Rejection of suture material after surgery. Seroma of a postoperative suture - what is it, causes of occurrence and features of treatment. What types of surgical intervention provoke the development of a ligature fistula

Hello Sergey.

Those "two holes" that have formed in your postoperative suture are nothing more than fistulas, which indicate the development of an inflammatory process in the human body after the operation. Fistulas can appear immediately after the placement of postoperative sutures, and can appear many years after surgery.

Infection and inflammation after surgery can occur for many reasons. If you say that pus is released from there, then the infection took place unambiguously.

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 inner cavity... This often happens if, during the operation, a foreign body enters the body, which then begins to be rejected by the body, the patient behaved incorrectly after the operation, or the infection got into open wound... Infection can have a profound effect on a person's immune system, and over time protective functions the body gradually weaken, and 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 sutures. If the stitches were removed for you, then you have formed precisely ligature fistulas (since there are two holes). Ligature fistulas appear due to violations of the rules for antiseptic treatment of postoperative sutures and wounds after removing surgical sutures.

Discharge of pus from the holes indicates that there is an infection in the wound. Also, when removing the threads, doctors could leave a 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 seam was just being applied. Lack of treatment in this case leads not only to serious inflammatory processes, but also to complete or partial dehiscence of the seams.

Postoperative fistula treatment methods

If a patient with a fistula has a sufficiently strong organism and strong immunity, then the therapy passes quickly, and the recovery period is slightly delayed. If inflammation is observed at the seam site, then the treatment of ligature fistulas will most likely be carried out surgical methods.

It is imperative that a diagnosis be carried out for the presence in the wound foreign body... Today they use modern technologies giving fast and truthful results. If the doctors' suspicions about the foreign object are confirmed, then the fistulas will be opened, and through a special channel they will withdraw and foreign object, and purulent masses.

Further treatment can be medication, but this, as mentioned earlier, depends on the person's immunity, the specificity of infection and inflammation of the seam, as well as the vital activity of pathogenic microorganisms. Sometimes, after the performed manipulations, the fistula eliminates 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 to the work of the whole body.

Methods of conservative therapy are used if there are few fistulas, and the amount of pus released does not exceed the permissible values. Gradually remove dead tissue and remove pus, carrying out regular antiseptic measures to treat problem areas. In parallel, the patient takes antibacterial drugs and those whose action is aimed at strengthening the immune system.
Surgical therapy is prescribed for 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 indispensable. The operation is excision of the fistulous canal, cauterization of the affected tissues or their removal. Sometimes the postoperative suture is removed together with the fistulas - this is a complex and voluminous 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.

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

Sutures are natural and synthetic, absorbable and non-absorbable. A pronounced inflammatory process at the suture site can lead to the release of pus from the incision.

The outflow of serous fluid, thickening and swelling of tissues speaks of such a pathological phenomenon as a ligature fistula of a postoperative scar.

Why does a ligature fistula appear after the operation?

A ligature is a thread used to ligate blood vessels. By suturing, doctors seek to stop bleeding and prevent its occurrence in the future. A ligature fistula is an inflammatory process at the site of wound stitching.

It develops due to the use of material contaminated with pathogens. The pathological element is surrounded by a granuloma - a seal 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 suture material... The development of an unfavorable process is provoked by a variety of factors:

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

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

Symptoms of a ligature fistula

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

In the first days after the operation, the area becomes denser, swells, and causes pain when palpating. The skin surrounding the wound turns red, the local temperature rises.
A week later, when pressing on the seam, serous fluid and pus are released.
The body temperature rises to 37.5 - 39 ° C.
The behavior of the fistula is unpredictable - the course can spontaneously close and later reopen.

Only a second operation helps to get rid of the canal completely. What a ligature fistula looks like can be seen in the photo.

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

A fistula is a hollow channel inside the body, a kind of link between organs and external environment... It can also be the junction of 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. It is characterized by the presence of two outputs. This structure promotes rapid healing.
Incomplete. The fistula has one outlet inside abdominal cavity... In such conditions, the pathogenic flora multiplies rapidly and intensifies the inflammatory process.
Tubular. A properly designed canal secretes purulent, mucous and fecal masses.
Lip-shaped. The fistula grows together with muscle and dermal tissue. It is removed only with the help of an operation.
Granulating. The fistula is overgrown with granulation tissue, the surface of the surrounding skin looks hyperemic and edematous.

