How long does it take for a wound to heal after fistula surgery? Fistulas on postoperative sutures

Fistula - what is it? You will find the answer to this question in the materials of the presented article. In addition, we will tell you why this pathological condition occurs, as well as what symptoms it is accompanied by and how you can get rid of it.

General information

Fistula - what is this deviation? IN medical practice such a pathological phenomenon is often called a fistula. This word is derived from the Latin “fistula” and literally means “tube”. In other words, a fistula is a kind of canal that connects a tumor or abscess with the surface or two cavities (two organs) with each other.

Appearance

Fistula - what is this pathological phenomenon, what does it look like? As a rule, such a fistula looks like a rather narrow channel, which is lined with an epithelial layer and is accompanied by characteristic discharge.

Main reasons

Why does a fistula develop? The reasons for this deviation include the following:

• After any inflammation stops, the pus usually comes out. Moreover, the channel through which it flows subsequently heals painlessly. However, in some cases (for example, if the inflammatory process has not been completely eliminated), deep in the tissue there continues to be a cavity with an infection (sometimes even with a dead area of ​​bone), and therefore the “tube” does not grow together, but forms a purulent fistula.
• Fistulas can arise from the roots of the tooth (with chronic periodontitis), passing through the gum and jaw.
• If fragments of bullets and bones were not removed in time after the blind, then suppuration also forms next to them, which leads to the development of fistulas.
• This deviation often occurs after surgical operations when sutures suppurate near ligatures (that is, threads used to bandage internal tissues, blood vessels etc.). In this case, a ligature fistula occurs.

Types of fistulas by location

Before starting treatment for such a deviation, its type should be determined. This is not difficult to do, since this classification depends, first of all, on the location:

• Gastric fistula. This pathology most often occurs after surgical operations (for example, after resection of the main digestive organ).
• Rectal fistula.
• Anorectal fistula. This deviation is characterized by a pathological channel coming from anus(or rectum) to the skin.
• Fistula pararectal. It goes outward from the anal crypt to the skin.
• Rectovaginal fistula. With this disease, the rectovaginal septum is damaged.
• Duodenal, or so-called intestinal fistulas. This is the external canal coming from the duodenum.
• Bronchial fistula. Such a deviation is accompanied by a pathological connection between the bronchial lumen and the pleural cavity.

Types of fistulas due to their appearance

Absolutely any fistula (photos of these deviations are presented in this article) can be classified as follows:

• Purchased. In other words, this phenomenon occurs as a result of suppuration (for example, a tooth fistula with either such serious illnesses, such as osteomyelitis or tuberculosis.
• Congenital. In this case, fistulas arise from developmental defects (at the navel, neck, etc.)
• Created artificially. Such deviations form after surgery (for example, ligature fistula).

Types of fistulas based on contact with the environment

In this case, such a pathological phenomenon may be:

• External, that is, going directly to the skin (for example, rectal fistula).
• Internal, that is, not communicating in any way with external environment, but to connect only adjacent cavities (for example, bronchoesophageal fistula).

Types of fistulas according to the nature of the secretion that is released from them

Such fistulas include:

• purulent;
• mucous membranes;
• gall;
• urinary;
• feces, etc.

Main symptoms of the disease

The clinical picture of such a pathology depends, first of all, on the location of the fistulas and the cause of their appearance.

Thus, the main symptom of this disease (external) is a hole in the skin from which fluid is released. By the way, the appearance of a fistula can be preceded by either trauma to this area, or inflammation of nearby tissues and organs, or surgery.

As for internal fistulas, most often they appear as a result of complications of chronic or acute diseases. For example, gallstones are often formed due to obstruction of the ducts by a stone. In this case, the symptoms of the deviation depend on the amount of bile that is secreted in abdominal cavity. Thus, the patient may feel severe pain and pronounced disorders of the digestive tract.

Bronchoesophageal fistulas are often complicated by food entering the tracheobronchial tree. It is this fact that leads to the development of aspiration pneumonia or bronchitis with corresponding symptoms.

Rectal fistula can be identified by the following symptoms:

• The presence of a barely noticeable hole in the anus (on the skin). In this case, the patient may experience copious discharge pus, due to which he is forced to constantly wear a pad and take regular showers.
• Aching pain in the anus. As a rule, such sensations are most intense during bowel movements, and then they noticeably subside.

