What is postoperative fistula. Ligature fistula: how to deal with the disease

If you know that all types of fistulas are divided into congenital, acquired, and artificially created, then the ligature fistula of the postoperative scar will belong to the latter category. Therefore, it can occur anywhere if there has been a surgical intervention, after which inflammation has developed from the suture surgical material itself - the ligature. And there is absolutely no difference which thread was used (synthetic, natural, absorbable or not). Sometimes the cause of a fistula is the negligence of medical personnel, but it happens that the body itself rejects foreign material.

Conservative treatment of ligature fistula of postoperative scar

As a rule, the pathological process that has begun makes itself felt even before the patient is discharged home. Unfortunately, not everyone is attentive to their condition after the operation and certainly strives to be discharged from the hospital as quickly as possible. After all the worries about the upcoming surgical procedures, a slight redness in the suture area seems like such a trifle. However, only at the first signs of fistula development and the initial stage of suppuration, its conservative treatment is possible.

An experienced surgeon himself will determine that the healing process of the suture has deviations and will take timely action. Firstly, the site of inflammation is carefully examined, dead tissue is removed so that the wound heals faster. This is done in several stages with constant treatment of the seam with an antiseptic solution. Secondly, threads are removed in parallel, the endings of which appeared on the surface.

Medical treatment is prescribed:

• antibiotics (, Ceftriaxone, Norfloxacin, Levofloxacin);
• local antiseptics in the form of powders and water-soluble ointments (Levomikol, Trimistin);
• enzymes that dissolve dead cells.

Popular Vishnevsky ointments and synthomycin-based ointments are contraindicated due to their fatty base.

Surgical excision of the ligature fistula

It is much worse if the fistula is on the internal organs. Or outside, but the inflammation has gone too far. In this case, there are two options for drastic measures:

• removal of suture material without dissection of the fistula through its hollow channel;
• complete excision of the fistula in order to remove the ligature and flush the wound from suppuration.

A ligature fistula, which is treated both conservatively and surgically, is subjected to quartzization or ultrasound in a medical institution. Ultrasonic control allows you to make sure that all threads are removed without residue.

Treatment of ligature fistula at home

There are a lot of unconventional methods of treating various kinds of fistulas, but you should not rely on the ability to quickly cope with inflammation from the remnants of the ligature if they are not previously removed by dissecting the place of suppuration. If you miss the time, trying to fight with improvised means at home, then the process can be aggravated up to sepsis. When the focus of inflammation is correctly removed in the hospital, the doctor himself will probably give advice on what simple procedures can be done at home to speed up the closure of the wound.

For example:

1. A salt bandage is applied to the ligature fistula as an antiseptic as a prevention of re-inflammation, it helps even if it was not possible to release all the threads during dissection. Concentration saline solution is made at the rate of 1 tsp per glass of hot boiled water.
2. You can wash the fistula site with hot enough salty water, make lotions or.
3. Treatment of a ligature fistula with Dimexide is also quite common at home. This is a cheap universal concentrate, from which a 50% -90% aqueous solution can be prepared for lotions. Demixid has the ability to draw out all the impurities from a festering wound.

Hello Sergey.

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

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

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

Fistulas can be divided into certain types and depend on their location (rectal, gastric, bronchial, etc.). A ligature fistula is the one that appears after the imposition of non-absorbable threads. If you had stitches removed, then you had exactly ligature fistulas (since there are two holes). Ligature fistulas appear due to violations of the rules of antiseptic treatment of postoperative sutures and wounds after removal of surgical sutures.

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

Methods of treatment of postoperative fistulas

If a patient with a fistula has a strong enough body and strong immunity, then the therapy passes quickly, and the recovery period is not much delayed. If inflammation is observed at the site of the suture, then the treatment of ligature fistulas will most likely be carried out surgical methods.

