Postoperative ligature fistula: symptoms, causes, treatment, prognosis. Fistula after surgery: what is it and how to treat it How to get rid of postoperative fistulas

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

What is a ligature fistula?

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

1 - lumen of the vessel; 2 - muscles of the anterior abdominal wall; 3 - skin of the anterior abdominal wall; 4 - lumen of the tubular fistula; 5 - wall small intestine

How long after surgery does the disease appear?

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

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

A similar pathology can occur during the following operations:

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

Photo gallery: location of sutures after various operations

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

What is ligature infiltrate and ligature granuloma?

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

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

Causes of ligature fistula

A similar pathology develops after bacterial microorganisms enter the wound. Most often it is staphylococcus, streptococcus or Pseudomonas aeruginosa. However, the following factors from the body and environment:

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

How does the formation of such pathology manifest itself?

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

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

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

Chronic and asymptomatic course of such pathology is quite rare. Most often it occurs in older people, which is associated with impaired speed metabolic processes in organism.

With further progression, the wound becomes purulent.

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

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

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

Methods for diagnosing the disease

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

What treatment methods help get rid of the disease?

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

within one and a half to two weeks.

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

Drug therapy of pathology

Treatment of ligature fistula with conservative means involves the use of pharmaceutical drugs with local and general effects. They allow not only to get rid of the symptoms of the disease, but also to completely eliminate the cause that provoked the development of the disease. Remember that the use of any medications without medical prescription is strictly prohibited. In my practice, I have encountered a patient who independently began to take antibacterial agents without reading the contents of the instructions. He also suffered from cardiovascular pathology , in which there is a rather limited list of drugs acceptable for use. In an effort to recover faster, the patient also exceeded the dosage many times over. antibacterial drug

. This led to the development of serious complications: the man fell into a comatose state, from which the intensive care unit doctors had to bring him out. The situation ended happily, but the victim acquired a profound disability as a result of his experiments. That is why doctors advise to be very careful when choosing medications. Means for local treatment

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

Photo gallery: preparations for local wound treatment

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

Medications for general therapy:

Antibiotics have pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Claforan, Tetracycline, Vibramycin, Caten, Augmentin, Unazin, Azlocillin, Zinnat, Aztreonam, Imipenem, Vancocin, Rondomycin.
Steroidal anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body and relieve redness and swelling of soft tissues. The use of Hydrocortisone, Cortef, Laticort, Dexona is acceptable.
Vitamins 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 effective technique with a similar disease. If the disease progresses steadily, doctors decide on the need for repeated surgery. It is carried out under the following conditions:

addition of purulent complications;
a sharp deterioration in the patient's condition;
no effect from conservative therapy;
cutting through suture material.

Contraindications to surgery:

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

Excision of tissue is necessary to prevent recurrence of the fistula

The operation is carried out in several stages:

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

How to properly care for the site of suppuration

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

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

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

What is strictly prohibited to do during rehabilitation period:

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

Video: methods of dressing and treating wounds

Features of treatment of ligature fistula after various types of operations

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

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

A feature of the treatment of this condition is the impossibility of using many usual medications, since they fall into breast milk and can be transmitted to a newborn baby, negatively affecting the condition of his body. This is why doctors predominantly use local therapy: the suture must be treated with an antiseptic solution several times a day, and the woman must also keep the surrounding tissue clean. Drugs local action

do not pass into breast milk and do not affect the condition of the baby. If the pathological process progresses, doctors prescribe antibiotics that have minimal effects on the newborn: Amoxicillin, Erythromycin, Cefatoxime.

Treatment prognosis and possible complications of such pathology Healing of soft tissues is a long and not always predictable process, which can encounter a number of truly serious complications. Duration largely depends on the patient’s age and state of health. In children and young people, a ligature fistula heals in a period of two weeks to three months, while in the elderly population this period can last up to six months.

Patients with diabetes mellitus, hypertension, and cardiovascular diseases have a lower rate of soft tissue healing, as a result of which they have a significantly increased risk of developing secondary complications. Equally important in the treatment of ligature fistula is strict adherence to hygiene and rules for treating postoperative wounds. While working in the department purulent surgery

I happened to encounter a man who developed a serious complication in the form of the 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, tissue trauma constantly occurred, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly alleviated his condition.