A fistula on the gum is determined by such signs as:

• severe tooth mobility;
• tooth pain that gets worse when touched;
• purulent discharge.

Diagnostic methods

If you observe at least one of the above signs, then you need to immediately consult a doctor for diagnosis. correct diagnosis. It should be noted that specialists do not encounter any particular difficulties in diagnosing such a deviation. After all, it is based on collecting anamnesis, studying the characteristic complaints of patients, the type of fistula, analyzing the composition and amount of fluid released, as well as changing the functioning of the affected organs.

To clarify the direction and length of the fistula canal, as well as its direct connection with the lesion, probing and radiography are often used together with the introduction of a contrast agent into the passage.

By the way, you can clarify the diagnosis of “gastric fistula” with the help of studies for the presence of hydrochloric acid. If it is present in the canal, then this indicates the gastric location of the fistula. But urinary fistula is characterized by the presence of uric acid salts.

It should be especially noted that external fistulas are much easier to diagnose than internal ones. After all, they have a characteristic hole that is visible to a specialist with the naked eye. As for internal fistulas, they should be identified not only by existing symptoms and patient complaints, but also with the help of such diagnostic methods, How ultrasonography, radiography and endoscopy.

Fistula: treatment with official medicine

Therapy for patients with external fistulas is based on:

• local treatment;
• general therapeutic;
• operational.

Local therapy refers to the treatment of the resulting wound, as well as the protection of surrounding tissues from the effects of fluid that is released from the canal. For example, if the fistula is on the leg, abdomen, etc., then the purulent area is treated by various means(ointments, pastes and powders). They are applied at the external opening of the canal, thereby preventing the skin from coming into contact with pus, mucus, etc.

In addition, they can be used chemicals, which eliminate irritation of external tissues by neutralizing secretions from the fistula passage. For this, it is recommended to use enzymes (for example, “Gordox”, “Kontrikal”, etc.).

Mechanical methods of protecting the skin are aimed, first of all, at reducing or completely stopping discharge from the canal using special devices.

For general treatment purulent and other fistulas are treated with constant rinsing with an antiseptic solution.

Tubular granulating passages quite often close on their own after eliminating the causes of their occurrence (for example, removal of bone sequestration, ligature, etc.). But labiform fistulas never go away on their own. To treat such deviations, only surgical intervention is used to excise them, suturing the external holes, or resection of the affected organ.

It should also be noted that in some cases, surgeons create fistulas artificially specifically so that the patient can eat, or in order to remove accumulated secretions from any internal organ. These channels can be either permanent or temporary. After the patient's condition improves, the temporary canals are closed surgically.

In addition to external ones, internal fistulas (interorgan) are also created artificially. As a rule, they are imposed either for a long time or for life.

Treatment of fistula with folk remedies

Of course, treatment of such a deviation requires mandatory consultation with an experienced doctor. Indeed, with untimely and incorrect treatment, a fistula can lead to serious complications that can endanger human life.

But, despite this possibility, adherents alternative medicine still use numerous traditional methods to close the resulting fistulas. Let's look at some of them in more detail.

Treatment of ligature fistula with aloe

To prepare the medicine, you need to take 10-12 fleshy arrows from the presented plant, and then wash them in warm water. boiled water. Next, the aloe needs to be finely chopped and placed in liter jar. Pour 300 g of any honey into the container, cover loosely and place in a dark place for 7-10 days. In this case, after 4-5 days it is advisable to mix the mass well. Finally, the tincture must be strained several times and taken a dessert spoon three times a day.

Ointment for external fistulas

This ointment is good for healing and treating vaginal fistulas and for this we need water pepper grass, oak bark, lard and flax flowers. All imposed plants must be chopped, and then placed in some container and immediately poured with melted water. lard. In this case, the ratio of fat and herbs should be one to two.

After these steps, you need to place the filled dish in the oven and turn on low heat. It is advisable to heat the ointment for at least 7-11 hours. In conclusion medicine must be cooled at room temperature. The method of treatment with this ointment is quite simple. To do this, you need to make a cotton swab, generously lubricate it with the product, and then apply it to the fistula opening. It is advisable to change dressings every five hours.