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

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

Diagnosis and treatment of ligature fistula on the scar

Ligature fistula is diagnosed during examination postoperative wound... For full research the patient's suspicious area is referred for ultrasound and fistulography. This is a kind of X-ray using contrast agent... The picture shows the location of the fistulous canal.

Treatment of a ligature fistula involves an integrated approach. Patients are prescribed different groups of funds:

Chymotrypsin and trypsin enzymes.
Antiseptics for local treatment.
ShSD antibiotics - Norfloxacin, Ampicillin, Ceftriaxone, Levofloxacin.
Water-soluble ointments - Levomekol, Levosin, Trimistin.
Fine powders - Baneocin, Gentaksan, Tyrozur.

Enzymes and antiseptics are injected into the fistulous canal and surrounding tissues. Substances act within 3 - 4 hours, therefore, the problem area is treated several times a day. With an abundant outflow of purulent masses, it is forbidden to use Vishnevsky liniment and synthomycin ointment. They block the canal and delay the outflow of pus.

In order to relieve inflammation, the patient is sent to physiotherapy procedures. Quartzization of the wound and UHF therapy improve microcirculation of blood and lymph, reduce swelling and neutralize pathogenic flora. The procedures provide lasting remission, but do not promote complete recovery.

Complications of ligature fistula: abscess, phlegmon, sepsis, toxic-resorptive fever and eventration - organ prolapse due to purulent tissue fusion.

Non-closure ligature fistula is treated by surgical treatment complicated postoperative wounds. The site is disinfected, anesthetized and dissected for complete removal suture material. The cause of the formation of the fistula is also cut out together with the adjacent tissues.

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

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

Each operation is a serious risk to the body. Currently, doctors are trying to carry out most of the surgical interventions with minimal stitching on the wound area. However, even with careful observance of all the rules for caring for the operating area, complications such as ligature fistulas may occur. According to statistics, every tenth patient of working age and every fifth pensioner faces them. That is why it is necessary to know the first symptoms of the onset of the disease, as well as pay great attention to the rules of prevention. So you can protect yourself and your loved ones from the development of such a complication.

What is a ligature fistula

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

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

How long after the operation does the disease appear?

A ligature fistula can develop in the early postoperative period (in the first seven to ten days after surgery). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then these are the consequences of defects in care and dressing.

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

A similar pathology can occur against the background of the following operations:

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

Photo gallery: location of sutures after various operations

Caesarean section is one of the hardest operations in which a large incision is usually made
With mammoplasty, a ligature fistula under the breast is often formed. After surgery to remove the appendix, the suture is located to the right of the midline

What is ligature infiltrate and ligature granuloma

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

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

Reasons for the appearance of a ligature fistula

A similar pathology develops after bacterial microorganisms enter the wound. Most often it is staphylococcus, streptococcus or Pseudomonas aeruginosa. However, the following factors from the body and are also involved in the formation of a ligature fistula environment:

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

How does the formation of such a pathology manifest

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

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

After a few days, hemorrhages of the type of large and small bruises appear in the area of damage. Along with this, the nature of the discharge from the wound changes: from yellowish, colorless or bloody it becomes purulent. At the same time, the color changes to green, as well as an unpleasant odor, which is provided by existing bacteria. Patients complain of severe pain and an increase in the amount of discharge when pressed. The skin near the affected area acquires a dense edema, becomes hot and tense, the stitches can erupt and injure the surrounding tissue.

The chronic and asymptomatic course of such a pathology is quite rare. Most often it occurs in elderly people, which is associated with a violation of the rate of metabolic processes in the body.

With further progression, the wound becomes purulent.

With more severe course ailment, symptoms of general intoxication gradually increase:

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

In some cases, the purulent canal ruptures and the wound is independently cleared. So you can see the formed passage - the fistula. At the last stage, the formation of such an ailment can be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and needs immediate resuscitation.

Methods for diagnosing the disease

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

What methods of treatment help get rid of the disease

Ligature fistula is a pathology that is prone to frequent recurrence. That is why therapy lasts an extremely long time and requires a responsible attitude not only from the doctor, but also from the patient himself. At the initial stage, doctors prescribe local drugs to external processing wounds. In this case, the patient needs to appear every two days for dressings or at least once a week to show the suture to the attending physician (when it is not possible to constantly travel to the hospital). If pathological process continues to progress, more drugs are prescribed general action that affect the state of the whole organism. Surgical intervention is carried out in the absence of positive dynamics from conservative treatment for one and a half to two weeks.

