How long does it take to change the dressing after anal fistula surgery

Anal fistula surgery is a very common anorectal surgery, and anal fistula surgery is usually very complicated. There are many causes of anal fistula. When treating anal fistula, it is best to find out the cause first, and then treat it in a targeted manner. Anal fistula treatment generally requires surgery. Other treatment methods are not particularly effective for anal fistula. How long does it take to change the dressing after anal fistula surgery?

How long does it take to change the dressing after anal fistula surgery?

After anal fistula surgery, proper dressing changes can promote wound growth, accelerate healing, reduce patient pain, shorten hospital stay, and reduce patient hospitalization costs. If the dressing is not changed properly, even if the operation is successful, the wound will heal very slowly, which will not only prolong the patient's hospitalization time and increase pain, but may even cause anal fistula to form again, requiring another operation, causing unnecessary pain and cost to the patient. It can be said that postoperative dressing change is as important as surgery, and young anorectal surgeons must not ignore it during the learning process.

The postoperative dressing change for anal fistula should follow the three-stage theory of wound healing:

In the early stage, the wound secretes more and the pus has not been completely eliminated. Therefore, when changing the dressing, the wound should be rinsed and cleaned to remove foreign matter and pus, keep the wound drainage unobstructed, and reduce the irritation of secretions. Oil gauze strips are embedded inside the wound to promote the shedding of pus and rot, fill the wound with granulation tissue, and ensure smooth drainage. Our department often uses homemade red gauze strips to achieve the above purposes. According to clinical observation, the effect is better than general oil gauze strips.

In the middle stage, the pus and rot have basically fallen off, and granulation tissue begins to fill the wound. The new granulation tissue is tender and has rich blood vessels. In this stage, in addition to removing foreign matter and maintaining smooth drainage of the wound, the dressing should also protect the granulation tissue. If the granulation tissue is high, hypertonic saline or magnesium sulfate should be applied externally to the wound, and appropriate pressure should be applied to flatten the granulation tissue to prepare for epithelial growth. If necessary, you can use tissue scissors to trim the granulation tissue appropriately, and apply Yunnan Baiyao powder externally to stop bleeding.

In the later stage, the wound is well filled with granulation tissue, the base of the wound becomes shallower, and the epithelial cells at the wound edge crawl toward the center of the wound, finally covering the wound until it heals. During this period, the stimulation to the wound surface should be reduced, and cleaning should be done as little as possible during dressing changes. Muscle-growing medicine should be applied to embed into the wound surface to protect the epithelial cells on the surface of the wound. Traditional Chinese medicine has rich experience in healing wounds and promoting tissue regeneration. Drugs for removing dead tissue and promoting tissue regeneration can improve local blood circulation in wounds and promote new flesh growth. For patients diagnosed as having positive symptoms of sores and ulcers by TCM, Huiyang Yulong Powder can be used, which has the functions of warming yang, activating blood circulation, removing dead tissue and promoting tissue regeneration. For patients diagnosed as having positive symptoms of sores and ulcers by TCM, Yuebai Zhenzhu Powder or Badu Shengji Powder can be used, which have the functions of clearing away heat and detoxifying, removing toxins and promoting tissue regeneration.

Several precautions for dressing changes after surgery

Dressing changes after anal fistula surgery cannot be simply understood as changing the wound dressing. What is more important is to closely observe the changes in the wound and deal with problems in a timely manner when they are discovered. We must do the following:

1. When changing the dressing, the patient should be asked about his or her subjective symptoms, paying attention to whether there are any symptoms related to the wound, and judging whether they are consistent with the local situation. If they are not consistent, the cause should be further investigated and treated accordingly.

2. Observe whether the granulation tissue on the wound surface is growing healthily and firmly, and whether there is edema or excessive granulation tissue. If the above situation occurs, it should be dealt with in time, either by pruning or applying medicine. If granulation edema and loss of granulation tissue freshness occur repeatedly, the cause should be sought to determine whether the patient is allergic to local medications, whether the internal opening is improperly handled, or whether there are residual branches causing recurrence.

3. Observe the wound for any secretions, the color and consistency of the secretions, ask the patient about the approximate amount of secretions, and check whether there is any secretion flowing out by pressing around the wound.

4. Check whether the wound drainage is unobstructed, whether the skin at the wound edge is turned inward, and whether there is a pocket at the distal end of the wound. If so, it should be dealt with in time.

5. Observe the wound for adhesion and false healing.

6. For high anal fistula, regular wound inspections should be performed to understand the growth of granulation tissue at the bottom and the tightness of drainage and hanging threads. If necessary, deep wounds should be rinsed with 1:5 hydrogen peroxide saline.

7. When changing the dressing, use a dry cotton ball to absorb the secretions and feces on the wound surface. Do not rub it hard to avoid wiping off the fiber protective film on the surface of the granulation tissue and causing bleeding.

8. After the examination, place the dressing evenly on the wound from the bottom of the fistula, not too tight, to ensure that granulation tissue grows from the base of the wound and does not form a bridge-shaped healing. Use gauze to fix it. When changing the dressing, different strips should be selected according to the growth of local granulation tissue.

9. 5-7 days after the operation, when the acute inflammatory period is over and tissue repair is vigorous and there is no abnormality in the drainage of the branch tube, the drainage gauze should not be placed too deep to avoid hindering its healing.