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

Photo gallery: possible complications of the disease

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

How to prevent the development of a ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection entering the surgical wound still remains unresolved. In order to prevent this pathological condition In the early stages, recommendations for individual and group prevention are developed annually. Within the framework of the latter, practicing professors medical universities

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

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

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

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, do not worry and worry again: modern system The provision of medical care has long foreseen the occurrence of such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to accurately determine the cause of the ligature fistula and suggest effective ways combat such a problem.

Ointment for all occasions
Take pine resin, medical tar, butter, aloe leaf pulp, and flower honey in equal proportions. Place this mixture in a water bath and heat there, stirring until the mixture becomes homogeneous. If it turns out very thick, dilute with vodka.
This ointment helps to cure any non-healing fistulas, bone tuberculosis, abscesses. You need to put it around the fistula, cover it with a sterile napkin, polyethylene and secure it with an adhesive plaster. (newspaper “Bulletin of Healthy Lifestyle” 2003, No. 3, p. 25)

Traditional treatment of fistula with cabbage
A woman developed a fistula under her knee; for 2 months doctors prescribed various ointments, but they did not help, her leg hurt. A neighbor suggested an unusual folk recipe: attach a fresh one to the sore every day cabbage leaf and walk with him all day. Do the procedure for 12 days in a row. On the 13th day, red dots should appear around the fistula. If they appear, it means the treatment was successful, everything will heal quickly. The woman began making cabbage compresses; within a day the leaf dried out and became transparent. And after the 12th procedure, red dots around the fistula were discovered under the sheet. Everything went smoothly. After 3 days there was no trace left of the fistula. (recipe from Healthy Lifestyle 2002, No. 3, p. 18,)

Fistula in a newborn - treatment with aloe and mumiyo at home.
An umbilical fistula in a newborn child was cured with the following folk remedy.
Dilute the mumiyo with boiled water to the color of strong tea leaves. Mix the mummy solution and aloe juice in equal parts. Moisten a bandage with this mixture and apply to the navel. (folk recipe from Healthy Lifestyle 2003, No. 9, p. 27)

Ligature fistula - treatment with infusion of aloe and honey at home.
A man’s ligature fistula had not healed for 4.5 years; he turned to the readers of the newspaper “Vestnik ZOZH” to advise him folk remedies to cure a fistula. I received a lot of advice. But the following folk recipe turned out to be very effective: tear off 12 leaves from the bottom of a 2-3 year old aloe, put in the refrigerator for 10 days, rinse in boiled water and chop finely. Pour the crushed aloe into a jar, add fresh liquid honey there so that the aloe pieces are completely covered. Infuse the mixture for 6 days, shaking daily. Then strain the mixture, discard the aloe leaves, and take 1 tsp of the liquid. 3 times a day before meals. In addition to this treatment, the man also washed the ligature fistula daily with a furatsilin solution from a small syringe. After a month and a half of continuous treatment, the fistula began to actively heal. (recipe from Healthy Lifestyle 2004, No. 1, p. 27)

Traditional treatment of fistula after cancer surgery
The man was operated on for lung cancer. The postoperative fistula did not heal for a long time - it hurt, festered, the temperature rose, the patient lost 12 kg after the operation.
After studying a lot of literature, we decided to treat the fistula with celandine. The man began to drink an infusion of this herb. My appetite returned immediately and my health improved. He drank in courses: he drinks for a month, rests for a week. The fistula has healed, the tumors are not growing. (recipe from Healthy Lifestyle 2004, No. 12, p. 26)

External fistula - onion and calendula ointment.
Finely chop 200 g of onion, pour in 500 ml of hot rendered pork fat. Heat in a frying pan until the onion browns. Pour into a jar and cover for 8 hours.
Pour 1 cup of calendula flowers into 500 ml of hot rendered pork fat. Keep at 60 degrees for two days. Apply bandages to the fistula with these ointments, alternating them. (2005, no. 11, pp. 18-19)

Bread and salt - folk method fistula treatment.
The man had 2 fistulas in the wall abdominal cavity. I tried to treat fistulas at the clinic for three weeks, but to no avail. I decided to use folk remedies.
I pressed as much salt into the crumb of black bread as possible. I made a cake, smeared it on one side with saliva and applied the same side to the fistula. The second fistula was not touched for comparison. .Changed the cake every other day. On the fourth day, the fistula cleared up and began to heal. I got rid of the other one using the same method. Soon there were no traces left, only the skin was whiter at first. (review from Healthy Lifestyle 2005, No. 11, p. 31)

