home Drugs Ligature fistula. Fistula - what is it? Treatment of fistula with folk remedies. Ligature fistula Types of postoperative fistulas

Ligature fistula. Fistula - what is it? Treatment of fistula with folk remedies. Ligature fistula Types of postoperative fistulas

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

Any, even the simplest, surgical intervention on the human body, as a rule, requires quite a lot of time for wounds to heal. Absolutely all operations end with sutures, which should contribute to a faster and better recovery of the patient.

But sometimes, precisely in the place where the open wound was sutured, a strong inflammatory process begins, which is characterized by redness of the skin and the formation of pus. All this indicates that the person has developed a rather serious complication that requires immediate and high-quality treatment.

If you do not start fighting the fistula as quickly as possible, then it is likely that the patient may require another surgical intervention.

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

A fistula has formed in the middle of the seam

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

Outwardly, it looks like an ordinary deep wound, around which the skin has become inflamed. A fistula can appear on almost any part of the body, and not necessarily in the place where the incision was made. There are cases when the inflammatory process occurs inside the body for a long time and a person learns that something is wrong with him only when a characteristic hole appears on his body, releasing purulent masses

But not only pus can be released from the fistula; if the problem has not been dealt with for a long time, and it has affected the internal organs, then feces, urine and bile can be released from the canal that has formed

Fistula in the coccyx area

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

Full. It has two exits at once, which contributes to faster relief of the inflammatory process and healing
Incomplete. Has only one exit, which is usually located inside the abdominal cavity. This contributes to the intensive proliferation of pathogenic microflora and increased inflammatory processes
Lip-shaped. In this case, the fistula fuses with the dermatological tissue and muscle tissue. It can only be removed surgically
Granulating. This type of fistula is characterized by the formation of granulation tissue, hyperemia and quite severe swelling
Tubular. A fully formed duct that secretes pus, mucus and feces

Ligature fistula of postoperative scar after childbirth, cesarean section, appendicitis: signs, causes

Ligature fistula

Ligature- these are special medical threads that doctors use for layer-by-layer stitching of tissues damaged during surgery. Usually, before using them, the open wound is thoroughly treated with disinfectants and only after this proceed to suturing

But sometimes such actions are not enough and pathogenic bacteria enter the body along with the thread, provoking severe suppuration and the formation of a ligature postoperative fistula. As a rule, it opens after a few days and the material that was used to stitch the wound comes out along with pus.

Most often, this problem is caused by silk threads, so recently doctors have begun to use a material that dissolves on its own after a minimum period of time and does not require the removal of sutures or additional processing

The main reason for the development of postoperative fistula is infection

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

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

Signs of a fistula:

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

Redness will be clearly visible near the infected scar. Moreover, it will look brightest as the ligature is applied

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

Severe suppuration appears, which, if not treated correctly, turns into a weeping quite large size

The fistula opening may heal for a while and then become inflamed with renewed vigor.

Consequences that cause fistulas

Postoperative fistula can provoke the development of sepsis

Postoperative fistula itself is not life-threatening. But if the patient lets everything take its course, then the pathogenic bacteria that are inside the fistula opening will begin to infect healthy organs and tissues, and this will provoke the appearance of quite serious diseases.

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

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

Abscess. Purulent masses fill the entire internal cavity of the fistula opening
Phlegmon. In this case, the pus, in addition to tissues, also begins to affect fatty tissue.
Sepsis. A fistula opening occurs inside the human body. The pus ends up on the patient’s internal organs.
Fever,provoked by a purulent mass. Temperatures can rise to maximum levels. In this case, a person may lose consciousness and have difficulty oriented in space.

Purulent fistula on a surgical suture - treatment

Treatment of purulent fistula

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

If the doctor decides to delay the intervention, the patient will be prescribed conservative treatment. But it should also be carried out under the strict supervision of a specialist and preferably in a hospital setting. Typically, such treatment is aimed at eliminating pathogenic microflora that provokes inflammation

If the therapy is chosen correctly, the fistula opening will heal fairly quickly and the patient will be able to return to normal life. To treat an inflamed area of skin, drugs that have antiseptic, antibacterial and bactericidal effects are usually used

In addition, the patient must be prescribed antibiotics and vitamins, which help maintain the body’s defenses at a normal level. But I would like to immediately say that conservative treatment does not provide a 100% guarantee that the fistula will not reopen. Therefore, most doctors suggest not to suffer and immediately perform surgery to remove the purulent focus

Only surgical intervention can help completely get rid of the fistula.