Decoctions for external fistulas

Infusions and decoctions medicinal chamomile Use only externally - for washing holes. To prepare them, you need to take 1 large spoon of dried flowers, brew them with one glass of boiling water, and then leave for 60 minutes and filter.

Also, decoctions made from calendula are used to wash fistulas and create compresses.

Prevention

Now you know how to treat a fistula, what it is, and why it occurs. Prevention of acquired channels should include prevention infectious diseases. In addition, it is necessary to strictly observe the rules of asepsis when surgical interventions.

Regarding prevention congenital fistulas, then this is impossible, since the disease occurs in the first trimester of pregnancy.

Fistula after surgery It is very easy to recognize, therefore, as soon as the patient notices it, he should immediately tell his doctor about it. Such a wound will not heal on its own, so you should not wait and hope that it will heal on its own!

A fistula after surgery may appear for some reason; using a probe, doctors can determine the length of the fistula, and also its connection with the organs inside the body. If the fistula is labial, then most often the problem is solved surgical treatment. Other types of treatment have no prospects in this situation.

The fistula can also be tubular. It happens that it closes on its own. But this can only happen if the discharge has stopped.

If it is a pancreatic fistula, then it can be closed using radiotherapy.

There are also purulent fistulas, to get rid of them it is necessary to remove the foreign body, because it is this that provokes the onset of the inflammatory process.

It happens that during examination a congenital fistula is discovered. Its appearance is associated with developmental defects.

If a postoperative fistula is detected, then it can be cured with a compress. Honey is applied to the cloth and applied to the sore spot. It will begin to heal. You can also apply a cabbage leaf in the same way.

Ligature fistulas occur very often. And they are, in fact, a very serious phenomenon. As a rule, its treatment requires new surgical intervention. Therefore, he needs to report the problem as quickly as possible.

Fistulas can be either granulating or epithelialized. Folk ways or only a tubular fistula – granulating, which has not yet formed – can be treated with medication. The walls of such a fistula are covered not with epithelium, but granulation tissue. The healing process, however, will be hampered by the fact that the tissue is constantly exposed to the secreted fluid. Therefore, granulations collapse from chemical active substances and enzymes. In addition, microbial toxins are also released. It is possible that such a fistula will heal on its own, but to do this it is necessary to stop the release of substances. Very it is also important to stop inflammation in the sore spot. Suitable for this conservative methods. For example, it could be something antibacterial agent or physical therapy. While performing the dressing, it is necessary to clean the skin around the fistula, then treat it with sterile Vaseline and syntomycin emulsion. We must not forget about the discharge; while it is going on, it must be collected so that normal skin didn't get inflamed either.

Hello, Sergey.

Those “two holes” that formed on your postoperative suture are nothing more than fistulas, which indicate the development of an inflammatory process in the human body after surgery. Fistulas can occur immediately after postoperative sutures are placed, or they can appear many years after surgical interventions.

Infection and inflammation after surgery can occur for many reasons. If you are talking about pus being released from there, then there was definitely an infection.

By the way, the fistula canal can go not only outside, but also inside, therefore, pus comes out not only to the surface, but also into the internal cavity. This often happens if during an operation a foreign body enters the body, which then begins to be rejected by the body, the patient behaves incorrectly after the operation, or an infection enters the body. open wound. The infection can have a profound effect on a person's immune system, and over time protective functions the body gradually weakens, and the inflammatory process, accompanied by suppuration, intensifies.

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

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

Treatment methods for postoperative fistulas

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

Diagnostics must be carried out to determine the presence of foreign body. Today they use it for this modern technologies, giving quick and truthful results. If doctors' suspicions about a foreign object are confirmed, then the fistulas will be opened, and through a special channel they will be removed and foreign object, and purulent masses.

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

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

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

Sincerely, Natalia.

Any surgical intervention is a serious test for a person, requiring time and effort. full recovery. That is why it is very important that there are no complications after the operation. Unfortunately, fistulas often occur in operated patients. What are they and how to deal with them?

Description

A fistula (also called “fistula”) is quite easy to recognize: in fact, it is an opening in skin, followed by a narrow channel.

