How long does a drained ligature fistula heal. Postoperative ligature fistula: symptoms, causes, treatment, prognosis. Causes of postoperative fistula

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

Any, even the simplest, surgical intervention in the human body, as a rule, requires a lot of time for wound healing. Absolutely all operations end with suturing, which should contribute to a faster and better recovery of the patient.

But sometimes it is in the place where the open wound was sutured that a strong inflammatory process begins, which is characterized by reddening of the skin and the formation of pus. All this indicates that a rather serious complication has begun in a person, requiring 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 need another surgical intervention.

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

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

• 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 an 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 fought for a long time, and it has affected the internal organs, then feces, urine and bile can be released from the formed channel

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

1. Full. It has two exits at once, which contributes to a faster removal of the inflammatory process and healing
2. Incomplete. It has only one exit, which is usually inside the abdominal cavity. This contributes to the intensive reproduction of pathogenic microflora and the intensification of inflammatory processes.
3. labial. In this case, the fistula grows together with the dermatological integument and muscle tissue. It can only be removed surgically.
4. Granulating. This type of fistula is characterized by the formation of granulation tissue, hyperemia and rather severe edema.
5. Tubular. Fully formed duct that secretes pus, mucus, and feces

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

• Ligature- these are special medical threads that doctors use for layer-by-layer stitching of tissues damaged during surgery. Usually, before using them, an open wound is carefully treated with disinfectants, and only after that they 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 is opened after a few days and, together with pus, the material that was used to sew the wound comes out of it.

• Most often, this problem is provoked by silk threads, so recently doctors have begun to use a material that dissolves itself after a minimum time period and does not require removal of sutures and additional processing.

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

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

Signs of a fistula:

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

• Redness will be clearly visible near the infected scar. Moreover, it will look brightest in the course of applying the ligature.

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

• Severe suppuration appears, which, if not properly treated, turns into weeping of a rather large size.

• The fistulous opening can be delayed for a while, and then become inflamed with renewed vigor

Consequences that cause fistulas

By itself, the postoperative fistula does not pose a threat to life. But if the patient lets everything take its course, then the pathogenic bacteria that are inside the fistulous opening will begin to affect healthy organs and tissues, and this will provoke the appearance of quite serious diseases.

In addition, the body may refuse to respond properly 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 fistulous opening
• Phlegmon. In this case, pus, in addition to tissues, also begins to affect fatty tissue.
• Sepsis. There is an opening of the fistulous opening inside the human body. Pus at the same time gets on the internal organs of the patient
• Fever,provoked by purulent mass. Temperatures can rise to maximum levels. In this case, a person can lose consciousness and have poor orientation in space.

Purulent fistula on the surgical suture - treatment

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

• If the doctor decides to postpone 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 the pathogenic microflora that provokes inflammation.

• If the therapy is chosen correctly, then the fistulous opening will close rather quickly and the patient will be able to return to normal life. To treat the inflamed area of ​​​​the 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 right away I want to say that conservative treatment does not give a 100% guarantee that the fistula will not reopen. Therefore, most doctors suggest not to suffer and immediately perform an operation to remove the purulent focus

• After washing the wound, drainage is usually installed in it. In the postoperative period, 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, dressings can be used, with ointments that will stimulate the healing process. In this case, for example, troxevasin ointment can be prescribed. As soon as the purulent ceases to stand out, the drainage is taken out of the wound and then the patient only has to make sure that the infection does not get into it and periodically change the bandage

In the trailer, it is permissible to treat ligature postoperative fistulas using folk methods. Some of the methods described below are quite good at removing inflammation and reducing 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 a specialist. After all, if you have started your condition very strongly, then it is likely that you will only aggravate the course of the disease.

So:

• Take olive oil and strong vodka in equal parts and mix until smooth. Rub the resulting mixture 3-4 times a day on the inflamed area of ​​the skin. To enhance the therapeutic effect, you can immediately apply a cabbage leaf scalded with boiling water in advance. So 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 mummy and aloe juice. Mummy should be soaked in boiled water, and when it turns dark brown, add aloe juice to it. In this solution, you will need to moisten a sterile bandage and apply it to the sore spot.

• If you need to draw out the pus as quickly as possible, then use the familiar herb St. John's wort for this. In this case, it will be possible to use both decoction and leaves. First, tear off the leaves of St. John's wort, fill them with water, and then simmer over low heat for 10-15 minutes. When the broth cools down a bit, soak a bandage in it and put the leaves on it in one layer. Fix this bandage on the fistula and leave it applied 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 the fistula from the inside. If you prepare a decoction of this plant and take it regularly for a month, then the substances that are in its composition will kill the infection in the fistula and help relieve inflammation. But since this decoction thickens the blood very much, it will be better if the doctor determines the dosage.