After washing the wound, drainage is usually installed in it. In the postoperative period, the drainage is washed daily and sterile dressings are changed. If after a few days the amount of purulent masses does not begin to decrease, then the patient is additionally prescribed anti-inflammatory drugs, antibiotics and vitamin E

In addition, bandages and ointments can be used to stimulate the healing process. In this case, for example, troxevasin ointment may be prescribed. As soon as the purulent ceases to be released, the drainage is removed from the wound and then the patient can only make sure that no infection gets into it and periodically change the bandage

Folk remedies for the treatment of fistula

It is permissible to treat postoperative ligature fistulas in a trailer. Some of the methods described below remove inflammation quite well and reduce the amount of pus.

But still, if you decide to get rid of the problem in this way, then before starting treatment, be sure to consult with a specialist. After all, if you have neglected your condition very much, then it is likely that you will only aggravate the course of the disease.

So:

Take equal parts olive oil and strong vodka and mix until smooth. Wipe the inflamed area of skin with the resulting mixture 3-4 times a day. To enhance the therapeutic effect, you can immediately apply a cabbage leaf previously scalded with boiling water. This way you will not only kill pathogenic microflora, but also contribute to a faster discharge of pus

To prepare the next miracle remedy, you will need mumiyo and aloe juice. The mummy should be soaked in boiled water, and when it turns it dark brown, add aloe juice to it. You will need to moisten a sterile bandage in this solution and apply it to the sore spot.

St. John's wort decoction for the treatment of fistulas

If you need to draw out pus as quickly as possible, then use the familiar herb St. John's wort for this. In this case, you can use both the decoction and the leaves. First, tear off the St. John's wort leaves, fill them with water, and then simmer over low heat for 10-15 minutes. When the broth has cooled a little, soak a bandage in it and place the leaves on it in one layer. Fix this bandage on the fistula and leave it there for 4 hours. After this time, the bandage must be removed, the sore spot treated with hydrogen peroxide, and then a fresh one applied.

A decoction of celandine will help you fight fistula from the inside. If you prepare a decoction from this plant and take it regularly for a month, the substances that it contains will kill the infection located in the fistula opening and help relieve inflammation. But since this decoction thickens the blood very much, it will be better if the dosage is determined by a doctor

You can try to get rid of a fistula with regular black bread. Take the pulp and lightly sprinkle it with water. When the top layer softens a little, apply the bread to the sore spot and secure with a sterile bandage. This procedure must be carried out once a day. Before each znamenny bread, be sure to treat the wound with hydrogen peroxide. If you do everything correctly, then approximately on the third day you will see that the fistula is completely cleared of pus and begins to heal

Ointment for the treatment of postoperative fistula

Ointment with calendula for healing fistulas

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

You need to protect yourself from re-infection of the fistula opening. After all, if you apply unsterile dressings and use a product of questionable quality, you are unlikely to improve your condition.

The most popular ointments:

At home, you can also use an ointment that will have anti-inflammatory and healing properties. To prepare it you will need pine resin, natural honey, butter, aloe pulp and medical tar. All ingredients are mixed in equal parts and brought to homogeneity in a water bath. The resulting product should be applied to previously disinfected areas of the skin.

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

As mentioned a little above, the best way to get rid of a postoperative fistula is to completely excise it. Although this procedure is quite painful and has a fairly long recovery period, it will protect you from the development of complications such as sepsis and phlegmon.

Stages of the operation:

First, the fistula opening and all the skin around it are treated with antiseptic agents.
Anesthetic substances are then injected into the wound area
At the next stage, the wound is carefully dissected and all pus and remnants of the ligature are removed from it.
After this, everything is washed well, drainage is installed and closed with a secondary suture.
In this case, the vessels are not sutured, as this can lead to the formation of another fistula

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

Video: Ligature fistula of the perineum

A prospective study found that more 62,000 surgical wounds are infected. The degree of wound infection varies markedly depending on the degree of contamination of the surgical field. The risk of wound infection in sterile surgical conditions (there is no infection in the operating room, there are no violations in aseptic procedures, the internal organ is not opened) is less than 2%, whereas in non-sterile conditions it is 40% or more.