Do not forget that there is also a risk of a ligature fistula with a second operation. It is necessary to care for the wound according to the same principles as in the primary surgical intervention.

Drug therapy of pathology

Ligature fistula treatment conservative means is to use pharmaceuticals local and general impact. They allow not only to get rid of the symptoms of the disease, but also to completely eliminate the cause that triggered the development of the disease.

Remember that without a doctor's prescription, the use of any medication is strictly prohibited. In my practice, I have come across a patient who independently began to take antibacterial agents without reading the contents of the instructions. He also suffered from cardiovascular disease, at which there is a rather limited list of medicines allowed for use. In an effort to recover faster, the patient also exceeded the dosage of the antibacterial drug many times. This led to the development of serious complications: the man fell into a coma, from which the doctors had to take him out. intensive care unit... The situation ended well, but the victim acquired a deep disability as a result of his experiments. That is why doctors are advised to be very careful in the choice of drugs.

Means for local treatment of ligature fistula:

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

Photo gallery: preparations for local wound treatment

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

Medicines for general therapy:

Antibiotics have a pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, they use: Claforan, Tetracycline, Vibramycin, Keyten, Augmentin, Unazin, Azlocillin, Zinnat, Aztreonam, Imipenem, Vankocin, Rondomycin.
Steroid anti-inflammatory drugs are hormones that can reduce the effect of bacterial toxins on the body, relieve redness and swelling of soft tissues. The use of Hydrocortisone, Cortef, Latikort, Deksona is acceptable.
Vitamin and mineral complexes accelerate healing processes and restore the body's need for certain substances. Most often used: Complivit, Calcium D3-Nycomed, Aevit, Vitrum, Supradin.

Photo gallery: drugs for systemic effects on the body

Augmentin is a broad spectrum antibiotic that kills bacteria Cortef helps relieve inflammation Vitrum contains everything necessary for the body mineral elements

Surgical treatment of ligature fistula

Conservative therapy is not always effective methodology with a similar disease. If the disease progresses steadily, doctors decide on the need for repeated surgery. It is carried out under the following conditions:

accession purulent complications;
a sharp deterioration in the patient's condition;
lack of effect from conservative therapy;
eruption of suture material.

Contraindications to surgery:

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

Tissue excision is necessary to prevent re-development fistula

The operation is carried out in several stages:

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

How to properly care for a place of suppuration

To avoid the addition of a secondary infection and protect your body from the development of purulent complications, you need to monitor the cleanliness of the wound. The first few days after the operation, the dressing and suture processing is engaged nurse under the supervision of a doctor. But in some cases, the patient has to independently take care of the surgical wound from the very beginning. That is why it is necessary to observe the following processing steps:

Wash your hands with soap and water, then dry them with a paper towel (this will help minimize bacteria). Disinfect your palms and fingers with an antiseptic.
Apply water and cotton pads to the skin around the wound. Alcohol-free gels can be used. If necessary, also wipe the skin with an antiseptic without touching the seams.
Remove the bandage carefully. It is necessary to do this with soft and unsharp movements, as jerking can damage the surrounding tissue. If soaking with blood and blood has occurred, soaking the dressing in an antiseptic or in plain water is allowed.
Use a small gauze swab to evenly coat the seam surface. Try to remove dirt and dried blood. Continue flushing until the wound is clear.
Apply a bandage with the ointment prescribed by your doctor and gently wrap it with an elastic bandage. At the same time, try not to overtighten the soft tissues.

Be extremely careful: some actions can cause deterioration of the seam.

What is strictly forbidden to do during the rehabilitation period:

Visit baths or saunas, swim in hot tub... The steam softens the tissue around the suture, causing the threads to cut through and form an even deeper fistula. For the same reason, you should not apply a heating pad to the affected area.
Swim in public ponds, rivers and quarries. This water does not undergo special treatment and is the source of many harmful bacteria that penetrate even through the applied dressing. Swimming in pools is limited due to the presence of bleach, which disrupts the healing process of soft tissues.
Use alcohol-containing solutions to treat wounds without a medical prescription. Such drugs not only kill bacteria, but also damage smallest vessels causing bleeding. That is why their use is strictly limited.

Video: method of dressing and wound treatment

Features of ligature fistula therapy after various types of operations

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

According to statistics, every third birth ends with the suturing of the damaged perineum.