• You can try to get rid of the fistula with ordinary 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 fix it 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 right, then approximately on the third day you will see that the fistula is completely cleared of pus and begins to tighten

Ointment for the treatment of postoperative fistula

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

It is necessary to protect yourself from re-infection of the fistulous opening. After all, if you apply non-sterile dressings and use a product of dubious quality, then you are unlikely to improve your condition.

The most popular ointments:

• At home, you can also use an ointment that will have both 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 must be applied to pre-disinfected skin areas.

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

As mentioned a little higher, 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 is she who will protect you from the development of complications such as sepsis and phlegmon.

Stages of the operation:

1. First, the fistulous opening and all the skin around it are treated with antiseptic agents.
2. An anesthetic is then injected into the wound area.
3. At the next stage, the wound is carefully dissected and all pus and remnants of the ligature are removed from it.
4. After this, everything is washed well, drainage is installed and closed with a secondary suture.
5. Vessels in this case are not sutured as this can lead to the formation of another fistula

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

Video: Ligature fistula of the perineum

Most surgical interventions end successfully: after suturing, the tissues gradually heal, and as a result, only a small scar remains on the body. But sometimes something goes wrong in this process, and a ligature fistula may appear.

A ligature move appeared: what is it?

The term "ligature fistula" is used by physicians to refer to a pathological course that has formed in the area of ​​​​the superimposed suture material, which, in turn, was used to fasten (stitch) the tissues at the site of the surgical intervention. Such a violation is accompanied by the development of the inflammatory process and suppuration. Among all the possible complications after surgery, the ligature fistula is considered one of the most common - a similar problem is recorded in 5% of patients who have undergone various surgical interventions.

Most often, the ligature course appears after manipulations on hollow organs localized in the abdominal cavity or in the pelvic area, since the risk of infection during such operations is the highest. The fistula is extremely superficial, but sometimes it is formed at a rather considerable depth.

Causes of an abscess on a postoperative scar

Doctors claim that the main reason for the formation of a ligature fistula lies in the body's attempt to reject a foreign body, represented by a thread that the surgeon used to suture tissues cut during the operation. Most often, pathological processes of this kind occur after the use of silk threads, an order of magnitude less often, lavsan or nylon material becomes the culprit. There is evidence that an abscess can also form when catgut is used, although it is an absorbable thread. At the same time, Vicryl or Prolene threads are practically unable to cause an inflammatory process.

As for the factors that can provoke the formation of a ligature fistula, among them are:

• Introduction of infection. Such a development of events is possible if pathogenic microorganisms penetrate to the suture material due to inflammation of the wound left after the operation. The infection can spread due to insufficient sterility of the surgical field or the instruments used. It can also be provoked by the patient's insufficient compliance with medical recommendations, the accidental addition of a so-called hospital infection, or a significant decrease in the body's defenses (exhaustion, etc.). In rare cases, infectious agents enter the body already on the thread if doctors have violated the rules of sterility.


• Development of immune rejection. The natural activity of the immune system can lead to the rejection of a foreign body, which, in fact, is a suture material. The risk of such a problem depends solely on the individual characteristics of the patient and it is impossible to predict its occurrence.
• Sewing of a hollow organ. A similar situation can happen if the doctor accidentally captures the entire wall of the organ, which is accompanied by the penetration of the thread into its lumen. As a result, the suture material comes into contact with the non-sterile filling of the organ and, naturally, becomes infected. Pathogenic microorganisms gradually spread throughout the thread, activating the inflammatory process.

Regardless of the cause of its formation, a fistula can permanently disrupt the patient's ability to work, aggravating the course of the underlying ailment.

Pathogenesis

If the suture heals normally, scar connective tissue cells gradually form around the threads, the suture material is surrounded by a capsule.

Features of ligature fistulas:

• They can be formed with equal probability when suturing superficial tissues (for example, on the leg or arm) or in the depth of the wound (during operations on the peritoneum or pelvic organs).
• Deeply localized ligature passages can involve internal organs in a purulent-inflammatory process.
• They may appear years, months or weeks after the intervention.
• They may present with various symptoms.

If the thread comes out on its own or is removed surgically, the cause of the inflammatory process disappears, as a result of which the fistula is successfully closed. However, if this does not happen, the inflammation constantly recurs and may be complicated by the addition of a secondary infection. But even with successful rejection of the thread, suppuration of the wound can occur.

Symptoms of an abscess on the seam

Abscess formation can occur after the patient has been successfully discharged from the hospital, even after several years. The pathological process can make itself felt by local and general disorders:

• Painful sensations in the projection of the location of the infected suture material.
• Weakness, a feeling of weakness, an increase in temperature.
• The formation of a painful induration in the projection of the postoperative scar.
• A change in the color of the skin over the site of inflammation. Most often, the skin becomes purple or cyanotic.
• A few days after the development of primary symptoms, a spontaneous breakthrough of the abscess occurs.
• A medium-sized passage is formed through which serous-purulent fluid (mass) is released in a small volume. If there are surgical sutures on the body, then a typical serous fluid begins to stand out from under them, and then it is replaced by pus.
• After a breakthrough, unpleasant symptoms disappear sharply, the severity of inflammation decreases.