Before surgery, the skin surface is treated with hexachlorophene to prevention of infection of surgical wounds, but at the same time, shaving hair at the surgical site increases the risk of infection. Treatment of the surgical field 5 minutes before surgery was as effective as 10 minutes before surgery. The risk of wound infection increased with prolonged hospital stay, as well as with prolonged surgery.

In addition, concomitant appendectomy increases the risk of wound infection in patients after performing “clean” operations. It has been found that the likelihood of wound infections can be reduced by shortening the preoperative hospital stay, treating the surgical site with hexachlorophene, reducing the area of hair shaving, good surgical technique, reducing operative time as much as possible, placing drains outside the surgical wound, and educating surgeons regarding the frequency wound infection. Compliance with these rules led to a sharp decrease in the frequency of wound infections - from 2.5 to 0.6% over 8 years.

Although wound infection with most gynecological operations below 5%, which reflects the “purity” of most of them, the risk of wound infection in patients with malignant neoplasms of the genital organs is higher.

Symptoms of wound infection often present postoperatively, usually after 4 days, and include fever, erythema, tenderness, induration, and purulent discharge from the wound. The cause of wound infections detected on days 1-3 is usually streptococcal and clostridial infections. Treatment of wound infections is usually mechanical: opening the infected wound area above the fascia, cleaning the edges of the wound, if necessary.

Maintaining surgical wound includes sanitation and changing the gauze bandage 2 or 3 times a day, which promotes the growth of granulation tissue at the site of the defect after secondary surgery with gradual scarring. The use of a special vaccine for large wounds speeds up healing and reduces the number of dressings. Cleanliness and granulation of the wound often helps reduce the time required for complete secondary healing.

Delayed method healing of the primary wound can be used to reduce the likelihood of injury. Briefly about this method: before the surgical procedure begins, the surgical wound is left open above the fascia. A vertical interrupted suture is applied through the skin and subcutaneous tissue, 3 cm away from the edge, without connecting the edges of the wound. Immediately after surgery, the wound is monitored until the wound begins to granulate well.

The seam can then be joined nearby skin edges sewn or fastened. Using delayed primary wound healing has been shown to reduce the overall rate of wound infection from 23% to 2.1% in high-risk patients.

Stump infection vagina after hysterectomy it is characterized by erythema, induration and tenderness of the stump. Sometimes there is purulent discharge from the upper part of the vagina. Parametritis is often limited and does not require treatment. Fever, leukocytosis and pain in the pelvic cavity can be associated with severe inflammation of the loose tissue of the vaginal stump, which often extends to the parametrium. In such cases, therapy with broad-spectrum antibiotics against gram-negative, gram-positive and anaerobic microorganisms is indicated.

If in a cult vagina there is extensive suppuration or fluctuating masses are noticed in it, it should be carefully examined, opened with a blunt instrument and left open for drainage.

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The application of surgical sutures is the last stage of intracavitary surgery. The only exceptions are operations on purulent wounds, where it is necessary to ensure the outflow of contents and reduce inflammation in the surrounding tissues.

Sutures can be natural or synthetic, absorbable or non-absorbable. A severe inflammatory process at the site of the suture can lead to the release of pus from the incision.

The leakage of serous fluid, compaction and swelling of the tissues indicate such a pathological phenomenon as a ligature fistula of a postoperative scar.

Why does a ligature fistula appear after surgery?

A ligature is a thread for ligating blood vessels. By applying a suture, doctors try to stop bleeding and prevent its occurrence in the future. Ligature fistula is an inflammatory process at the site of wound suturing.

It develops due to the use of material contaminated with pathogens. The pathological element is surrounded by a granuloma - a compaction that consists of different tissues and cells:

The ligature thread is also part of the granuloma. Its suppuration is dangerous by the development of an abscess.

It is clear that the main reason for the formation of a ligature fistula lies in infection of the suture material. The development of an unfavorable process is provoked by various factors:

Avitaminosis.
Syphilis.
Tuberculosis.
General condition and age of the patient.
Hospital infection (streptococcus, staphylococcus).
Oncological diseases leading to protein depletion.
High immune reactivity of a young organism.
Rejection of the thread by the body due to individual intolerance to the material.
Wound infection due to lack of antiseptic treatment.
Metabolic disorders (diabetes, obesity).
Localization of the operated area (abdomen in women after cesarean section, paraproctitis).