Diagnosis must be carried out for the presence in the wound foreign body. Today they use modern technologies giving fast and accurate results. If the doctors' suspicions about the foreign object are confirmed, the fistulas will be opened, and both the foreign object and purulent masses will be removed through a special channel.

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

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

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

Sincerely, Natalia.

The bulk of surgical interventions ends with the application of a ligature, in place of which, in some cases, a ligature fistula of a postoperative scar occurs. It is with the help of a ligature that the damaged tissues are connected in layers. Naturally, operations are carried out under sterile conditions, the wound is disinfected before suturing with a special solution. But it is not always possible to completely remove bacteria from the wound, it is in this case that the risk of suppuration of the ligature suture increases, and, as a result, a ligature fistula is formed.

Where does the ligature fistula come from?

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

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

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

Treatment is prescribed based on the cause that caused this process.

Causes of ligature fistulas after surgery

Surgery is an emergency measure to save a person's life, but it is a serious stress. After the operation, the patient is waiting for a recovery period, during which various complications may occur, one of which is a ligature fistula. A number of factors that provoke its formation should be listed:

1. Infections that penetrated the wound during the operation. This occurs when the sterility of the equipment is insufficient and the ligature becomes infected with the contents of the wound.
2. Allergic reactions to suture material. They rarely occur, but they can also cause the formation of postoperative infiltrates. Often, the phenomenon is accompanied by an abscess.
3. The patient's age and physical state are a predisposing factor. Such inflammatory processes often occur in patients of the older age group, and often occur with complications.
4. Chronic infections in the human body.
5. Saprophytic microorganisms that are constantly present on the patient's body (staphylococci, streptococci).
6. Protein depletion of the patient's body due to prolonged illness.
7. Metabolic disorders.

The rate of development of the ligature fistula is influenced to a greater and lesser extent by all of the listed predisposing factors.

It is worth noting that ligature fistulas occur in different layers of the tissue, depending on where the inflammatory process occurs. The time of their appearance can vary from a few days to several years after the operation. The consequences for the patient can be tragic, the formation of an infiltrate must be removed from the affected cavity immediately, otherwise an abscess occurs that can take the patient's life. Timely treatment is mandatory.

Symptoms of education and treatment

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

It is not difficult to identify the formation of a ligature fistula in a timely manner, it is necessary to pay attention to the previous symptoms:

• redness in the suture area;
• discomfort, pain at the suture site, not infrequently there is itching and burning;
• a significant increase in body temperature;
• pus under the skin.

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

Diagnosis of this process is not difficult, in most cases the patient complains of pain at the suture site to the surgeon. Depending on the clinical manifestations, are held necessary examinations and treatment is given. Treatment of ligature fistulas differs depending on the severity and location of the ligature.

It is not always possible to choose a sparing method of treating this complication. In some situations, surgery is required. The fistulous passages are viewed, the contents are scraped out with a special spoon, purulent ligatures are removed.

Interesting! When re-suturing, only self-absorbable synthetic threads are used.

Other complications after surgery and prognosis for recovery

An infiltrate is an accumulation of particles of lymph or blood inside tissues, or any organ. It is a kind of seal. By nature, it can be neoplastic and inflammatory.

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

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

Caesarean section is a fairly common operation that helps a woman become a mother. But often there is endometriosis of the postoperative scar. This complication occurs due to the fact that the cells of the inner layer fall into the cicatricial connection. Such a formation occurs quite often; surgeons and gynecologists are involved in the treatment of this problem.

Sometimes, after performing surgical procedures, a seroma forms. It is an accumulation of fluid from injured lymphatic and venous capillaries. This manifestation most often occurs in obese people. Basically, a seroma is formed after plastic surgery in women in the area of ​​​​the mammary glands, abdomen and thighs. It is much easier to prevent gray than to cure, it is enough to appropriately treat the place of suturing.