If the thread remains in the wound, the fistula may periodically close and open. But after the successful removal of the suture material, the tissues heal successfully (in the absence of complications).

Complications

A ligature fistula is able to go away on its own, but in some situations its formation can result in quite serious complications:

• Secondary infection, which will be accompanied by the spread of a purulent process.
• Skin dermatitis due to leakage of secretions from the ligature passage.
• Hyperpigmentation of the skin at the site of injury.
• The development of superficial or deep ulcers.
• The defeat of nearby organs, both as a result of a purulent inflammatory process, and due to unsuccessful extraction of the suture material by a surgeon.
• Eventration (prolapse) of internal organs through a defect in the wall of the peritoneum. A similar situation can occur as a result of purulent fusion of tissues.
• Sepsis.
• Lethal outcome.

At the slightest suspicion of the development of an inflammatory process in the suture area, it is necessary to seek medical help, even if quite a lot of time has passed after the operation.

Diagnostics

Usually, with superficial fistulous passages, there are no difficulties in their diagnosis. For this, only a medical examination in a dressing room is enough. Immediately after examining the fistulous tract, the doctor may even remove the ligature. But if the fistulous tract is tortuous or not typically located, additional research methods may be required.

To determine the clear localization of the fistula, the presence or absence of complications, ultrasound is performed.

On the stomach

When a fistulous tract is formed in the peritoneal region, it becomes necessary to perform fistulography. Such a study allows us to find out the depth and features of the form of the resulting passage. The specialist injects a contrast agent into the cavity of the fistula, after which he takes several x-rays in various projections. Ultrasound can also be used for this purpose.

How to cure?

Most often, it is possible to cope with a ligature fistula only through surgical intervention. You definitely cannot do without the help of surgeons if the pathological course exists for a long time. In parallel with the surgical removal of the ligature, drug treatment is carried out. Only sometimes doctors can try to get by with only methods of conservative therapy.

Conservative treatment

For the treatment of ligature fistula, various groups of medicines can be used:

• Local antiseptic preparations. Usually, preference is given to water-soluble ointments, for example, Levosin, Levomekol or Trimistan, as well as fine powders, in particular, Baneocin and Gentaxan. Fat-based ointments (for example, the well-known Vishnevsky ointment) can impede the outflow of pus, so their use is not recommended, especially if there is a significant amount of purulent discharge.
• Antibacterial medicines. Preference is given to drugs with a wide spectrum of action: ampicillin or ceftriaxone.
• Enzymes to eliminate dead tissue. Trypsin is usually used for this purpose.

Medicines must be injected into the fistulous tract, and also distributed through the tissues near the wound, several times a day. In parallel, methods of physiotherapy can be used, in particular: quartz treatment or UHF therapy.

Surgical intervention

To eliminate the ligature fistula, doctors usually perform a classic intervention, which consists of several stages:

• The surgical field is treated with an antiseptic (usually iodine tincture is used).
• Anesthetize the problem area with injections of Lidocaine or Novocaine.
• A special dye is introduced into the fistula for a complete examination.
• The formed fistula is dissected and the suture material is removed.
• Carry out an audit of adjacent tissues.
• Stop bleeding with electrocoagulation or peroxide.
• Carry out a thorough sanitation of the wound with the use of antiseptics.
• The wound is closed with sutures and active drainage is established.

Competent operation with full sanitation of the wound avoids serious complications. Expectant tactics in the case of a ligature fistula are completely unjustified.

Forecast

In most cases, with the formation of a ligature fistula, the prognosis is favorable for the patient's life and relatively favorable for his recovery. As a rule, such a complication ends in a successful cure, although it may require repeated surgical intervention.

However, in about 60-65% of cases, doctors manage to remove the suture material without surgery. But even in this case, the ligature fistula can recur.

Prevention

The main measures for the prevention of ligature fistula are:

• Competent and careful organization of sterility during surgical interventions.
• Proper preparation of suture material.
• The use of the suture material, which rarely causes complications.
• Performing adequate antibiotic therapy after the intervention of surgeons.
• Compliance by patients with all the recommendations of the doctor and timely visits to the hospital for examinations after surgery.

Doctors assure that there are no 100% effective methods for preventing the appearance of ligature fistulas, because even with absolute sterility there is a risk of infectious agents entering the surgical wound. And it is completely impossible to predict and prevent the possible rejection of the suture material.