A feature of the therapy of such a condition is the impossibility of using many familiar medications, as they pass into breast milk and can be passed on to a newborn baby, negatively affecting the state of his body. That is why doctors predominantly use local therapy: the seam should be treated several times a day with an antiseptic solution, and the woman also needs to keep the surrounding tissues clean. Topical preparations do not penetrate into breast milk and do not affect the condition of the child. If the pathological process progresses, doctors prescribe antibiotics that have minimal effect on the newborn: Amoxicillin, Erythromycin, Cefatoxim.

Treatment projections and possible complications of such a pathology

The healing of soft tissues is a long and not always predictable process that can face a number of really serious complications. The duration of the recovery period largely depends on the patient's age and state of health. In children and young people, the ligature fistula heals within two weeks to three months, while in the elderly population this period can last up to six months. Patients with diabetes mellitus, hypertension, cardiovascular diseases have a lower rate of healing of soft tissues, as a result of which they have a significantly increased risk of developing secondary complications.

Important in the treatment of a ligature fistula is strict adherence to hygiene and the rules for processing postoperative wounds. While working in the department of purulent surgery, I happened to encounter a man who developed a serious complication in the form of the attachment of bacterial microorganisms to the area of the postoperative incision. As it turned out, the victim did not clean his hands before changing the bandage, and also periodically covered it with a rough plaster. When it was separated from the skin, tissues were constantly traumatized, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly eased his condition.

What complications can occur in patients with ligature fistula:

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

Photo gallery: possible complications of the disease

The phlegmon of the leg can be located very deep and not give other symptoms other than edema. An abscess is a purulent mass with a capsule A scar is an overgrowth of connective tissue

How to prevent the development of a ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection penetration into operating wound still remains unresolved. In order to prevent this pathological condition in the early years, recommendations for individual and group prevention are developed annually. Within the framework of the latter, practicing professors of medical universities organize lectures and open seminars dedicated to the period of rehabilitation of patients after surgery. There anyone can get information not only about care, but also about restorative procedures.

While studying at the Department of Traumatology, I had the opportunity to participate in an event dedicated to the problem of the occurrence of a ligature fistula in the early and late postoperative period. To get the most detailed information, doctors presented illustrative cases from their practice: a selection of patients aged between twenty and eighty years old who were not fortunate enough to face a similar ailment. In the course of the study, all victims were asked to fill out questionnaires containing questions related to lifestyle, diet and hygiene measures for wound treatment. As it turned out after analyzing the data obtained, about 20% of patients continued to abuse alcohol and did not follow the rules of food preparation, 5% missed taking the necessary pills, and 40% performed dressings at home, which increased the risk of infection from the environment. The doctors came to the conclusion that the overwhelming majority of patients had violated the rules of the recovery period: this influenced the formation postoperative fistula... Based on the data obtained, we have developed universal recommendations for the prevention of the development of such an ailment, the use of which helps to reduce the risk of its occurrence several times.

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

Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for allergic reaction into suture components. This can be done in the same hospital where the operation will be performed. To do this, ask the surgeon for samples of the alleged threads and take them to the allergy laboratory. There, the doctor, with the help of cutaneous or intradermal tests, will reveal the presence of a pathological reaction. In case of redness, swelling and swelling of the skin, it is better to refuse the use of this type of material. Currently there is great amount suture threads: one of them will definitely suit you.
Application test detects allergen
Try to avoid stress and mental shock. During the recovery period of the body after surgery, even a slight anxiety can worsen the condition. Proven to be in times of tension and stress internal glands humans secrete hormones that slow down the processes of rehabilitation and tissue healing.
Maintain your hygiene. Majority opportunistic bacteria live on the skin even in healthy person... Under normal conditions, with undisturbed tissue integrity, they cannot enter the bloodstream and cause infectious process... But in the postoperative period, the body becomes especially vulnerable, and the wound is the entrance gate for bacteria. That is why it is so important to keep an eye on the cleanliness of the surrounding tissues. It is recommended to wear loose clothing made from natural materials that will not cover the incision site or injure it in any way. In the morning and in the evening it is necessary with the help of water and detergents process the skin without touching the bandage.
Antiseptic gel removes germs from the surface of the skin
Give up physical activity. Prolonged lifting and carrying heavy loads or exercising in the gym can cause suture material to erupt in soft tissue, causing the wound to spread apart. This will not only increase the risk of developing an infection, but may also be the reason for reoperation. That is why doctors prohibit playing sports and lifting loads of more than one kilogram for several months after surgery. Once a stable scar is formed, you can go back to unrestricted training again.
In the period before and after surgery, try to adhere to proper nutrition... Popular vegetarian and vegan diets with complete absence animal protein reduce the rate of healing of soft tissues and lengthen the recovery processes. During the rehabilitation period, the body needs to receive large quantities of fats and carbohydrates, and the caloric content of the diet should not be less than 2500-2700 units. Doctors recommend giving up food fast food, fast food, carbonated drinks and packaged juices, as well as from sweets. These foods slow down the body's metabolism and may have a negative effect on wound healing. Give preference to vegetables, fruits, berries, lean meat and fish, as well as cereals and cereals. You can restore the amount of protein and calcium in the body with the help of dairy products and special vitamin and mineral complexes.
Dairy products are necessary for the nutrition of patients in the postoperative period