Ligature fistulas occur in any part of the body and in all types of tissue. As for the time of their appearance, there are no exact forecasts. For some patients, the problem occurs after a week or a month, but it also happens that the fistula bothers you a year after surgery.

Symptoms of ligature fistula

The following symptoms help identify a fistula on a scar after surgery:

In the first days after surgery, the area thickens, swells, and causes pain when touched. The skin surrounding the wound turns red, and the local temperature rises.
After a week, when pressure is applied to the suture, serous fluid and pus are released.
Body temperature rises to 37.5 – 39°C.
The behavior of the fistula is unpredictable - the passage can spontaneously close and later reopen.

Only repeated surgery can help completely get rid of the canal. You can see what a ligature fistula looks like in the photo.

Externally, it is a deep wound with inflamed skin around the edges. Interestingly, a fistula can form completely different from where the incision was made. Doctors know of cases where inflammation developed for a long time inside the patient’s body, but the person himself realized that he was sick only when a small hole appeared on the body, from which purulent-serous fluid oozed.

A fistula is a hollow canal inside the body, a kind of link between organs and the external environment. It can also be a junction between the internal cavity and an oncological neoplasm. The canal, which looks like a tube, is lined with epithelium from the inside. Pus comes out through it. In advanced cases, bile, urine, and feces come out of the fistula.

Postoperative fistulas are divided into several types:

Full. Characterized by the presence of two outputs. This structure promotes rapid healing.
Incomplete. The fistula has one exit inside the abdominal cavity. Under such conditions, pathogenic flora rapidly multiplies and intensifies the inflammatory process.
Tubular. A properly designed canal releases purulent, mucous and fecal matter.
Lip-shaped. The fistula fuses with muscle and dermal tissue. It can only be removed through surgery.
Granulating. The fistula becomes overgrown with granulation tissue, the surface of the surrounding skin looks hyperemic and swollen.

In ICD-10, ligature fistula is listed under code L98.8.0.

Most often, ligature fistulas are formed in places where silk thread is applied. To avoid this problem, modern doctors use a material that does not require the removal of sutures and dissolves on its own after a short time.

Diagnosis and treatment of ligature fistula on a scar

Ligature fistula is diagnosed during examination of the postoperative wound. For a complete examination of the suspicious area, the patient is referred for ultrasound and fistulography. This is a kind of x-ray using a contrast agent. The image clearly shows the location of the fistula canal.

Treatment of ligature fistula requires an integrated approach. Patients are prescribed different groups of drugs:

Enzymes chymotrypsin and trypsin.
Antiseptics for local treatment.
SSD antibiotics – Norfloxacin, Ampicillin, Ceftriaxone, Levofloxacin.
Water-soluble ointments - Levomekol, Levosin, Trimistin.
Fine powders – Baneocin, Gentaxan, Tyrosur.

Enzymes and antiseptics are injected into the fistula canal and surrounding tissues. The substances act for 3 – 4 hours, so the problem area is treated several times a day. In case of profuse discharge of purulent masses, it is forbidden to use Vishnevsky's liniment and synthomycin ointment. They clog the canal and delay the outflow of pus.

In order to relieve inflammation, the patient is referred to physiotherapeutic procedures. Quartz treatment of the wound and UHF therapy improve microcirculation of blood and lymph, reduce swelling and neutralize pathogenic flora. The procedures provide stable remission, but do not contribute to complete recovery.

Complications of a ligature fistula: abscess, phlegmon, sepsis, toxic-resorptive fever and eventration - loss of organs due to purulent melting of tissue.

A non-closing ligature fistula is treated by surgical debridement of a complicated postoperative wound. The area is disinfected, numbed and incised to completely remove the suture material. The cause of the fistula is also excised together with adjacent tissues.

To stop bleeding, use an electrocoagulator or hydrogen peroxide (3%), otherwise suturing the vessel will provoke the formation of a new fistula. The surgeon’s work is completed by washing the wound with an antiseptic (Chlorhexidine, Decasan or 70% alcohol), applying a secondary suture and organizing drainage in the treated area.

In the postoperative period, the drainage is washed and the dressing is changed. For multiple purulent leaks, antibiotics are used, Diclofenac, Nimesil and ointments - methyluracil or Troxevasin. Minimally invasive methods of fistula removal, for example, through ultrasound, are ineffective.