Content

As a result of an inflammatory process or surgical intervention, a so-called fistula can form - a channel connecting two cavities to each other or an organ to the surface of the body. Inside the fistula is filled with exudate, so over time the inflammation progresses. Such a pathology cannot heal on its own; mandatory medical treatment or surgical intervention is required.

What is a fistula

As a result of various pathological processes, purulent fluid accumulates in the focus of inflammation - it consists of bacterial cells along with their metabolic products and dead leukocytes. During the development of pathology, the amount of exudate gradually increases, it does not fit in the cavity, so the body tries to give it an outlet. This is how a fistula is formed - a fistula (tube, channel), which connects the affected cavity or organ to the exit site of the exudate (the surface of the skin or another cavity).

Through the fistula, the surface of which is covered by an epithelial layer or granulation tissue, a purulent secret constantly passes, increasing inflammation, therefore, spontaneous healing of such a pathology is problematic, but in some cases it is possible. In addition, fistulas often have multiple branches, which makes it difficult to surgically remove the pathology.

Under certain conditions, microorganisms from the purulent fluid can “migrate” to the surrounding organs and tissues, provoking the appearance of new foci of inflammation. The composition of the separated substance directly depends on the organ with which the channel is connected; the more aggressive the secret, the more it damages the skin or nearby tissues. When fistulas occur, there is a loss of fluid, intoxication of the body, which leads to metabolic disorders and water-salt balance.

Fistulas can exist in the body for a long time and, if not properly treated, affect several organs. If the inflammation of the original organ stops, purulent secretions stop flowing into the canal, it closes and heals. When the pathological process resumes, the fistula begins to function again, accumulate and secrete exudate - a relapse occurs.

What does a fistula look like

There are internal fistulas, which connect the cavities inside the body, and external ones. A fistula on the skin looks like an inflamed wound, from which pus oozes, the edges may resemble lips (see photo below). An external fistula occurs on the skin of a person near cavities - for example, in the throat and nose. In some cases, a person may not be aware of the presence of an inflammatory process in the body until a fistulous opening appears on the surface of the skin. In case of severe damage to the internal organs, not only purulent exudate, but also fecal, urinary, and bile can be released from the canal.

What does it come from

Gram-negative, anaerobic bacteria, streptococcus aureus, staphylococci, some types of fungi, etc. can act as an etiological factor. Fistulas are formed for the following reasons:

• (severe chronic disease of the gastrointestinal tract);
• actinomycosis - chronic diseases resulting from infection with a fungus;
• complications after surgery (for example, a ligature fistula is formed due to suppuration around the sutures on the blood vessels);
• chronic ENT diseases;
• the presence of sequesters - dead areas of the bone;
• injuries of the intestinal tissue;
• dental pathologies (periodontitis, caries);
• - inflammation in the crypts of the anal canal of the intestine;
• neoplasms (benign and malignant) on the rectum;
• suppuration around foreign bodies inside the body (for example, a bullet or its fragments).

Symptoms

The signs of a fistula in most cases are similar, depending on the location of the focus of inflammation and the affected organ. Fistulas can occur anywhere, for example: on the back, buttocks, groin, chest, heel, finger, abdomen, perineum, etc. With pathology, the patient observes the following symptoms:

• subfebrile body temperature due to the presence of an inflammatory process in the body;
• signs of intoxication - weakness, headaches and muscle pain, sleep disturbance, decreased performance;
• the presence of a characteristic pain syndrome, if the fistulous course affects the nerve endings (for example, the fistula of the rectum is accompanied by pain in the anus, which intensifies during defecation);
• the pain subsides after the bubble breaks through at the end of the canal and the secretion is released onto the skin or into the cavity.

Kinds

There are several classifications of fistulas. By origin, the following types are distinguished:

1. Congenital fistulas are formed due to malformations of the embryo; some of them (for example, umbilical fistula) are detected by doctors before or during childbirth.
2. Acquired pathological channels arise as a result of inflammatory processes, injuries or operations (for example, a fistula on a leg or arm may occur due to a fracture or bruise).
3. artificially created fistulas are designed to remove fluids from the body (purulent, urinary, fecal, bile).

By location, fistulas are divided into the following types:

1. Urinary- are installed on the ureters, bladder or urethra, formation as a result of trauma is possible.
2. Biliary fistulas occur due to operations on the gallbladder. The secret secreted by such a fistula leaves burns on nearby tissues, so treatment should be started immediately.
3. Purulent channels can appear anywhere on the body, often they appear on the gums due to a poorly healed tooth. In rare cases, a purulent fistula can heal on its own, but more often a relapse occurs and purulent exudate begins to flow through the canal again.
4. salivary fistulas are formed due to inflammatory processes in the cheek, neck or ear, saliva is secreted through them.
5. Bronchial- connect the bronchi to the pleural cavity.
6. Gastric fistulas are established artificially for enteral feeding of the patient after resection of the stomach with deviations of the digestive system and gastrointestinal tract.
7. There are fistulas of the upper and lower small intestine. The former arise due to injuries or operations, often heal on their own with proper care, the latter are created by surgeons to remove feces in case of intestinal obstruction or peritonitis (fecal fistula).
8. Canals in the large intestine arise as a result of injuries, operations or are established artificially. Often heal on their own, but require special care - the use of protective ointments to avoid injury.