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, do not once again worry and worry: modern delivery system medical care long ago foresaw the occurrence of such a situation. When the first signs of the development of an illness appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to pinpoint the cause of the ligature fistula and suggest effective ways dealing with such a problem.

Any surgical intervention is a big test for the patient's body. This is due to the fact that all his organs and systems are experiencing increased load, it does not matter whether the operation is small or large. Especially "gets" the skin, blood and, if the operation is performed under anesthesia, then the heart. Sometimes, after, it would seem, everything is behind, a person is diagnosed with a postoperative suture seroma. What it is, most patients do not know, so many are afraid of unfamiliar terms. In fact, seroma is not as dangerous as, for example, sepsis, although it also does not bring anything good with it. Consider how it turns out, why it is dangerous and how it should be treated.

What is it - postoperative suture seroma

We all know that many surgeons in the operating room perform "miracles", literally returning a person from the other world. But, unfortunately, not all doctors faithfully carry out their actions during the operation. There are times when they forget cotton swabs in the patient's body, do not completely ensure sterility. As a result, in the operated person, the seam becomes inflamed, begins to fester or diverge.

However, there are situations where suture problems have nothing to do with the negligence of doctors. That is, even if 100% sterility is observed during the operation, the patient suddenly accumulates a liquid in the area of the incision that looks like an ichor or pus of a not very thick consistency. In such cases, they talk about the seroma of the postoperative suture. What it is, in a nutshell, we can say this: this is the formation in the subcutaneous tissue of a cavity in which serous effusion accumulates. Its consistency can vary from liquid to viscous, the color is usually straw-yellow, sometimes supplemented with blood streaks.

At-risk groups

Theoretically, a seroma can occur after any violation of the integrity of the lymph vessels, which do not "know how" to rapidly thrombose, as blood vessels do. While they are healing, lymph flows along them for some time, flowing from the places of ruptures into the formed cavity. By classification system ICD 10 seroma of the postoperative suture does not have a separate code. It is put down depending on the type of operation performed and on the cause that influenced the development of this complication. In practice, it most often happens after such cardinal surgical interventions:

abdominal plastic;
cesarean section (for this seroma of the postoperative suture, the ICD code 10 "O 86.0", which means suppuration of the postoperative wound and / or infiltration in its area);
mastectomy.

As you can see, the risk group is mainly women, and those of them who have solid subcutaneous body fat... Why is that? Because these deposits, when their integral structure is damaged, tend to exfoliate from the muscle layer. As a result, subcutaneous cavities are formed, in which fluid begins to collect from the lymph vessels ruptured during the operation.

Also at risk are such patients:

suffering from diabetes mellitus;
aged people (especially overweight);
hypertensive patients.

Causes

To better understand what it is - a postoperative suture seroma, you need to know why it is formed. The main reasons do not depend on the competence of the surgeon, but are the result of the body's response to surgery. These reasons are:

Body fat. This has already been mentioned, but we add that too obese people, whose body fat is 50 mm or more, seroma appears in almost 100% of cases. Therefore, doctors, if the patient has time, recommend liposuction before the main operation.
Large area of the wound surface. In such cases, too many lymph vessels are damaged, which, accordingly, secrete a lot of fluid, and take longer to heal.

Increased tissue trauma

It was mentioned above that the seroma of the postoperative suture depends little on the conscientiousness of the surgeon. But this complication directly depends on the skills of the surgeon and on the quality of his surgical instruments... The reason a seroma can occur is very simple: the work with the tissues was too traumatic.