Fistula on the coccyx - traditional treatment mumiyo.
The woman repeatedly developed a fistula on her tailbone, lost her legs, and was unable to sit. They performed surgery several times, but the fistula on the tailbone opened again. Then the elderly doctor gave the patient a piece of mountain mumiyo the size of a match head - this was enough for a month's course - the woman did water solution mumiyo and washed the fistula, made lotions. Three months later she carried out another course of treatment for the fistula. Since then, this sore has not bothered her. And now mumiyo can be bought without any problems at any pharmacy. (review from Healthy Lifestyle 2005, No. 24, p. 26)

Fistula on the leg - home treatment resin.
A man used oleoresin to save his toe from amputation. The finger was black and had a fistula with unpleasant smell. He applied softened resin to a rag and wrapped his finger in it. The fistula closed after 3 days. (review from Healthy Lifestyle 2006, No. 4, p. 31)

Homemade ointment for fistula
After the operation, the man was left with a fistula. It was small, but blood was constantly oozing from it. At the hospital, his fistula was expanded, cleaned, and washed. And so several times, but to no avail. So they discharged me with a fistula that did not close. Every day by lunchtime the temperature rose, my whole body ached, sometimes the temperature jumped to 40 degrees and I had to call an ambulance. This went on for 8 months. In the summer, the patient moved to the village, where he began asking local residents for folk remedies for non-healing wounds and fistulas. He was advised to make an ointment from pine resin, wax, vegetable and butter. The man collected pine resin and prepared an ointment, adding more propolis. I soaked a bandage in the ointment, wrapped it around a match, and inserted the match into the wound before going to bed. The match went in almost completely. The next day the temperature did not rise. In the evening he performed the same procedure again, the Match only entered 3/4 of the way. The fistula gradually closed, and after a week it healed completely.
Here is the ointment recipe:
Take 1 tsp. crushed wax, propolis, resin, 2 tbsp. l. vegetable oil and 2 tbsp. l. (40-50 g) butter. Place everything in an enamel bowl and put on the lowest heat. Heat, stirring, until everything is dissolved. Immediately strain the hot mixture through 4 layers of gauze. (review from Healthy Lifestyle 2007, No. 19, p. 33)

Treatment of fistula with folk remedies.
One of the most effective folk remedies for fistula is mumiyo. It must be taken once a day on an empty stomach for 28 days (1 course of treatment). In advanced cases, the second course should be given after 10 days. Mumiyo should be dissolved in 50 ml of water, or preferably milk. Daily dose mumiyo depends on the weight of the patient: up to 70 kg - 0.2 g, up to 80 kg - 0.3 g, up to 90 - 0.4 g, more than 90 kg - 0.5 g.
High-quality mumiyo dissolves in water without residue.
Simultaneously with oral administration, mumiyo is also used externally - make lotions by dissolving 3 g of mumiyo in 100 ml of water.
On fistulas and any abscesses, it is useful to apply cakes made from comfrey root powder overnight. Comfrey stimulates the growth of healthy skin cells.
Rinse the fistulas with very hot salt water (1 teaspoon of salt per 1 cup of water).
Lubricate wounds with celandine juice 2-3 times a day
(review from ZOZH ZOZH 2008, No. 19, p. 32-33)

Fistula in a child - treatment of fistula with dandelion tincture at home.
The child had fistulas near the ear tragus: holes appeared, sometimes sticky transparent liquid oozed from them. Pharmacy ointments did not help - the holes did not heal. When I had a cold, the fluid became purulent and my ears hurt. Over time, a foul odor appeared from the fistulas. It was time for the girl to go to school; she had to somehow get rid of the fistula. A tincture of dandelion flowers in triple cologne came to the rescue. At first, the tincture was simply applied to the wounds. After 3-4 times the inflammation stopped, the fistulas almost healed. But after a while the inflammation started again, let's go purulent discharge Then the parents decided to pour dandelion tincture directly into the fistulas with a pipette. After three such procedures, the fistulas near the ears were completely healed, healed very quickly and did not open again. (HLS 2010, No. 9, p. 10)