Treatment of seroma is not given due attention, many surgeons claim that it resolves on its own within 4-20 days. Indeed, in most cases this is the case, and the liquid is not dangerous to humans. But it should be borne in mind that in some cases, seroma is a dangerous manifestation that causes irreversible consequences. Drainage is used to get rid of seroma. Vacuum aspiration is also used to treat seromas.

Oleogranuloma of the mammary gland often occurs in women as a result of surgical operations, such as the installation of implants in the breast. Oleogranuloma develops due to contact of breast tissue with foreign bodies. Painful ulcers and cracks appear on the surface of the mammary gland. Prompt medical attention and complex treatment help prevent complications.

Important! In the process of development of the oleogranuloma, the cells of the mammary gland tissue die. In their place, cysts and other malignant neoplasms form.

Lipogranuloma is a benign tumor in the breast. Such formation often occurs as a result of trauma, excessive compression and other mechanical effects.

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

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.

How long after surgery does the disease appear?

A ligature fistula may develop in the early postoperative period (in the first seven to ten days from the surgical intervention). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then 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:

1. Appendectomy. This is a surgical procedure to remove the appendix of the caecum, which is located in the right side of the abdomen just above the pubis.
2. 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 the doctors sequentially dissect the skin, adipose 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.
3. 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.
4. Episiotomy is an operation to cut the perineum. Used for difficult births multiple pregnancy, big child).
5. 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 body also take part in the formation of the ligature fistula: environment:

• hypothermia or overheating in the sun;
• infection of the suture material;
• insufficient disinfection of the skin during the operation;
• transferred bacterial or viral diseases(cold, 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.

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 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 are appointed by 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 drugs are prescribed. general action 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 is to use pharmaceuticals local and general impact. 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 medicines acceptable for use. In an effort to recover faster, the patient also repeatedly exceeded the dosage 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:

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

1. 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.
2. 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.
3. 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.

The operation is carried out in several stages:

1. 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.
2. 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).
3. Using vacuum suction, surgeons remove accumulations of blood, lymph fluid, and areas of dead tissue. The formed fistula is excised with a scalpel.
4. 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 seams close sterile dressing with 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 bandaging and processing of the suture is done by 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:

1. 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.
2. 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.
3. 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.
4. 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.
5. Apply a bandage with the ointment prescribed by the doctor and gently wrap it elastic bandage. At the same time, try not to overtighten the soft tissue.

What is strictly forbidden to do during the rehabilitation period:

1. 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.
2. 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.
3. 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 fall into breast milk and can be transmitted to a newborn child, negatively affecting the state of his body. That is why doctors predominantly use local therapy: the seam should be treated several times a day with an antiseptic solution, and the woman also needs to maintain the cleanliness of the surrounding tissues. Preparations local action 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. Duration recovery period largely depends on the age of the patient and the state of his 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 happened to encounter a man who developed 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:

1. 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.
2. 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 rather 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.
3. 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 using detoxifying, antibacterial and anti-inflammatory agents.
4. 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 the early stages, recommendations for individual and group prevention are developed annually. As part of recent practicing professors medical universities organize lectures and open seminars dedicated to the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

While studying at the Department of Traumatology, I had the opportunity to participate in an event dedicated to the problem of the occurrence of 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:

1. Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for the presence of allergic reaction on suture components. 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
2. 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.
3. Follow hygiene. Most opportunistic bacteria live in skin even 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 with the help of water and detergents treat the skin without touching the bandage.
   Antiseptic gel removes germs from the surface of the skin
4. 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.
5. In the period before and after the operation, try to adhere to proper nutrition. Popular vegetarian and vegan diets total absence animal proteins reduce the rate of healing of soft tissues and lengthen the recovery processes. 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, do not worry and worry once again: modern system rendering medical care long ago foreseen the occurrence of such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to accurately determine the cause of the ligature fistula and suggest effective ways dealing with such a problem.

