Leg fistula - how to treat?
A fistula, or fistula, is a hollow channel formed in the tissues of the human body. It appears due to purulent tissue fusion as a result of the inflammatory process. From the inside, the fistula is lined with epithelial or granulation tissue, it can have one, two or more holes.
The formation of an abscess or phlegmon in the tissues of the body leads to the appearance of a fistula. Sooner or later, pus, formed in the cavity of an abscess or in the subcutaneous fatty tissue, as in the case of phlegmon, comes out to the surface of the body. If a fistula appears on the leg, you should immediately contact a surgeon or traumatologist.
Content:
- Causes of the appearance of a fistula on the leg
- Leg fistula symptoms
- Diagnostics
- Foot fistula treatment
Causes of the appearance of a fistula on the leg
In many cases, this pathology is based on a leg injury as a result of burns, hypothermia, bruising, broken bones, exposure to aggressive chemical compounds. Trauma can spread to bones, periosteum, muscles, tendons, and leg skin. In total, from a few millimeters to tens of centimeters of limb tissues can be affected.
As a result of a closed or open injury, bone fracture, hematomas occur, and soft tissues and leg bones become infected. If a staphylococcus, streptococcus or Pseudomonas aeruginosa gets into the wound, an inflammatory process begins, an abscess or phlegmon is formed. An abscess is a cavity bounded by a capsule that contains pus. Phlegmon - spreading of pus over a large area of leg tissue with penetration between the muscles and muscle fascia. Sooner or later, pus from the abscess and phlegmon finds a way out.
If the patient suffers from endogenous or post-traumatic osteomyelitis, this condition will necessarily be accompanied by the formation of fistulas with the release of serous fluid or pus. Such fistulas are prone to temporary self-healing, but subsequently a relapse will surely occur.
In moderate and severe forms of diabetes mellitus, the blood supply to the tissues of the lower extremities is impaired, from which peripheral vessels suffer. Violation of tissue microcirculation leads to the formation of phlegmon, abscesses and gangrene. The consequence of this is the formation of fistulas.
Another reason for the appearance of a fistulous canal is postoperative complications in the form of inconsistency of the operating sutures, the introduction of infection into the operating wound, an atypical reaction of the body to the suture material (ligature), its rejection.
A predisposing factor for the appearance of pathology is the low immune reactivity of the body due to old age, excessive physical or mental fatigue, and a prolonged course of the disease.
Leg fistula symptoms
The manifestations of this pathology are divided into general and local.
Common symptoms of leg fistula:
- Weakness, increased fatigue;
- Weight loss;
- An increase in temperature ranging from subfebrile to very high;
- Sleep disturbances;
- Frequent respiratory and intestinal infections of a long course due to weakened immunity;
- With diabetes mellitus - pain in the muscles of the legs, increased sweating.
Local symptoms:
- A hole in the skin of the limb;
- Hyperemia and soreness of the tissues near the fistula;
- Discharge from the hole of pus and blood fluid;
- Additional symptoms depending on the cause of the fistula.
Diagnostics
Clarification of the diagnosis when a fistula appears on the leg is not difficult. Usually, the picture of pathology becomes clear to a specialist already upon visual examination.
To determine the direction and size of the fistula on the leg, the following research methods are used:
- Probing of the fistulous canal;
- Ultrasound to determine the location and size of the abscess;
- X-ray with the introduction of a contrast agent into the fistulous canal (fistulography).
To determine the body's reaction, the doctor may prescribe a general blood and urine test, a biochemical blood test. If the fistulous canal has not yet found an outlet, it may be difficult to visualize it, since it is filled with pus.
Foot fistula treatment
A radical method that allows you to completely get rid of the fistula on the leg is surgery. During the operation, the fistulous canal is excised, drainage is installed, and the focus of infection is treated. If the cause of the fistula is rejection of the ligature, the surgical thread is removed from the wound. In case of osteomyelitis, devices for osteosynthesis are installed, after an injury, bone fragments and foreign bodies are removed.
Granulation fistulas can be treated without surgery.
For this, a set of conservative therapy measures is used, some of which are also used in the treatment of patients who have undergone surgery:
- Detoxification of the body;
- Treatment of the underlying disease, which became a prerequisite for the appearance of a fistula;
- Vitamin therapy (vitamins C, B, PP);
- Strengthening immunity with immunomodulators;
- Appointment of absorbable agents (vitreous, placenta suspension);
- Laser exposure;
- The use of antiseptics in the form of ointments and powders;
- Antibacterial therapy to reduce the intensity of the inflammatory process.
Prerequisites for the use of antibiotics may be test indicators and symptoms such as redness of the skin, high temperature for several days, severe pain. When prescribing antibiotics, contraindications and side effects of drugs must be taken into account.
Antibacterial drugs for the treatment of foot fistula:
- Metronidazole - 0.25-0.5 g 3 times a day;
- Ciprofloxacin - 0.125-0.25 g 3-4 times a day;
- Vancomycin.
Careful hygienic care of the fistula significantly reduces the risk of recurrence. Wound treatment, timely dressing with modern materials will facilitate rapid healing.
In order for the fistula on the leg to heal quickly, you need to seek medical help at the very first symptoms of the inflammatory process, treat the underlying disease in a timely manner.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
