Postoperative ligature fistula: symptoms,causes, treatment, prognosis

Almost every surgical intervention ends with closure.
wounds with surgical sutures, except for
operations performed for purulent wounds, where the opposite is created
conditions for the normal outflow of pus and decrease
infiltration (inflammation) around the wound.

Surgical sutures can be either synthetic or
natural origin, as well as those that are absorbed and not
dissolve in the body after some time.

Sometimes it happens that there is a pronounced
inflammatory process, serous (cherry color), and then purulent
discharge and this is a reliable indicator that
fistula formed after the operation and rejection began
by the body. It is important to understand that postoperative fistula is
manifestation of a non-normal flow of this period and requires
further treatment.

Causes of ligature fistula after operative
interventions

  • Attaching an infection that has entered the wound through the sutures
    (inadequate adherence to clean wounds, not adherence to sufficient
    antiseptics during surgery);
  • Rejection by the body due to an allergic reaction to
    thread material.

Also on the occurrence of postoperative ligature fistula
period is affected by the following factors:

  • Age and general condition of the patient;
  • High immune reactivity of the body (young and full of strength
    people);
  • The presence of chronic specific infection in the body
    (tuberculosis, syphilis and many others);
  • Hospital infection, that is, the one that is constantly
    in all hospitals, and saprophytic microorganisms (staphylococcus or
    streptococcus), living on human skin is normal;
  • Вид и место оперативного interventionsа (свищ после операции по
    about paraproctitis or ligature fistula after cesarean
    section);
  • Oncological diseases that deplete the body (meaning
    protein depletion);
  • Lack of vitamins and minerals;
  • Metabolic disorders (diabetes, obesity,
    metabolic syndrome).

Interestingly, ligature fistulas:

  • Occur in any part of the body;
  • In different layers of the wound (skin, fascia, muscle,
    internal organ);
  • Do not depend on the time frame (occur in a week, month,
    year);
  • They have different clinical manifestations (rejection of sutures by the body
    with further healing or prolonged inflammation with suppuration
    wounds without healing);
  • Arise regardless of the material of the surgical thread;

Manifestations

  • The first days in the projection of the wound there is a seal
    redness, slight swelling, tenderness and increased local
    temperature
  • After one week from under the seams, especially when pressing,
    serous fluid begins to act, and later pus.
  • In parallel with this, the body temperature rises to subfibril
    numbers (37.5-38);
  • Sometimes an inflamed fistulous passage closes on its own, but
    after some time it opens again;
  • Full cure occurs only after a follow up.
    operations and eliminate the cause.

Complications arising from a ligature fistula

  • Abscess – cavity with pus
  • Cellulitis – distribution of pus in the subcutaneous fat
    cellulose
  • EVENTATION – prolapse of internal organs due to purulent
    melting the wound
  • Sepsis – in case of breakthrough of purulent contents into the abdominal cavity,
    chest skull
  • Toxic-resorptive fever – severe temperature reaction
    organism for the presence of a suppurative focus in the body.

Diagnostics

It is possible to diagnose ligature fistula during clinical
examination of the wound in the dressing room. Also a prerequisite will be
performing an ultrasound examination of the surgical wound that
It is done to identify possible purulent leakage or abscess.

With the difficulty of diagnosis due to the deep location
fistula using fistulography. The essence of the latter is
introduction of a contrast agent in the fistulous course with the subsequent
performing radiography. The picture clearly shows
the location of the fistulous course.

Treatment

Before treating a fistula it is necessary to understand that in
большинстве случаев без хирургического interventionsа излечения не
his long existence will only aggravate the flow
diseases. Also, when ligature fistula treatment should be
complex, with mandatory use:

  • local antiseptics: – water-soluble ointments: levomikol,
    trimistin, levosin – finely dispersed powders: tyrosur, baneotsin,
    Gentaxan
  • broad-spectrum antibiotics – ceftriaxone,
    norfloxacin, levofloxacin, ampicillin
  • enzymes that dissolve dead tissue – trypsin and
    chymotrypsin.

These antiseptics and enzymes must be entered as in the
fistulous passage, and in the surrounding local tissue several times
per day, as their activity lasts no more than 4 hours.

It is necessary to know that in case of abundant discharge of pus from the fistula
It is strictly forbidden to use fatty ointment (Vishnevsky,
syntomycinic), as they clog his channel and thereby
disturbed outflow of pus.

Also in the phase of inflammation can be actively use
physiotherapeutic procedures, namely quartz treatment of the wound and
UHF-therapy. The latter significantly reduce swelling and
spread of infection due to improved microcirculation
blood, lymph and harmful effects on microorganisms. Such
activities do not guarantee complete recovery, but can only
cause persistent remission.

To the question: “what to do when the fistula is not closing?”
answer only that it is a guaranteed indication to
проведению оперативного interventionsа. Treatment лигатурного свища
operation is the “gold standard”, because only
surgical treatment can eliminate the cause of permanent
suppuration.

The course of surgery for ligature fistula

  • Treatment of the surgical field with antiseptics (alcohol solution
    iodine) thrice;
  • Anesthetic is inserted into the projection of the wound and under it.
    substance (2% lidocaine solution, 0.5-5% novocaine);
  • For convenience of the search, a dye is introduced into the fistula tract.
    (brilliant green and hydrogen peroxide);
  • Dissection of the wound with the removal of the entire suture
    material;
  • The cause of the fistula is located and is removed from its surroundings.
    tissues;
  • Bleeding is stopped only by electro
    coagulator or 3% hydrogen peroxide, flashing the vessel strictly
    it is forbidden, as it may cause a fistula again;
  • After stopping bleeding, the wound is washed with solutions
    antiseptics (chlorhexidine, 70% alcohol, decasan) and closes
    secondary sutures with its obligatory active drainage.

In the postoperative period, periodic dressings are performed with
flushing drainage, which, in the absence of purulent discharge,
retrieved. If there is evidence (extensive phlegmon,
multiple purulent drips), the patient receives:

  • antibiotics
  • anti-inflammatory drugs (NSAIDs – dicloberl, diclofenac,
    nimesil)
  • ointments, stimulating healing processes (methyluracil,
    troksevazinovaya)
  • along the way, you can use herbal preparations
    of origin, especially those rich in vitamin E (sea buckthorn
    oil, scarlet).

It is important to note that the operation for ligature fistula
most effective in its classic form, namely with a wide
dissection and adequate revision. All little invasive techniques (with
using ultrasound) in this case do not show high efficiency in
combat this affliction.

It should be noted that self-treatment in the case of ligature
fistula postoperative scar is not acceptable, because all the same
закончится оперативным interventionsом с последующей хирургической
treatment, but time will be lost and possible development of complications
life threatening.

Prognosis after surgery and prevention

In many cases, surgical treatment of ligature fistula
effective, but there are cases when the human body
in every way rejects all surgical threads, even after multiple
repeated operations. With self-treatment of the fistula, the prognosis is not
favorable.

Preventing fistula in most cases is not possible,
since the infection can penetrate the seam even at the
aseptic conditions, not to mention the reaction of rejection.

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