In clinical work, most of the sinus tracts in the abdominal wall are formed because the wound does not heal properly after surgery, such as diffuse peritonitis, appendicitis, cholecystitis, gastric cancer, rectal cancer and other post-surgical procedures. After surgery, improper wound treatment, or heavy wound contamination, or large surgical incisions, deep wounds, inability to completely remove foreign bodies from the deep bottom of the wound, etc.. , leading to the formation of sinus tracts, . After the formation of sinus tracts, the general superficial sinus tracts can be cured by routine drug changes, but the more secretions, deeper sinus tracts more delayed, the patient suffering, cost more, especially appendicitis post-operative incision infection, sinus tract formation, patients do not heal after a long time, because appendicitis surgery is relatively small, the patient’s expectations are relatively high, so often bring doctor-patient disputes. The author, together with some colleagues from sister hospitals, made a summary of the concept of sinus tract, the reasons for not healing, and the successful experience in dealing with the method, case presentation, etc. We hope to help our colleagues and sinus tract patients. 1, concept, sinus tract (deep blind fistula ) is a deep tissue to the body surface of the pathological blind tube, generally only the external mouth. The main difference between a sinus tract and a fistula is that a sinus tract has one opening, while a fistula has two openings. The treatment of sinus tracts is completely different from that of fistulas, which are much more complex than sinus tracts, so they must be clearly identified, usually by sinus tractography. The main reason for sinus tract formation is that bacteria invade the soft tissues of the abdominal wall, causing a localized form of persistent chronic inflammation. These bacteria or various inflammatory mediators caused by the affected area and persistently stimulate the surrounding soft tissues and cause stress, so that a large number of purulent secretions do not drain well and are forced to first destroy the deep soft tissues in a circuitous manner, forming sinus tracts. The reason for its persistence may be the presence of foreign bodies and infections, resulting in poor local blood flow. The destruction of fibrin and necrosis of tissue cells during infection affects blood flow and the growth of new granulation, which also prevents the normal healing of the sinus tract 3, sinus tract assessment, sinus tract assessment is very important and directly determines the treatment method. Generally, when we encounter patients with chronic sinus tracts, we must first distinguish the nature of the sinus tract, which is generally divided into three types: chronic bacterial infection sinus tract, tuberculous sinus tract, and cancerous ulcerative sinus tract. The latter two types of sinus tracts are less common, but must be clearly identified. Generally, they can be clarified through detailed history taking, and if not, pathological examination or some other special tests are feasible. The treatment we describe focuses on sinus tracts formed by chronic bacterial infections. Next, sinus tractography is performed to understand the shape and direction of the sinus tract. For example, whether the sinus tract is large in the inner cavity and small in the outer cavity, or large in the outer cavity and small in the inner cavity, whether it is simple or complex, whether it is ding-shaped or 7-shaped, or whether it is earthworm-shaped, through-shaped, and deep and shallow. Sinus imaging is important to identify the presence or absence of GI fistula, and if the contrast enters the GI tract, the presence of GI fistula is clear. If the contrast agent enters the digestive tract, the presence of a fistula is clear. Then some other complex treatment is required, which is not discussed here. 4, sinus tract treatment, some conventional methods, (1) antibiotic treatment. Generally, the sinus secretions to perform bacterial culture plus drug sensitivity test, the choice of effective antibiotics. But the sinus wall blood supply is poor, generally can not reach the effective antibacterial concentration, so the effect is poor. (2) Sinus scraping. The choice of sinus scraping is generally some superficial inflammation of the less chronic sinus, and sometimes the method fails or later recurrence may be due to the complexity of the sinus, or some sinus wall is not scraped to, the sinus inflammatory granulation tissue or epithelium is not completely removed c Chinese medicine change. Generally use drugs that dispel decay and generate muscle. The effect on the general sinus tract is okay, but the effect on the complex sinus tract is not good. (3) Surgical excision. For those that do not heal for a long time or recurrence, surgical excision is chosen, in which the foreign bodies such as fibrous scar tissue, thread knots and necrotic tissue are completely removed from the sinus wall, and the postoperative drainage is unobstructed. The experience of the author and sister hospitals found that complex sinus tracts are easy to recur after surgery, and patients soon reappear after surgery sinus tracts. 