Diagnostic methods

To make an accurate diagnosis, the doctor gets acquainted with the patient's history, palpates the inflammatory focus, evaluates the amount and appearance of the secreted fluid, and asks the patient about complaints about violations of the functioning of internal organs. After that, the doctor directs the patient to further diagnostic measures:

• A blood and urine test, blood culture for the presence of pathogenic bacteria can indicate the presence of inflammation and its nature.
• CT (computed tomography), MRI (magnetic resonance imaging) are often used as a means of diagnosing fistulas.
• One of the most effective methods is radiography with the introduction of a contrast agent into the fistula cavity to determine the size, length, branching of the fistula.
• The probing method is considered no less effective; it is used only in cases of external fistulas, in which the outer edge comes to the surface of the skin.
• Studies of purulent fluid are used to determine the primary organ that gave rise to the pathological canal.
• During the operation to remove the fistula, specialists inject staining substances (for example, methyl blue) to assess the entire structure of the canal and accurately identify the original organ.
• Ultrasound is rarely used to diagnose fistulas, because this method is less informative.

Fistula treatment

In fact, a fistula is a tube with dead bacterial remnants, often its treatment consists in excising the canal, cleaning it chemically or mechanically and removing inflammation of the organ from which the fistula began. For example, when getting rid of the fistula of the rectum, the most effective method is surgery. Full recovery of the patient occurs in 20-30 days, at this time the patient is recommended to take therapeutic baths and refrain from physical activity in order to avoid injury to the sphincter.

Also, for the treatment of fistulas, local remedies are used (baths, ointments, powders, antiseptic solutions for washing, etc.). In some cases, the doctor prescribes antibiotics to eliminate bacterial infection, painkillers and antipyretics to improve the patient's condition. As drugs used for the treatment of fistulas, the following medicines are used:

Folk remedies

Treatment of simple fistulas with medicinal herbs is highly effective. In some cases, there is a complete recovery. Ointments, baths based on natural ingredients are used as medicines. Aloe and cabbage have the most effective therapeutic effect, the juice of these plants helps to remove pus from the fistula and quickly heal the wound. Before using all medicines, the patient should consult with a specialist.

Ointment

The following remedies are used as home ointments:

1. Vodka and olive oil are mixed in a ratio of 1: 1, the affected area is treated with the mixture several times a day, then a cabbage leaf is applied to remove pus. For maximum effect, the product is used for several weeks.

Decoctions

A few examples of tinctures and decoctions for the treatment of fistulas:

1. Equal amounts of aloe juice and mummy juice are mixed (after soaking it in water), a bandage soaked in the solution is applied to the sore spot for a long time.
2. 2 tablespoons of St. John's wort pour 2 cups of water, boil the mixture for 10 minutes, filter the resulting solution. The mixture is spread on a film and the sore spot is wrapped with such a compress, then the focus of inflammation is washed with the remaining solution. The agent is used until the channel begins to release exudate.
3. Prepare a tincture of dandelion flowers in triple cologne to cure external fistulas. The resulting liquid is instilled with a pipette directly into the fistula channel to achieve the maximum therapeutic effect.

Video

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Ointment for all occasions
Take in equal proportions pine resin, medical tar, butter, aloe leaf pulp, flower honey. Put this mixture in a water bath and heat there, stirring until the mixture becomes homogeneous. If it's too thick, thin with vodka.
This ointment helps to cure any non-healing fistulas, bone tuberculosis, abscesses. It is necessary to put it around the fistula, cover it with a sterile napkin, polyethylene and fix it with adhesive tape. (Newspaper "Bulletin of healthy lifestyle" 2003, No. 3, p. 25)

Alternative treatment of fistula with cabbage
The woman developed a fistula under her knee, for 2 months the doctors prescribed various ointments, but they did not help, her leg hurt. A neighbor suggested an unusual folk recipe: every day, tie a fresh cabbage leaf to the sore and walk with it 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, then the treatment was successful, everything will heal quickly. The woman began to make cabbage compresses, during the day the leaf dried out, became transparent. And after the 12th procedure, red dots around the fistula were found under the sheet. Everything went painlessly. After 3 days, there was no trace left of the fistula. (recipe from HLS 2002, No. 3, p. 18,)