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

A postoperative fistula is a through channel that is hollow inside and connects organs located in the peritoneum with the environment. Based on its etiology and symptoms, the pathology is considered extremely dangerous, as it prevents stable wound healing. This increases the likelihood that microbes, viruses and fungal infections will penetrate the internal organs, which can cause many secondary diseases of varying severity. After the operation, its formation is associated with the lack of normal dynamics of healing of the strip suture.

The very nature of the formation of a fistula is such that it is formed during the acute phase of inflammation, when purulent masses accumulated in the subcutaneous layer break through the epithelium, naturally drain and come out, creating a hole in the abdominal cavity or on any other part of the body. The most common fistula lesions in the abdominal cavity and lower extremities occur in medical practice. This is due to the physiological and anatomical structure of the human body.

Reasons for education

In modern surgery, it is generally accepted that prolonged non-healing of the wound surface formed after surgery is a complication that requires medication and sometimes even surgical treatment. For it to be effective, it is extremely important to establish the factor contributing to the development of the pathological condition of the suture. The following causes of postoperative fistulas of varying localization and severity are identified:

improper care of the wound, lack of antiseptic treatment with solutions specially designed for this (Chlorhexidine, Miramistin, Hydrogen Peroxide, Iodocerin), rare replacement of dressing material;
entry of pathogenic microflora directly at the time of the operation, if surgical instruments and threads that have undergone insufficient sterilization are used, or infection occurs during the rehabilitation process;
low-quality suture threads were used, which led to a negative reaction of the body and their rejection began with extensive inflammation and the formation of purulent masses;
reduced immune status of the patient, when the cells responsible for suppressing the activity of pathogenic microflora are not able to cope with the functional responsibility assigned to them and even non-dangerous strains of microorganisms enter the wound, leading to purulent damage to the epithelium with the formation of a hollow drainage canal (fistula);
excess body weight, when a thick layer of adipose tissue excludes normal regeneration of epithelial cells (the cut area of the body simply physically cannot heal, since the fat exerts constant static pressure on the wound);
senile age of the patient (patients who are already 80 years of age and older tolerate very poorly not only the surgical intervention itself, but also the period of recovery of the body, because the cells responsible for the formation of fibrous tissue, from which the suture scar is formed, divide at too slow a pace) ;
medical negligence and leaving surgical instruments in the abdominal cavity (such cases periodically occur in different countries of the world, and their occurrence is associated with insufficient care of medical personnel directly at the time of the operation).

By promptly eliminating these causative factors, it is possible to ensure stable recovery of the human body in the postoperative period, as well as to avoid the development of inflammatory processes.

How to treat a fistula after surgery?

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

Antibiotics

Washing the seam

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

Surgical debridement

Quite often, a fistula forms a scar consisting of fibrous tissue that is unable to grow together. This results in a hole that is no longer capable of healing on its own. To eliminate this pathology, the surgeon cuts off the edges of the fistula in order to start a new process of regeneration of exposed tissues.

Before surgery, antibiotics are used to ensure complete elimination of the infectious inflammation. Otherwise, the operation will only lead to an expansion of the diameter of the fistula. The described complex treatment of a non-healing wound ensures gradual healing of the inflamed wound with relief of the drainage channel.

Any surgical intervention is 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 worries 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 are not taken and the factors of suppuration are not 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. In women giving birth, the functions of the immune system are reduced, which is due to the process of gestation and labor stress. Sometimes this leads to the cells rejecting a foreign body (thread) or provokes an allergic reaction to the surgical material.

Why is a fistula dangerous?

Timely diagnosis of pathology is the key to a quick recovery

Fistula is a dangerous phenomenon that requires 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, expressed by extremely 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. In the 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:

Fistula may appear as a late complication of CS. 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. There is also no need to wait for the thread to exit spontaneously. 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 medications that kill bacteria. Frequent washing of the wound is necessary to remove pus and disinfect the suture area itself. This promotes rapid healing of the incision site. 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 the body’s protective functions return 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 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. The advantage of this method is that the doctor knows exactly where the material is localized. However, this method is not practiced in all clinics, because the procedure requires modern equipment.

Removal of the thread is considered a gentle surgical method, but there is also a radical method - 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 of the procedure is 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.

Whether preventive measures will be taken 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.