5.Introduce a new treatment method. This method is simple, effective and fast healing time. The specific method is as follows:: sinus tract dilation with miniature double cannula flushing and drainage. This method is carried out under local anesthesia, the sinus tract will be cut transversely on both sides of the skin 1 ~ 2 cm, and then use the electric knife to cut deep to reach the blind end of the sinus tract, do not use silk ligature bleeding point, should use electrocoagulation to stop bleeding. After the sinus tract is opened, the wound is basically “V” shaped, and after seeing the blind end, the first thing is to check whether there are any wire knots left there, and if there are any wire knots left, they should be removed completely. Probe the sinus tract must see the bottom of the sinus tract, generally with a probe probe. Then scrape the sinus tract with the sinus scraping method, the sinus tract wall must see the blood, place a miniature double cannula, double cannula should be placed at the bottom of the sinus tract, and then perform continuous drip flushing drainage. The author counted 56 cases of sinus tract patients in sister hospitals and our hospital with this method. There were 30 cases in men and 26 cases in women, aged 18-70 years. The causes of abdominal wall sinus tracts were wound infection after appendectomy in 20 cases, incisional infection after diffuse peritonitis in 12 cases, incisional infection after biliary tract surgery in 10 cases, poor healing of incision after gastric cancer in 8 cases, and wound infection after rectal cancer in 6 cases. The duration of the disease ranged from 1 to 20 months, and all cases did not improve after more than 4 weeks of treatment by conventional drug exchange methods, and were then switched to sinus dilation with micro double-cannula flushing and drainage. Two cases did not heal, one case was confirmed to be a recurrence of rectal cancer, and one case was healed after ileal resection due to excessive length of the appendix stump. 6, sinus tract treatment experience sinus tract often does not heal after a long time, consider the reasons: (1) poor blood supply to the sinus tract wall. Sinus tract wall consists of fibrous tissue, especially long sinus tract, fibrous thickening is obvious, the blood supply is very poor, so the healing ability is very poor (2) chronic infection of sinus tract bacteria Sinus tract often exists chronic bacterial infection, especially the sinus tract contains foreign bodies, such as wire knots. Bacteria cling to the foreign body for recurrent infection. It is often difficult to control these chronic infections with conventional drug exchange methods. (3) Poor drainage. Whether it is with Chinese herbal medicine or ordinary conventional drug exchange methods, all are passive drainage methods, there is poor drainage problems, the effect is poor, the sinus tract bacteria can not be cleared. For these reasons, we take corresponding treatment methods. (4) The earlier the sinus tract is treated, the better. Sinus tract time is short, the blood supply is relatively good, and the healing ability is better. If the sinus tract is very long, the fiber thickening is obvious, the tissue healing ability is very poor, it is difficult to operate again to remove the fiber tissue clean, easy to recur after surgery. (5) Scrape the sinus tract must see blood, and to scrape the entire sinus tract to increase the blood supply to the sinus tract to promote healing. (6) Change passive drainage to active drainage. Reduce the number of bacteria in the sinus tract by means of drainage. (7) Try to remove foreign bodies such as thread knots. Foreign bodies are an important cause of chronic infection. (8) Discontinue the use of antibiotics. Poor blood supply to the sinus tract, antibiotics in the sinus tract can not reach effective antibacterial concentration, so the effect is often very poor, long-term use of antibiotics may bring dysbiosis, and in vain to increase the patient’s economic burden. (8) Before dealing with sinus tracts, be sure to conduct a sinus tract assessment to determine the nature, size, and direction of the sinus tract.