- this is a pathological course surrounded by an inflammatory infiltrate in the area of ​​​​a non-absorbable suture thread, which was used for suturing tissues during various surgical interventions. Prone to relapsing course. It is manifested by the presence of a seal, in the center of which there is a small hole with a scanty serous-purulent discharge. The skin around the lesion has a purple-bluish or dark color. A ligature fistula is diagnosed based on symptoms, a history of surgery, fistulography data, and ultrasound. Treatment is curettage of granulations and removal of ligatures or excision of the fistula.

ICD-10

L98.8 Other specified diseases of skin and subcutaneous tissue

General information

Ligature fistula is a fairly common complication. Occurs in 5% of patients undergoing various surgical interventions. Significantly more often diagnosed after surgical manipulations on hollow organs abdominal cavity and small pelvis (conditionally aseptic operations), which is due to an increased likelihood of infection of surrounding tissues, even with strict observance of the rules of asepsis and antisepsis. The prevalence of this complication after gynecological interventions is 8.9%, hernia repair - 9.5%, operations for gastric ulcer and duodenal ulcer - 7.8%. The ligature can be located both superficially and at a considerable depth. Due to the tendency to recurrence, pathology often causes long-term disability. Aggravates the course of the underlying disease.

The reasons

The reason for the development of a ligature fistula is the rejection reaction of a foreign body - a thread used to suture deep and superficial tissues during surgery. Usually, pathological passages occur when non-absorbable threads are rejected. More often in the fistula, silk threads are found, somewhat less often - lavsan and kapron. Despite the fact that catgut is an absorbable thread, there are references in the literature to catgut ligature fistulas. The disease is almost never caused by Vicryl or Prolene threads. Provoking factors include:

• Infection. Pathogenic microorganisms penetrate the suture area as a result of suppuration of the surgical wound, which may be due to the non-sterility of the surgical field and instruments, violation of medical recommendations, the addition of a hospital infection, a change in reactivity or exhaustion of the body, etc. If the rules for sterilization of the suture material are violated, infectious agents may be on the thread at the time of tissue suturing.
• Immune rejection reaction. Occurs in response to the introduction of a foreign body, the likelihood of occurrence depends on individual immunological characteristics. The thread is not covered by the capsule, but becomes a target for immune cells that recognize it as a foreign antigen.
• Stitching of a hollow organ. It is observed when the entire wall of the organ is accidentally captured and the thread exits into its lumen. Upon contact with the non-sterile contents of the organ, the thread becomes infected, pathogenic microbes spread along its entire length and give rise to a focus of inflammation.

Pathogenesis

Usually, over time, a layer of scar connective tissue forms around non-absorbable threads, the threads are encapsulated. With the development of a purulent-inflammatory process, encapsulation does not occur, an abscess forms around the thread. Subsequently, the cavity of the abscess is opened in the area of ​​the postoperative scar, phenomena acute inflammation decrease due to the constant outflow of content. The thread may remain in place or migrate along the pathological course.

When the thread comes out on its own or is surgically removed, the cause of inflammation disappears, the fistula closes. Otherwise, the inflammation acquires a recurrent character, may be complicated by a secondary infection. Fistulas can be both single and multiple, formed in the area of ​​the threads used to suture superficially located tissues, or in the depths of the wound, for example, in the abdominal cavity. In the latter case, there is a possibility of involvement internal organs in the purulent-inflammatory process.

Symptoms of a ligature fistula

Pathology can occur both in the early and late postoperative period. Sometimes fistulas form several years after the intervention. During the formation of an abscess, local and general signs of purulent inflammation are revealed. There are pains, the localization of which is determined by the location of the infected thread. Weakness, weakness, fever may be noted. Then, a painful induration appears in the projection of the postoperative scar. The skin over the site of inflammation acquires a purple or cyanotic hue. A few days later, the abscess spontaneously erupts. A small fistula is formed, from which a meager serous-purulent discharge is released. Inflammatory phenomena decrease, intoxication syndrome disappears. Subsequently, the fistula usually periodically closes and opens until the thread is removed or spontaneously discharged.