Cabbage leaf for postoperative fistula.
The woman underwent surgery, after which a fistula formed at the site of the suture. I turned to the surgeon, who said that I would have to live with the fistula. I read a recipe in the Healthy Lifestyle Bulletin that fistula can be treated with cabbage. The patient washed the cabbage leaf, lightly beat it until the juice appeared and applied it to the wound. After seven procedures, the fistula seemed to disappear, but the recipe said that it should be applied 12 times. The woman continued treatment. And after the eighth procedure, I saw on the removed piece of paper that the threads had been bunched up and sewn up due to carelessness during the operation. After the threads came out, the fistula healed, everything fell into place. (2012, no. 9, p. 31)

Ligature fistula does not close - what to do.
After surgery to remove a hernia, a fistula formed. It has been bothering the woman for five years: it constantly festers, a lump the size of egg. Surgeons believe that it is necessary new operation. The patient contacted Vestnik ZOZH with the question “How to avoid surgery?”
Candidate of Medicine answers. Sci. A. I. Vanin.
The patient has a ligature fistula - a fistula caused by the presence of an infected suture ligature (thread), which is tied during surgery on a crossed vessel. Usually, a ligature fistula closes and heals after the festering threads have drained away. This did not happen for the patient. Therefore, she needs to have a fistulogram - X-ray examination fistula with contrast, see if it is connected with internal organs. Based on the results of the studies, the doctor will prescribe treatment for the fistula.
For now, you need to wash the wound with a 1% solution of dioxidine: inject the solution inside with a syringe without a needle and cover with a napkin soaked in the same solution. Secure with adhesive tape. Do the procedure every day for a week. If a lot of pus and fluid comes out, then rinse several times a day. Usually on the 3-4th day the fistula stops flowing. You can apply an oily solution of propolis or levomikol ointment.
At the same time, take sumamed tablets - 0.5 g 1 time per day 1-2 hours after breakfast at the same time. Course 3 days.
After this, take Complivit vitamins once a day for a month.
From folk remedies - take 1 tsp. 3 times a day aloe honey syrup, the recipe for which is given above.
A decoction of calendula flowers is also suitable for washing the fistula: 1 tbsp. l. for 1 cup boiling water. Add a few drops of tea tree oil to the warm broth. With the same decoction, apply compresses to the wound 1-2 times a day for 5-10 days.
Take medications and folk remedies to boost your immunity. (HLS 2013, No. 12, p. 16)

A fistula is a pathological channel that connects a hollow organ and the external environment or two hollow organs. Most often appearsfistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor’s instructions.

A fistula is a hollow neoplasm that in appearance resembles a deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

Lip-shaped. IN in this case fusion of fistulas and skin is observed, as well as muscle tissue. Removal of fistulas is carried out using a surgical method.
Full. Characterized by the presence of two outputs, which provides the opportunity for maximum effective fight with an inflammatory process.
Tubular. It is a fully formed canal from which there is a constant release of feces, pus and mucus.
Incomplete. The neoplasm is characterized by one exit, the location of which is the abdominal cavity. With this type of fistula, pathogenic microflora multiplies and inflammation worsens.
Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are quite often observed.

About, what is a fistula after surgeryonly the doctor knows. After carrying out the appropriate diagnostics, the specialist will be able to determine the type of formation, which will have a positive effect on the treatment process.

Reasons for appearance

Postoperative fistulascan develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After surgery, the human body can reject the thread, which is explained by intolerance to its components. Against this background appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

High immune reactivity of the body;
Elderly age;
Chronic specific infection;
Hospital infection;
Oncological diseases.

If the human body receives vitamins and minerals in insufficient quantities, this leads to the formation of fistulas. Postoperative fistula, treatmentwhich is very long-lasting, appears when there is a metabolic disorder - diabetes mellitus, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy for pathology should be aimed at eliminating it.

Symptoms

Fistulas after surgerycharacterized by the presence of certain characteristics. Initially, a thickening appears on the skin around the size. When it is palpated, pain is observed. In some patients, the appearance of pronounced tubercles is diagnosed, which secretes the infiltrate. At the site of infection of the scar, redness of the skin may be observed.