What does it mean? An experienced surgeon, performing an operation, works with damaged tissues delicately, does not squeeze them unnecessarily with tweezers or clamps, is missing, does not twist, the incision is made quickly, in one precise movement. Of course, such jewelry work largely depends on the quality of the instrument. An inexperienced surgeon can create a so-called vinaigrette effect on the wound surface, which unnecessarily injures the tissue. In such cases, the seroma of the postoperative suture code ICD 10 can be assigned as follows: "T 80". This means "complication of surgical intervention not noted in other headings of the classification system."

Excessive electrocoagulation

This is another reason that causes the gray suture after surgery and to some extent depends on the competence of the doctor. What is coagulation in medical practice? This is a surgical intervention not with a classic scalpel, but with a special coagulator that produces an electric current. high frequency... In fact, this is a targeted cauterization of blood vessels and / or cells with current. Coagulation is most often used in cosmetology. In surgery, she has also proven herself excellent. But if a medic without experience performs it, he may incorrectly calculate the required current strength or burn excess tissue with it. In this case, they undergo necrosis, and adjacent tissues become inflamed with the formation of exudate. In these cases, the seroma of the postoperative suture in the ICD 10 is also assigned the code "T 80", but in practice, such complications are recorded very rarely.

Clinical manifestations of small suture seroma

If the surgical intervention was on a small area of the skin, and the suture turned out to be small (accordingly, the traumatic manipulations of the doctor affected a small amount of tissue), the seroma, as a rule, does not manifest itself in any way. In medical practice, there are cases when patients did not even suspect about it, but such an education was found with instrumental research... Only in isolated cases does a small seroma cause insignificant painful sensations.

How to treat it and should it be done? The decision is made by the attending physician. If he sees fit, he can prescribe anti-inflammatory and pain relieving medications. Also, for a faster, the doctor may prescribe a number of physiotherapy procedures.

Clinical manifestations of seroma of large sutures

If the surgical intervention has affected a large volume of the patient's tissue or the suture is too large (the wound surface is extensive), in patients the appearance of a seroma is accompanied by a number of unpleasant sensations:

redness of the skin in the seam area;
pulling pain, aggravated in the "standing" position;
during operations in abdominal area lower abdominal pain;
swelling, bulging of a part of the abdomen;
temperature increase.

In addition, suppuration of both large and small seroma of the incision may occur. Treatment in such cases is very serious, up to surgical intervention.

Diagnostics

We have already figured out why a postoperative suture seroma can occur and what it is. Methods for treating seroma, which we will consider below, largely depend on the stage of its development. In order not to start the process, this complication must be detected in time, which is especially important if it does not declare itself in any way. Diagnostics is carried out by the following methods:

Examination by the attending physician. After the operation, the doctor is obliged to examine his patient's wound daily. If undesirable skin reactions are detected (redness, swelling, suture suppuration), palpation is performed. If there is a seroma, the doctor should feel a fluctuation under his fingers (overflow of a liquid substrate).

Ultrasound. This analysis perfectly shows whether or not there is accumulation of fluid in the seam area.

In rare cases, a puncture is taken from the seroma to clarify the qualitative composition of the exudate and decide on further actions.

Conservative treatment

This type of therapy is most commonly practiced. In this case, patients are assigned:

antibiotics (to prevent possible further suppuration);
anti-inflammatory drugs (they relieve inflammation of the skin around the seam and reduce the amount of fluid released into the resulting subcutaneous cavity).

More often, non-steroidal drugs are prescribed, such as Naproxen, Ketoprofen, Meloxicam.

In some cases, the doctor may prescribe steroid anti-inflammatory drugs, such as Kenalog, Diprospan, which block inflammation as much as possible and accelerate healing.

Surgery

According to indications, including the size of the seroma and the nature of its manifestation, it can be assigned surgery... It includes:

1. Punctures. In this case, the doctor removes the contents of the resulting cavity with a syringe. Positive sides such manipulations are as follows:

can be performed on an outpatient basis;
painlessness of the procedure.

The disadvantage is that the puncture will have to be done more than once, and not even twice, but up to 7 times. In some cases, it is necessary to perform up to 15 punctures before the tissue structure is restored.

2. Installation of drainage. This method is used for seromas that are too large in area. When setting the drainage, antibiotics are prescribed in parallel to the patients.

Folk remedies

It is important to know that no matter what the reasons for the seroma of the postoperative suture, treatment with folk remedies for this complication is not carried out.

But at home, you can perform a number of actions that contribute to the healing of the suture and are the prevention of suppuration. These include:

lubrication of the seam with antiseptic alcohol-free agents ("Fukortsin", "Betadine");
the imposition of ointments ("Levosin", "Vulnuzan", "Kontraktubeks" and others);
inclusion of vitamins in the diet.