Fistula in a newborn - treatment of aloe and mummy at home.
The umbilical fistula in a newborn child was cured by the following folk remedy.
Dilute the mummy with boiled water to the color of strong tea leaves. Mix mummy solution and aloe juice in equal proportions. 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 on honey at home.
A ligature fistula did not heal in a man for 4.5 years, he turned to the readers of the newspaper "Bulletin of Healthy Lifestyle" to advise him on folk remedies to cure the fistula. A lot of advice has come. But the following popular 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 pieces of aloe are completely covered. Infuse the mixture for 6 days, shaking daily. Then strain the mixture, discard the aloe leaves, and take the liquid in 1 tsp. 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 HLS 2004, No. 1, p. 27)

Alternative 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.
Having studied a lot of literature, we decided to treat the fistula with celandine. The man began to drink the infusion of this herb. Appetite returned immediately, health improved. He drank in courses: he drinks for a month, rests for a week. The fistula was delayed, the tumors do not grow. (recipe from HLS 2004, No. 12, p. 26)

External fistula - ointment from onion and calendula.
Finely chop 200 g of onion, pour 500 ml of hot rendered interior pork fat. Heat in skillet until onion is browned. Drain into a jar, wrap for 8 hours.
Pour 1 cup of calendula flowers with 500 ml of hot rendered interior pork fat. Keep at a temperature of 60 degrees for two days. Bandage the fistula with these ointments, alternating them. (2005, No. 11, pp. 18-19)

Bread and salt is a folk remedy for fistula.
The man had 2 fistulas in the wall of the abdominal cavity. For three weeks he tried to treat fistulas in the clinic, but to no avail. I decided to use folk remedies.
I pressed as much salt as possible into the crumb of black bread. He blinded the cake, smeared it with saliva on one side and attached it to the fistula with the same side. The second fistula was not touched for comparison. .Changed the cake every other day. On the fourth day, the fistula cleared and began to grow. Got rid of the other one the same way. Soon there were no traces left, only the skin was whiter at first. (review from HLS 2005, No. 11, p. 31)

Fistula on the coccyx - folk treatment mummy.
The woman repeatedly formed a fistula on the coccyx, her legs were taken away, it was impossible to sit. Several times they did the operation, but the fistula on the coccyx opened again. Then an elderly doctor gave a sick piece of mountain mumiyo the size of a match head - this was enough for a month's course - the woman made an aqueous solution of mumiyo and washed the fistula, made lotions. Three months later, she underwent another course of fistula treatment. Since then, this sore did not bother her. And now mumiyo can be bought without any problems at any pharmacy. (review from HLS 2005, No. 24, p. 26)

Fistula on the leg - home treatment with resin.
A man with the help of resin saved his toe from amputation. The finger was black, a fistula with an unpleasant odor appeared on it. He applied softened resin to a cloth and wrapped it around his finger. The fistula closed after 3 days. (review from HLS 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. In the hospital, his fistula was expanded, cleaned, and washed. And so several times, but there was no sense. So they discharged him with an unclosed fistula. Every day, by lunchtime, the temperature rose, the 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 to ask 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, prepared an ointment, adding more propolis. I soaked the bandage with ointment, wrapped it around a match, 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 did the same procedure again, the Match entered only 3/4. 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. All fall asleep in an enameled bowl and put on the weakest fire. Heat, stirring, until everything is dissolved. Immediately strain the hot mixture through 4 layers of cheesecloth. (review from HLS 2007, No. 19, p. 33)

Treatment of fistula folk remedies.
One of the most effective folk remedies for fistula is mummy. It should be taken once a day on an empty stomach for 28 days (1 course of treatment). In advanced cases, the second course is carried out after 10 days. Shilajit should be dissolved in 50 ml of water, and preferably milk. The daily dose of mummy 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.
A high-quality mummy dissolves in water without residue.
Simultaneously with ingestion, mummy is also used externally - lotions are made by dissolving 3 g of mummy in 100 ml of water.
On fistulas and any abscesses, it is useful to apply cakes from the powder of comfrey roots overnight. Comfrey stimulates the growth of healthy skin cells.
Rinse the fistulas with very hot salt water (1 teaspoon of salt to 1 cup of water).
Lubricate wounds with celandine juice 2-3 times a day
(review from HLS HLS 2008, No. 19, p. 32-33)

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

Cabbage leaf from postoperative fistula.
The woman underwent surgery, after which a fistula formed at the site of the suture. I turned to the surgeon, he said that I would have to live with a fistula. In the "Bulletin of Healthy Lifestyle" I read a recipe that a fistula can be treated with cabbage. The patient washed the cabbage leaf, slightly repulsed it until the juice appeared and applied it to the wound. After seven procedures, the fistula seemed to have disappeared, but the prescription said that it was necessary to apply 12 times. The woman continued her treatment. And after the eighth procedure, I saw threads knocked into a pile and sewn up inadvertently during the operation on the removed leaflet. After the threads came out, the fistula dragged on, everything fell into place. (2012, No. 9, p. 31)