The pathological process is often accompanied by a sharp increase in body temperature. This is explained by the inflammatory process in the human body. Reduce temperature to normal indicator impossible. Fistulas are accompanied by a purulent process. At untimely treatment pathology, the size of the abscess increases significantly. Patients experience tightening of the fistula opening for a certain period. After this, inflammation develops.

Fistulas are characterized by the presence of certain signs. If they appear, patients are advised to immediately consult a doctor. Timely treatment disease will eliminate the possibility of side effects.

Features of therapy

Treatment of fistula after surgeryin most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions, which will eliminate the possibility of infection. Surgery requires the use local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is injected into it.

The surgeon uses a scalpel to remove the fistula. All other actions of specialists are aimed at stopping bleeding. After this, it is recommended to wash the wound with an antiseptic solution. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

Drug therapy

Treatment of postoperative fistulas requires the use of not only surgery, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

Diclofenac;
Nimesila;
Dicloberla.

In order to speed up the wound healing process, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use drugs that have vegetable origin, - aloe, sea buckthorn oil etc.

That, How long does it take for a fistula to heal after surgery?, directly depends on the characteristics of the rehabilitation period. Patients are recommended to perform daily hygiene procedures in the area of the operation. The patient is advised to disinfect the sutures daily using special drugs. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to avoid heavy physical activity. Long-term work in a sedentary position must be avoided for three months.

How it appears fistula after surgery, what is it?only the doctor knows. That is why, if tumors occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

Any surgery associated with risks of complications. Surgical childbirth is no exception. Common complications include the appearance of a ligature fistula after cesarean section. Fistulas are dangerous because they are a source of infection. If you do not pay attention to the pathological phenomenon in time, then intoxication of the body may occur. What to do if a fistula appears? Seek qualified help; this is the only way to avoid the risks associated with the inflammatory process.

To avoid complications after the surgical birth process, you should follow all doctor’s recommendations.

Caesarean, like any other surgical intervention, ends with postoperative treatment of the incision site. The final stage of surgical childbirth is suturing. For this purpose, a ligature is used - surgical thread. It helps stop bleeding. The thread prevents subsequent blood loss. The surgical material should not cause any concern to the patient. However, during surgical childbirth, there is a high probability that the threads will rot, resulting in the formation of an abscess in the tissues.
The abdominal incision, which is mandatory for caesarean sections, is always cleaned before suturing. If bacteria get into the wound or pathogenic microorganisms end up on the thread, then suppuration occurs. This ultimately leads to complications.

The thread that tightens the edges of the incision “overgrows” with a granuloma - a compaction of tissue. Suture material, fibroblasts, and collagen fibers can get into the seal. Under the influence of microbes, suppuration of the suture occurs. After the breakthrough, purulent discharge oozes. Part of the surgical thread may also come out with it. The place where the suppuration opens begins to “whistle”, because a through hole appears - a fistula. Usually the suppuration breaks out in one place, but there are breakthroughs in several areas. It all depends on the cause and characteristics of the inflammatory process.

The complication may appear a couple of days after surgery, that is, while the patient is still in the hospital. The fistula may appear after discharge. Sometimes the inflammation subsides, the breakthrough closes, but after a while everything repeats itself. This happens when proper therapeutic measures and the factors of suppuration have not been eliminated.

Causes of complications

The formation of a fistula after cesarean section is due to a number of reasons. Complications occur when:

initial infection of the suture thread;
infection of surgical material with wound contents;
using low-quality thread;
violation of hygiene procedures during and after caesarean section;
insufficient seam processing.

The risks of developing an inflammatory process increase if the immune system is weakened. Women in labor have functions immune system reduced, which is due to the process of gestation and birth stress. Sometimes this leads to cell rejection foreign body(threads) or provokes an allergic reaction to surgical material.

Why is a fistula dangerous?

Timely diagnosis of pathology is the key to a quick recovery

Fistula – dangerous phenomenon requiring immediate action. With large purulent accumulations, the likelihood of secondary infection is high. When the purulent discharge is intense, skin irritation occurs. This leads to the occurrence of dermatitis. If the pathological process is ignored and allowed to develop, then severe intoxication of the body can occur - with a breakthrough, there is a high probability of bacteria that cause inflammation entering the blood. Because of this, the patient may become disabled. Deaths are also recorded.