If suppuration appears in the seam area, it is necessary to treat it with antiseptic and alcohol-containing agents, for example, iodine. In addition, antibiotics and anti-inflammatory drugs are prescribed in these cases.

Traditional medicine recommends making compresses with alcohol tincture larkspur. Only the roots of this herb are suitable for its preparation. They are well washed from the ground, crushed in a meat grinder, put in a jar and poured with vodka. The tincture is ready to use in 15 days. For a compress, you need to dilute it with water 1: 1 so that the skin does not burn.

There are many folk remedies for wound healing and surgery. Among them are sea buckthorn oil, rosehip oil, mummy, beeswax melted together with olive oil. These funds must be applied to gauze and applied to the scar or suture.

Seroma of the postoperative suture after cesarean

Complications in women who were assisted by caesarean section are common. One of the reasons for this phenomenon is the body of a woman in labor, weakened by pregnancy, unable to provide rapid regeneration of damaged tissues. In addition to seroma, a ligature fistula or keloid scar may occur, and in the worst case, suture suppuration or sepsis. Seroma in women in labor after cesarean section is characterized by the fact that a small dense ball with exudate (lymph) inside appears on the seam. The reason for this is damaged vessels at the site of the incision. As a rule, she does not cause concern. Seroma of the postoperative suture after cesarean treatment does not require.

The only thing a woman can do at home is to treat the scar with rosehip or sea buckthorn oil for its early healing.

Complications

The seroma of the postoperative suture does not always and not all go away on its own. In many cases, without a course of therapy, it is capable of festering. This complication can be provoked chronic diseases(for example, tonsillitis or sinusitis), in which pathogenic microorganisms penetrate the lymph vessels through the lymph vessels into the cavity formed after the operation. And the liquid that collects there is an ideal substrate for their reproduction.

One more unpleasant consequence seroma, which was not paid attention to, consists in the fact that it does not fuse with muscle tissues, that is, the cavity is constantly present. This leads to abnormal skin mobility and tissue deformation. In such cases, it is necessary to apply repeated surgical intervention.

Prevention

By the medical staff preventive measures consist in strict adherence to the surgical rules for the operation. Doctors try to sparingly perform electrocoagulation, to injure tissues less.

On the part of patients, preventive measures should be as follows:

Do not agree to surgery (if there is no urgent need for this) until the thickness of the subcutaneous fatty tissue reaches 50 mm or more. This means that you first need to do liposuction, and after 3 months, carry out the operation.
Wear high-quality compression hosiery after surgery.
Exclude physical activity for at least 3 weeks after the operation.

How is a postoperative fistula treated? We will introduce you to the most effective methods treatment of ligature fistulas, and also tell you why they appear.

Any, even the simplest, surgical intervention in the human body, as a rule, requires a lot of time to heal wounds. Absolutely all operations end with sutures, 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 of this indicates that the person began to rather serious complication 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?

A fistula 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, the fistula can connect the internal cavity with a benign or malignant formation... As a rule, this tube is lined with epithelium and is a channel through which pus that has formed inside the body after surgery is released.

Outwardly, it looks like an ordinary deep wound, around which the skin is inflamed. A fistula can appear on almost any part of the body, and not necessarily in the place where the incision was. There are times when the inflammatory process long time happens inside the body and a person learns that something is wrong with him only when a characteristic hole appears on his body, secreting 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 struck the internal organs, then feces, urine and bile can be released from the formed canal

Fistula in the coccyx area

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

Full. Has two outputs at once, which contributes to a faster removal of the inflammatory process and healing
Incomplete. Has only one outlet, which is usually located inside the abdominal cavity. This contributes to the intensive reproduction of pathogenic microflora and intensification of inflammatory processes.
Lip-shaped. In this case, the fistula grows together with dermatological integuments and muscle tissue. It can only be removed surgically.
Granulating. This type of fistula is characterized by the formation of granulation tissue, hyperemia and rather severe edema.
Tubular. Fully formed duct that secretes pus, mucus, and feces

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

Ligature fistula

Ligature- These are special medical threads that doctors use to suture tissue damaged during surgery layer-by-layer. Usually, the open wound is carefully treated before using them. disinfectants and only after that do they proceed to suture

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

Most often, silk threads provoke such a problem, so recently doctors have begun to use material that dissolves itself after a minimal time period and does not require removal of stitches and additional processing.