The ligature fistula does not close - what to do.
After surgery to remove the hernia, a fistula formed. He has been worrying a woman for five years now: he is constantly festering, a seal the size of a chicken egg has formed. Surgeons believe that a new operation is needed. The patient turned to the "Bulletin of Healthy Lifestyle" with the question "How to avoid surgery?"
Responsible candidate med. Sciences. A. I. Vanin.
In a patient, a ligature fistula is a fistula caused by the presence of an infected suture ligature (thread), which is tied during surgery on a crossed vessel. Usually, the ligature fistula closes and overgrows after the discharge of festering threads. This did not happen to the patient. Therefore, she needs to do a fistulography - an X-ray examination of the fistula with contrast, to see if it is connected with the internal organs. Based on the results of the research, the doctor will prescribe the treatment of the fistula.
While it is necessary to wash the wound with a 1% dioxidine solution: inject the solution inside with a syringe without a needle and cover with a napkin soaked in the same solution. Fix with plaster. Do the procedure daily 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 that, take vitamins Complivit -1 once a day for a month.
From folk remedies - take 1 tsp. 3 times a day aloe honey syrup, the recipe of which is given above.
For washing the fistula, a decoction of calendula flowers is also suitable: 1 tbsp. l. for 1 cup of boiling water. Add a few drops of tea tree oil to warm tea. With the same decoction, make compresses on the wound 1-2 times a day for 5-10 days.
Take drugs and folk remedies to increase immunity. (HLS 2013, No. 12, p. 16)

A fistula after surgery is always a postoperative complication. The fistula occurs as a result of suppuration, infiltration of the scar. Consider the main causes of fistula, its manifestations, complications and methods of treatment.

What is a fistula

A ligature is a thread used to tie blood vessels during surgery. Some patients are surprised by the name of the disease: they think that the wound after the operation can whistle. In fact, the fistula occurs due to suppuration of the thread. A ligature suture is always necessary; without it, wound healing and stopping bleeding, which always occurs as a result of surgical intervention, cannot occur. Without a surgical thread, it is impossible to achieve wound healing.

Ligature fistula is the most common complication after surgery. Looks like a normal wound. It refers to the inflammatory process that develops at the site of the seam. An obligatory factor in the development of a fistula is suppuration of the suture as a result of contamination of the thread by pathogenic bacteria. A granuloma appears around such a place, that is, a seal. As part of the compaction, the festering thread itself, damaged cells, macrophages, fibroblasts, fibrous fragments, plasma cells, collagen fibers are found. The progressive development of suppuration eventually leads to the development of an abscess.

Reasons for the formation

As already mentioned, it is the festering suture that contributes to the progression of the purulent process. A fistula always forms where there is a surgical thread. As a rule, the recognition of such a disease is not difficult.

Often fistulas result from the use of silk thread. The main reason for this phenomenon is the infection of the thread with bacteria. Sometimes it is not large and passes quickly. Sometimes a fistula occurs a few months after the intervention. In rare cases, the fistula appeared even after years. Most often they occur after operations on the abdominal organs. If a fistula occurs at the site of the surgical wound, this indicates that an inflammatory process is taking place in the body.

If during the operation a foreign body enters the body, it causes infection of the wound. The reason for this inflammation is a violation of the processes of removing purulent contents from the fistulous canal due to a large amount of fluid. If an infection gets into an open wound, this can be an additional danger, as it contributes to the formation of a fistula.

When a foreign body enters the human body, the immune system begins to weaken. Thus, the body resists viruses longer. Prolonged presence of a foreign body causes suppuration and subsequent release of pus from the postoperative cavity to the outside. Infection of the ligature thread often contributes to the formation of a large amount of pus in the postoperative cavity.

Main symptoms

The fistula at the seam has such pronounced symptoms:

Diagnosis and treatment

The correct diagnosis can be made by the surgeon only after a complete diagnosis. It includes such measures:

1. Primary medical examination. During such actions, the fistula canal is assessed, the granulomatous formation is palpated.
2. Study of patient complaints. There is a careful study of the medical history.
3. Sounding the channel (to assess its size and depth).
4. Examination of the fistula channel using X-ray, ultrasound, dyes.

All patients should remember that the treatment of fistula with folk remedies is strictly prohibited. It is not only useless, but also life-threatening. Treatment of the disease takes place only in the condition of the clinic. Before treating a fistula, the doctor conducts a detailed diagnostic examination. It helps to establish the extent of the fistulous lesion and its causes. The main principles of therapy are the removal of a festering ligature. It is necessary to take a course of anti-inflammatory drugs and antibiotics.