Fistulas are also dangerous due to their complications. The presence of a purulent focus can provoke a severe reaction of the body, extremely pronounced high temperature. An aggravated temperature reaction is called toxic-resorptive fever. It leaves its mark on all organs and systems. Fistula complications also include phlegmon. This is the name given to the process of spreading purulent deposits subcutaneously. Pus flows into the fatty tissue. If purulent discharge melts the wound after a cesarean section, organ prolapse may occur.

Risks can only be reduced by timely detection of a fistula. After diagnosing the pathological process, it is necessary to carry out treatment, including measures to prevent complications.

Symptoms of the pathological phenomenon

Ligature fistulas can be identified by a number of symptoms. It is not difficult to identify pathology, because it is accompanied by obvious signs. A woman can notice a fistula at the site of a cesarean section at home. This is important, because the complication does not always appear immediately after surgery; sometimes it occurs after a couple of months.
What are the signs of a complication? You need to pay attention to:

seals around the wound;
the wound canal area is hot to the touch;
redness near the scar (usually during suturing);
swelling of the tissue around the wound;
pus (sometimes the purulent contents are separated in a minimal amount: the sutured wound becomes a little wet).

Almost always, the formation of fistula openings is accompanied by a significant increase in temperature. On early stages temperature deviations from the norm may be minimal, but they should not be ignored.

Diagnostics

It is difficult not to notice the fistula. You can only miss the beginning of the formation of the inflammatory process. As it develops it becomes obvious. However, if the patient undergoes regular examinations after a cesarean section, the doctor will notice that the sutured wound becomes infected. Diagnostics include:

A fistula may appear as late complication KS. A woman after surgical childbirth should regularly inspect her wound. If you notice any alarming symptoms (even if they are minor), you should immediately consult a doctor. Qualified diagnostics will allow you to identify a complication before it begins to develop. This will make it possible to quickly take measures aimed at eliminating risks to the health and life of the patient.

Treatment methods

If complications in the form of a ligature fistula occur after a cesarean section, you should consult a doctor. Only a specialist can prescribe treatment that will bring results. Self-medication is strictly prohibited. This leads to irreversible consequences. Opening the suppuration and cleaning the fistula at home is fraught with intensification of the inflammatory process. No need to wait either spontaneous exit threads Waiting can lead to the spread of infection to nearby tissues and even the entire body. Severe cases often result in disability or death.

Conservative therapy

If a fistula opening occurs after a CS, the doctor determines the exact location of the infected area, finds the cause of inflammation, assesses the degree of development of the pathology and possible risks. Only after this the doctor determines the method of treatment.
If the case is not advanced, it is possible to resort to conservative therapy. This method involves removing the infection using various antibactericidal solutions and antiseptics.

The site of inflammation is treated daily with special medicines that kill bacteria. Frequent washing of the wound is necessary to remove pus and disinfect the suture area itself. This contributes fast healing incision sites. When the infection can be stopped, the fistula closes on its own. If the infection has spread, the doctor may prescribe a course of antibiotics. Additionally, the patient is prescribed vitamin complexes, the effect of which is aimed at increasing immunity. When protective functions the body returns to normal, the process of combating complications after a CS accelerates naturally.

Conservative treatment is not always possible. After such therapy, there remains a possibility of relapse, because the surgical thread remains intact. If the causes of complications were directly related to the thread, and the doctor was unable to determine this, then the development of fistulas may recur.

Operative methods

IN in some cases immediate medical attention is required

Treatment of fistulas most often involves surgery. Especially if the pathological process was not recorded immediately. The surgical method has two options:

thread removal;
excision of the fistula.

The surgical thread is removed through a small incision. First, the surgeon releases the pus, cleans the cavity, and thoroughly rinses the wound. The thread is removed blindly. This does not always work out the first time, so exacerbations are possible, during which the thread is removed again. If the surgical material can be obtained the first time, the fistula is permanently tightened.
Why don't they make a wide incision? This would provide a 100% result, because the ligature thread that led to inflammation could be seen. The use of such an incision is dangerous due to infection of “healthy” threads, which increases the risk of developing phlegmon.
After assessing the fistula tract, the doctor may decide not to make an incision at all, but to use a thin tool, such as a special clamp, to extract it. It is inserted into the fistula opening. The instrument penetrates the canal and removes the surgical material. After removing the thread that caused the complication, the wound is treated with antiseptics and dressings are made.