The main reason the development of a postoperative fistula is an infection

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

Orgasm perceives the material that was used to sew up 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
The patient is too old
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, which secrete an infiltrate

Redness will be clearly visible near the infected scar. Moreover, it will look brightest during the imposition of the ligature.

The temperature can rise very sharply. And since the inflammatory process will increase in the body all the time, then it will go astray until normal performance will not

Strong suppuration appears, which with wrong treatment turns into a rather large oozing

The fistulous opening may tighten for a while and then become inflamed with renewed vigor.

The consequences that cause fistulas

Postoperative fistula can trigger the development of sepsis

By itself, the postoperative fistula does not pose a threat to life. But if the patient lets everything go by chance, then the pathogenic bacteria that are inside the fistulous opening will begin to infect healthy organs and tissues, and this will provoke the appearance of rather serious diseases.

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

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

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 adipose tissue.
Sepsis. There is an opening of the fistulous opening inside human body... At the same time, pus enters the patient's internal organs.
Fever,provoked by a purulent mass. Temperature readings can rise to maximum levels. In this case, a person can lose consciousness and poorly navigate in space.

Purulent fistula on the surgical suture - treatment

Treatment of a purulent fistula

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, surgery is usually required for a favorable outcome.

If the doctor decides to postpone the intervention, then 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. Usually, such treatment is aimed at eliminating pathogenic microflora that provokes inflammation.

If the therapy is selected correctly, then the fistulous opening will heal rather quickly and the patient will be able to return to normal life. To treat the inflamed skin area, drugs are usually used that have antiseptic, antibacterial and bactericidal effects.

In addition, the patient must be prescribed antibiotics and vitamins, which help to 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 a purulent focus.

Only surgery can help completely get rid of the fistula.

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

In addition, dressings with ointments can be used, which will stimulate the healing process. In this case, for example, troxevasin ointment may be prescribed. As soon as the purulent ceases to stand out, the drainage is removed from the wound and then the patient can only monitor so that an infection does not get into it and periodically change the dressing

Folk remedies for fistula treatment

Treat ligature postoperative fistulas in a trailer folk ways permissible. Some of the methods described below work well enough to remove inflammation and reduce the amount of pus.

But nevertheless, 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 started your condition very strongly, then it is quite likely that you will only aggravate the course of the disease.

So:

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

To prepare the next miracle of the remedy, you will need a mummy and aloe juice. The mummy must be soaked in boiled water, and when it turns it 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.

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

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 the broth and the leaves. First, tear off the leaves of St. John's wort, cover them with water, and then simmer over low heat for 10-15 minutes. When the broth cools down a little, moisten a bandage in it and put the leaves on it in one layer. Fix this bandage over the fistula and leave it applied there for 4 hours. After this time, the bandage must be removed, processed sore spot hydrogen peroxide, and then apply fresh

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

You can try to get rid of the fistula with regular brown bread. Take the pulp and sprinkle it lightly with water. When upper layer will soften a little, apply the bread to the sore spot and fix it with a sterile bandage. This procedure should be carried out once a day. Be sure to treat the wound with hydrogen peroxide before each znamenny bread. If you do everything correctly, then on about the third day you will see that the fistula has completely cleared of pus and began to tighten

Ointment for the treatment of postoperative fistula

Calendula ointment for fistula healing

Home-made ointments have also proven themselves quite well. They quite well eliminate the cause of the infection and contribute to a faster recovery of the dermatological integument. But in this case, it is extremely important to be very careful about applying the ointment, and also preprocessing wounds.

You need to protect yourself from re-infection of the fistulous opening. After all, if you apply non-sterile dressings and use a product of questionable quality, then it is unlikely that you will 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 previously disinfected skin areas

Another effective remedy it is considered an ointment made from fresh calendula flowers. They must be tightly folded in 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 an earthen 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. The resulting agent can simply lubricate the fistulous opening or make medical dressings from it.

As mentioned a little above, the best way to get rid of a postoperative fistula is to complete its excision. 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:

At first antiseptic agents the fistulous opening and all the skin around it is treated
Then anesthetics are 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 that, everything is washed well, drainage is installed and closed with a secondary seam.
In this case, the vessels are not sutured as this can lead to the formation of another fistula.

After surgery, the affected skin area will require special care. The wound will definitely need to be treated with disinfecting solutions (for example, furacilin) 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 cauterized immediately.