It is necessary to strengthen the immune system. A strong immune system is the key to a cure for many pathologies. Elimination of formation is impossible without regular sanitation of the cavity. A solution of furacillin or hydrogen peroxide is used as a washing liquid, they remove pus and disinfect the edges of the wound. An antibacterial agent should be administered only according to the testimony of a doctor.

In case of ineffective treatment of the fistula, surgery is indicated. It consists in removing ligatures, scraping, cauterization. The most gentle way to remove festering ligatures is under the influence of ultrasound. With timely and high-quality treatment, the likelihood of complications of a fistula is minimal. The occurrence of inflammatory reactions in other tissues of the human body is minimal.

Postoperative fistula in some cases can be created artificially. So, for example, it can be created for artificial feeding or excretion of feces.

How to get rid of a fistula?

You don't have to wait for healing to happen. Lack of treatment can provoke an increase in suppuration and its spread throughout the body. The doctor can use the following techniques and steps to remove the fistula:

• dissection of tissue in the affected area to remove pus;
• excision of the fistula, cleaning the wound of pus and its subsequent washing;
• removal of suture material blindly (if possible);
• if it is impossible to remove the suture material blindly, the doctor makes a second attempt (further dissection of the zone is carried out last, since this measure can provoke further infection);
• the ligature can be removed using special tools (this is done through the fistula canal without additional dissection, which reduces the risk of further secondary infection);
• surgical treatment of the wound is performed (in case of unsuccessful removal of the fistulous canal, the wound is treated with an antiseptic).

If the patient has strong immunity, then the fistula can heal quickly, and inflammatory complications are not observed. It can self-destruct in very rare cases. Only with an inflammatory process of a slight degree of intensity, the patient is prescribed conservative treatment. Surgical removal of the fistula is indicated when a large number of fistulas appear, and also if the outflow of pus is very intense.

Remember that a healing antiseptic only temporarily stops inflammation. To permanently cure the fistula, you need to remove the ligature. If the fistula is not removed in time, this leads to a chronic course of the pathological process.

Why are bronchial fistulas dangerous?

Bronchial fistula is a pathological condition of the bronchial tree, in which it communicates with the external environment, the pleura or internal organs. They occur in the postoperative period as a result of the insolvency of the bronchus stump, necrosis. This type of bronchial fistula is a frequent consequence of pneumoectomy due to lung cancer and other resections.

Common symptoms of bronchial fistula are:

If water gets into such a hole, then a person has a sharp paroxysmal cough and suffocation. Removal of the pressure bandage provokes the appearance of the above symptoms, including loss of voice. Dry barking cough - sometimes a small amount of viscous sputum can be coughed up.

If the fistula develops against the background of purulent inflammation of the pleura, then other symptoms come first: secretion of mucus with pus, with an unpleasant fetid odor, pronounced suffocation. Air is released from the drain. Possible development of subcutaneous emphysema. As complications, the patient may have hemoptysis, bleeding from the lung, aspiration

The connection of the bronchus with other organs causes the following symptoms:

• coughing up food or stomach contents;
• cough;
• asphyxia.

The danger of bronchial fistulas refers to a high risk of complications, including pneumonia, blood poisoning, internal bleeding, and amyloidosis.

Urogenital and intestinal fistulas

Genitourinary fistula appears as a complication of operations on the genitals. Most often, messages are formed between the urethra and the vagina, the vagina and the bladder.

Symptoms of urogenital fistulas are very bright, and it is unlikely that a woman will be able not to detect them. With the development of the disease, urine is excreted from the genital tract. Moreover, urine can be excreted both immediately after urination, and all the time through the vagina. In the latter case, a person does not have voluntary urination. If a unilateral fistula is formed, then women most often have urinary incontinence, while arbitrary urination persists.

Patients feel severe discomfort in the genital area. During active movements, such discomfort increases even more. Sexual intercourse becomes almost completely impossible. Due to the fact that urine is constantly and uncontrollably excreted from the vagina, a persistent and unpleasant odor comes from patients.

Postoperative fistulas of the rectum are also possible. The patient is concerned about the presence of a wound in the anus and the release of pus, sanious fluid from it. When the outlet is blocked with pus, a significant increase in the inflammatory process occurs. During the increase in inflammation, patients complain of severe pain, sometimes making it difficult to move.

The fistula seriously worsens the general condition of the patient. Prolonged inflammation disrupts sleep, appetite, a person's performance decreases, and weight decreases. Due to inflammation, deformation of the anus can occur. The long course of the pathological process can contribute to the transition of the fistula into a malignant tumor - cancer.

Disease prevention

Preventing the development of a fistula does not depend on the patient, but on the doctor who performed the operation. The most important preventive measure is the strict observance of the rules of disinfection during the operation. The material must be sterile. Before suturing, the wound is always washed with an aseptic solution.