There is another way to remove the thread - under ultrasound control. Plus this method– the doctor knows exactly where the material is localized. However, this method is not practiced in all clinics, because the procedure requires modern equipment.

Removing the thread is considered gentle operative method, but there is also a radical one - excision of the fistula. The advantages of this procedure include efficiency. First, the doctor prepares the surgical site, administers local anesthesia, and then performs a single block excision. The fistula tract is removed, and with it the ligature thread. The final stage procedures – treatment of the removal site and suturing. The condition of the wound is monitored for the next five days and treated. The procedure involves removing the sutures when the excision site has healed.

Preventive measures

It is impossible to completely exclude the possibility of fistulas occurring after surgical childbirth. Complications can occur even if the most aseptic conditions were observed during the operation. Microorganisms can penetrate even when it would seem impossible. No one can predict the reaction of rejection.
However, there are a number of preventive measures that need to be taken to prevent complications after cesarean section. These include:

compliance with the rules of asepsis/antiseptics;
careful preparation of the wound;
use of modern surgical materials and their thorough testing.

Will they be fulfilled? preventive measures– depends on the doctor, so you need to choose the right specialist who will perform a cesarean section. It is important to assess the conditions of the hospital where the operation will take place. There is no 100% insurance against the appearance of a fistula, but timely detection and subsequent treatment can give a favorable prognosis.

Or fistula (from Latin - “tube”) is a channel connecting hollow organs to each other or to external environment or connecting a cavity or body surface to a tumor. The fistula looks like a narrow canal, covered with the top layer of skin - epithelium.

Fistula consequences differ pathological processes and fistula consequences surgery carried out to drain the contents of a hollow organ.

Postoperative fistula is considered a complication after surgery. As a rule, a fistula after surgery occurs as a result of suppuration, eventration or infiltrates of surgical scars. The main reason for the occurrence of a postoperative fistula is contamination of the suture material (ligature, or ligature thread) with pathogenic microorganisms. A compaction (granuloma) is formed around the fistula, which consists of the ligature thread itself and cells with fibrous tissue, macrophages, collagen fibers, etc. The fistula can be small in size and not cause any inconvenience.
Fistulas most often occur as a result of the use of a special silk thread.

Fistula after surgery: symptoms

The development of a fistula has its own distinct symptoms.

Seals and mushroom-shaped granulations (tubercles) that are hot to the touch form around the infected area of the sutured wound.
A limited area becomes inflamed postoperative scar.
A small (less often large) amount of pus is discharged from the wound.
The suture site turns red.
Swelling and pain appear in the area of the fistula.
Body temperature rises to 39 degrees.

Fistula after surgery: consequences of fistula

Sometimes the suppuration reaches a significant size and does not go away for a long time. The result of suppuration of the ligature thread can be an abscess. In such cases, ligature fistulas can secondarily infect a postoperative suture or lead to intoxication of the entire body, including disability. Frequent discharge of pus from the opening of the fistula can cause dermatitis.

Ligature fistula after surgery can occur several months after surgery.

Treatment of postoperative ligature fistula

Sometimes the ligature thread festeres and comes out with pus on its own. But you shouldn’t wait for such a moment; it’s better to immediately apply for medical care and prescription of treatment.

This treatment cannot be carried out independently at home. It can and should only be carried out by a specialist.

Treatment of a fistula most often involves surgical removal of the suppurating ligature thread. After this, the patient undergoes a medical course of treatment with antibiotics or anti-inflammatory drugs. In addition, doctors recommend taking vitamin complexes to strengthen the immune system. To speed up the healing of the wound, its sanitation is done by washing it with a solution of furatsilin or hydrogen peroxide, which perfectly neutralize the surface and wash away the released pus.

In addition to removing suppurating ligatures, excess granulations are also cauterized or scraped out.

There is also a more gentle way to treat postoperative fistula - ultrasound.

If several fistulas have formed, complete excision of the postoperative scar, removal of the infected ligature thread and re-suturing are prescribed.

Prevention of fistula after surgery

Such prevention depends on the surgeon, who must carefully observe all aseptic measures during the operation. The suture material must be sterile, and the wound must be washed before suturing. It is better to use modern absorbable threads - such as Vicryl, Dexon.