor. But in some cases, the patient has to take care of the surgical wound on his own from the very beginning. That is why the following processing steps must be observed:

Wash your hands with soap and water, then dry them with paper towels (this will help minimize bacteria). Disinfect your palms and fingers with an antiseptic.
Treat the skin around the wound with water and cotton pads. Alcohol-free gels can be used. If necessary, also wipe the skin with an antiseptic without touching the seams.
Carefully remove the bandage. It is necessary to do this with soft and unsharp movements, as jerks can damage surrounding tissues. If soaking with ichor and blood has occurred, it is allowed to soak the bandage in an antiseptic or in plain water.
Using a small gauze swab, evenly treat the surface of the seam. Try to remove dirt and dried blood. Continue rinsing until the wound is clear.
Apply a bandage with the ointment prescribed by the doctor and gently wrap it with an elastic bandage. At the same time, try not to overtighten the soft tissue.

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

What is strictly forbidden to do during the rehabilitation period:

Visit baths or saunas, bathe in a hot tub. Steam softens the tissues around the seam, as a result of which the threads are cut through and an even deeper fistula is formed. For the same reason, you can 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 the source of many harmful bacteria that penetrate even through the applied bandage. Swimming in pools is limited due to the presence of bleach, which disrupts the healing process of soft tissues.
Use alcohol-containing solutions for wound treatment without medical prescription. Such drugs not only kill bacteria, but also damage the smallest vessels, causing bleeding. That is why their use is strictly limited.

Video: dressing and wound treatment technique

Features of therapy 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 childbirth ends with suturing the damaged perineum.

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

Treatment forecasts and possible complications of such a pathology

Soft tissue healing is a long and not always predictable process that can face a number of really serious complications. The duration of the recovery period largely depends on the age of the patient and his state of health. In children and young people, the ligature fistula heals within two weeks to three months, while in the elderly this period can take up to six months. Patients with diabetes mellitus, hypertension, 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.

Important in the treatment of ligature fistula is strict adherence to hygiene and the rules for the treatment of postoperative wounds. While working in the department of purulent surgery, I had a chance to encounter a man who developed a serious complication in the form of attachment of bacterial microorganisms 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, tissues were constantly traumatized, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly alleviated his condition.

What complications can 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. An abscess develops gradually: edema begins to form in the wound area, pain increases sharply. After a couple of days, a motionless red elevation above the skin surface is formed, which has a densely elastic consistency. When probing, softening is observed in its middle, the boundaries of which increase with time. Treatment of an abscess is carried out by opening it and excising the capsule. In addition, doctors prescribe antibiotic therapy.
The development of phlegmon. Unlike an abscess, this accumulation of pus has no boundaries in the soft tissues and can spread further along the course of the fatty tissue. Phlegmon melts nearby vessels and nerves, as a result of which the blood supply to the most important organs and systems is disrupted. Its danger lies in the fact that often the formation lies deep in the tissues, and it is quite difficult to detect it. Edema and redness can form only 4-7 days from the onset of the disease. You can get rid of phlegmon only with the help of surgery and the further intake of antibacterial drugs.
Blood poisoning. One of the most dangerous complications that all doctors fear is sepsis. When bacteria enter the systemic circulation from the area of the ligature fistula, a cascade of pathological inflammatory reactions is formed, during which 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 the thickening of the blood - it cannot normally pass through the vascular bed. Treatment of this pathology is carried out in the intensive care unit and intensive care with the help of detoxification, antibacterial and anti-inflammatory drugs.
The development of a scar at the location of the ligature fistula. Usually, the entire defect is filled with connective tissue, which has a different structure than skin and muscles. The scar can be quite rough and even interfere with certain activities. In order to prevent this condition, doctors use physiotherapy and healing ointments and gels.

Photo gallery: possible complications of the disease

The phlegmon of the leg can be located very deep and do not give other symptoms, except for edema. 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 penetration into 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 of medical universities organize lectures and open seminars on the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

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

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

Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for 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 alleged threads and take them to the allergological laboratory. There, the doctor, using cutaneous or intradermal tests, will reveal the presence of a pathological reaction. With redness, swelling and swelling of the skin, it is better to refuse to use this type of material. Currently, there are a huge number of suture threads: one of them is sure to suit you.
The application test allows you to detect the allergen
Try to avoid stress and neuropsychic upheavals. During the recovery period of the body after surgery, even slight anxiety can cause a deterioration in the condition. It has been proven that during tension and stress, the internal glands of a person secrete hormones that slow down the processes of rehabilitation and healing of tissues.
Follow hygiene. Most opportunistic bacteria live on the skin even in a healthy person. Under normal conditions, with intact tissue integrity, they cannot enter the bloodstream and cause an infectious process. But in the postoperative period, the body becomes especially vulnerable, and the wound is the entrance gate for bacteria. That is why it is so important to keep clean surrounding tissues. It is recommended to wear loose-fitting clothing made from natural materials that will not cover the site of the postoperative incision or injure it in any way. In the morning and evening, it is necessary to treat the skin with water and detergents, while not touching the bandage.
Antiseptic gel removes germs from the surface of the skin
Give up physical activity. Prolonged lifting and carrying of weights or exercising in the gym can cause the suture material to cut through the soft tissues, as a result of which the wound will open. This will not only increase the risk of infection, but may also lead to a second operation. That is why doctors forbid playing sports and lifting loads of more than one kilogram for several months after surgery. Once a stable scar is formed, you can return to unlimited training again.
In the period before and after the operation, try to adhere to proper nutrition. Popular vegetarian and vegan diets with no animal protein reduce the rate of soft tissue healing and lengthen the recovery process. During the rehabilitation period, the body needs to receive fats and carbohydrates in large quantities, and the calorie 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 adversely affect 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 the nutrition of patients in the postoperative period