Complications

Most dangerous complication ligature fistula is a secondary infection with spread purulent process. Depending on the location of the ligature, the formation of superficial and deep abscesses and streaks, damage to nearby organs is possible. With purulent fusion of tissues, eventration of the internal organs is sometimes noted. The secondary infectious process, in turn, can be complicated by sepsis. In severe cases, there is a risk of death.

Due to leakage of a fistula discharged in the area of ​​​​the external opening, dermatitis often develops. soft tissues around the fistula become edematous, thicken, the skin acquires a purple-bluish color, over time a hyperpigmentation area forms, a cosmetic defect forms in the scar area. With an unsuccessful attempt to extract a deeply located ligature, in some cases, damage to surrounding tissues and internal organs is observed.

Diagnostics

Diagnosis and treatment is carried out by specialists who performed the operation. Due to the increased likelihood of the formation of ligature fistulas after interventions with the opening of hollow organs, pathology is most often detected by gynecologists and abdominal surgeons, somewhat less often by urologists, even less often by thoracic surgeons, traumatologists, neurosurgeons and other specialists. The diagnosis is usually not difficult due to the typical history (presence of surgical intervention) and the location of the fistula in the area of ​​the postoperative scar. The main task is to determine the depth of the fistula and the configuration of the fistulous tract, to identify other factors that affect the tactics of treatment. The list of diagnostic measures includes:

• Inspection. Produced in a dressing room. The doctor evaluates the amount and nature of the discharge, notes changes in the surrounding tissues, and examines the fistulous tract with a clamp. With a slight tortuosity of the pathological course and the location of the ligature above the aponeurosis, this technique usually does not present any difficulties. Sometimes the thread can be removed during a diagnostic study. With a significant tortuosity of the fistulous tract or its penetration under the aponeurosis, the method is used with caution, trying not to disturb the demarcation shaft and not damage the internal organs.
• visualization techniques. The classic way to determine the depth and shape of the fistula is fistulography. A contrast agent is injected into the fistula, then images are taken in different projections, on radiographs, the cavity and passages are displayed as dark areas. AT last years for the same purpose, ultrasound is sometimes prescribed. Fistulous tracts are visualized as hypoechoic structures with a hyperechoic contour, nodes - as rounded hyperechoic structures.

Treatment of ligature fistulas

At the initial stage, dressings are usually performed, physiotherapeutic measures are prescribed, but the effectiveness of conservative methods is low, which forces specialists in the field of general surgery to resort to invasive manipulations. If the ligature thread does not come off on its own, they try to remove it with a clamp, but this technique has several disadvantages, since the doctor has to act blindly, which increases the risk of complications. At the same time, scraping of granulations is performed for better wound healing.

In the specialized literature, there are references to the extraction of ligatures under ultrasound control, which makes it possible to prevent accidental perforation of the wall of the pathological passage. With the long-term existence of fistulas, the presence of streaks and fistulous passages of complex shape, deep location of the ligatures, the fistula is excised. The disadvantage of this method is the need for a large-scale surgical intervention in the area of ​​scar tissue.

Forecast and prevention

The prognosis for ligature fistulas is usually favorable for life and conditionally favorable for recovery. In most cases, recovery is observed, however, to eliminate the pathology, repeated open manipulations or surgical interventions are often required. It is possible to successfully remove the ligature with a clamp in 65% of patients, while 21% of patients subsequently experience a relapse. The prevalence of purulent-inflammatory complications after excision of fistulous passages reaches 30%, 17% of patients require repeated operations.

Prevention consists in carefully ensuring sterility during operations, proper processing of threads, the use of suture material, which gives fewer complications, and adequate antibiotic therapy in the postoperative period. Patients must strictly follow the doctor's recommendations: do not remove the bandage, do not wet the wound, take prescribed drugs, etc.