A fistula may appear as a result of any pathological process in the body, but most often it occurs after surgery. Fistula is a common complication after surgery (up to 5% of cases); it can occur either a few days after surgery or after several months.

• The principle of cleanliness and sterility during surgery.
• Before the operation, it is mandatory to check the processing of instruments and the suture material used (integrity of packaging, expiration date).
• Thoroughly wash the wound before suturing.
• Use of high-quality self-absorbable suture materials.
• After the operation, the surgeon and another medical staff must also take all measures aimed at preventing postoperative complications, including the appearance of fistulas: regular inspection patient, dressings, treatment and sanitation of the suture.
• In addition, the doctor should always inform the patient about possible postoperative complications, their symptoms, the need and importance of timely seeking help.

Taking measures to prevent complications after surgical interventions, including fistulas, significantly reduces the risk of their occurrence.

While watching the video you will learn about what a fistula is.

Fistula is an unpleasant complication after surgery. His appearance requires immediate appeal to the doctor. Fistula speaks of inflammatory process in the body, suppuration of suture material. Treatment postoperative fistula consists of removing the purulent area and affected tissue.

It occurs as a result of inflammation and suppuration of non-absorbable surgical sutures that are used to stitch tissues (fascia, etc.) during various operations.

During surgical interventions, some tissues (muscles, subcutaneous tissue) are sutured with absorbable threads, and some (aponeurosis, tendons, etc.) with non-absorbable threads, because Such tissues grow together slowly and are susceptible to heavy loads. As a rule, non-absorbable sutures remain permanently in the tissue without causing any problems, but in in rare cases suppurate, then a small abscess appears in the area of ​​the thread, which opens through a small hole in the skin and a fistula is formed.

Causes of ligature fistulas.

The main reason for the appearance of ligature fistulas is infection of the thread. Most often it occurs during operations on hollow organs - intestines, stomach, gallbladder etc. During these interventions, the lumen of hollow organs is opened, and even with the most correct operation, infection cannot be avoided to one degree or another. Sometimes it happens that infection is caused by non-compliance with the rules of asepsis during surgery or poor quality suture material, but such cases are quite rare. Then everything depends on the aggressiveness of the microbe, immune status body. If the microbial agent is aggressive, and the immune forces are not enough to suppress it, the thread suppurates. If the thread has become suppurated, then until the thread is rejected purulent process does not stop, sometimes intensifying, sometimes calming down.

Symptoms, diagnosis ligature fistula .

Ligature fistula appears in different terms after surgery - from several days to several months and even years. In area postoperative scar redness, moderate pain occurs, and body temperature may rise. These phenomena are associated with suppuration and the appearance of an accumulation of pus under the skin - a ligature abscess. After a few days, the abscess spontaneously breaks out on the skin in the area of ​​the scar, pus flows out, and a small hole remains on the skin with the leakage of cloudy fluid - this is a ligature fistula. If more than one thread has festered, there may be several fistulas. During treatment, the fistula may close, but if the thread is not torn off (does not come out), the fistula inevitably opens again. So, periodically opening and closing, the fistula can exist for several months and even years until the thread is rejected on its own or is removed by a surgeon.

Photo below - ligature fistula after knee surgery

Below is the same patient, photo of the fistula opening, the tearing ligature is visible.

Treatment of ligature fistula.

At initial manifestations in the form of a ligature abscess, a small incision is made in the skin to drain the pus, because it is not advisable to wait until the pus breaks out on its own due to the risk of suppuration of the surrounding tissues and the formation of phlegmon - diffuse inflammation subcutaneous tissue. After opening the abscess, they usually try to blindly remove the ligature with a clamp. If this is successful, then after cleansing the wound, the fistula closes forever. If it is not possible to obtain a ligature, dressings with levomekol ointment are prescribed, against the background of which the inflammation subsides and the fistula can temporarily close. When there is new inflammation, they again try to get the ligature, sooner or later they succeed. You can make a wide incision in the area of ​​the fistula, try to find the inflamed thread and remove it, but this does not always work; moreover, during extensive intervention there is a risk of infection of neighboring threads with the subsequent formation of new fistulas.

To summarize the above, we can say that ligature fistula- a rare complication of abdominal and other surgical interventions, which is not life-threatening, but can bother the patient for quite a long time, until rejection or removal of the festering thread.

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