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, you should not worry and worry once again: the modern system of medical care has long provided for 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 deal with such a problem.

anonymously

Hello! Three years ago I had surgery for a postoperative 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 several mm in size appeared along the scar. Approximately 10 cm above the wound, superficial pains arose along the scar. She did not go to the doctor, the wound was treated with hydrogen peroxide and covered with a gauze napkin. 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 I was opened (a small puncture) of phlegmon, 150 ml of pus was removed, then treatment - injections of antibiotics, dressings - treatment with hydrogen peroxide, a tampon with chlorhexidine, drainage. They explained to me that this is rejection of the thread. A thread was not found at the opening of the phlegmon. After 12 days, she was discharged for outpatient treatment, both wounds are still open. Dressings with the same solutions. On tampons during 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, the temperature rose slightly. Today, during the dressing, the surgeon probed the wound, said that it began to flow out (it was closed and accumulated), again inserted a rubber band into the hole. They do not give me information: how long will the rejection of the thread continue, if this is the case? Weeks or months? It is problematic for me to be on sick leave for a long time. How long to wait, doing only dressings?

Hello. The situation is typical and it is not entirely clear what difficulties your doctors had with the removal of 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 Vasilyevich! As they explain to me, the difficulty in finding ligatures is a deep cavity. 7 days ago I was consulted by the curator of our regional hospital, a surgeon of the republican hospital. I did a "cleansing" of the cavity with a "spoon", got pus and necrotic masses, but did not find any threads. He put a drain (tube) and prescribed daily washing with dioxidine. The attending physician of the polyclinic carries out these appointments, but does not explain anything further, the only answer is "we'll see" .. The dressing material is saturated with ichor and something like white mucus in a day. Within 2 days after the "cleansing" I felt bad - a strong chill 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 resolution of the problem?

1) It is pointless to lead the cavity you have on the drains. It needs to be tamponed. 2) It is necessary to carry out a tank-seeding from the cavity for flora and sensitivity, and taking it into account, carry out complex antibacterial therapy. 3) Ultrasound control of both the anterior abdominal wall and the abdominal organs is required. And to treat with the volume that is carried out to you is completely pointless.

anonymously

Dear Alexey Vasilyevich! In early April, I was operated on in the surgical department of the Republic of Belarus of Karelia (excision of a purulent fistula), I will write right away - the site of the operation healed by primary intention. But three days after the operation, infiltration occurred, as the surgeon said, not related to the site of the operation (on the left lower abdomen, there was a drainage tube 6 years ago after resection of the sigma, 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 that moment, the surgeon could not explain to me the reasons for this phenomenon. She suggested paniculitis or a systemic connective tissue disease. She is sure that in the first case, since the onset of the disease, there was actually no phlegmon clinic, but something similar took place. After some thought, I was prescribed tests for rheumatology - the norm, blood for sterility three times, echinococcus, paratyphoid - the norm. Consultation of a rheumatologist - there is not enough data for paniculitis, there is some inflammation of the subcutaneous tissue, the reasons are unclear. Amoxiclav and indomethacin were prescribed for 3 weeks, she took it as prescribed on an outpatient basis. On May 7, I had a consultation with the operating surgeon, 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, for a day - on both dressings there is a little bit of blood or ichor, a few drops. At the consultation, the surgeon could not answer me anything, why it wasn’t healing. Today the situation is the same, that is, it has not changed for several weeks - two small holes and a little bleeding, a slight seal around the notch. I went to work, the bandages do not interfere with me and almost do not hurt, but why does it not heal? And I don’t know the reasons and I don’t know if there can be an exacerbation and how to avoid it?

anonymously

Thank you, Alexey Vasilyevich! Shortly before the operation for a "purulent fistula", a bacterial culture was done, but once, the result was Enterobacter agglomerans, but was it really from a fistula or from the skin by accident?? It would be necessary, of course, in dynamics at the same time. Before the operation in the Republic of Belarus, an ultrasound of the abdominal organs (nothing special) and the wound cavity were also performed. Fistulography was not done then, they managed with contrasting during the operation. They did a histology of the remote during the operation - the norm. Analyzes for oncotests are the norm. At discharge, it was indicated that a biopsy would be necessary in case of recurrence of infiltrates. Everything you indicated at the proper level can be done 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.