My Incision is Opening at 19 Days Post Operation with White Pus and Now White Cream Cheese Look Inside the Wound? (photo)

Question

It started at PO day 17 with a little white stringy pus coming out and now two days later it is a white cream cheese looking substance in the incision under the scab. I called my doctor before they closed for their Christmas holiday and my doctors 3 week vacation and the nurse called in Keflex for me and told me to call after the Holidays if it doesn't get better. Should I worry about the white stuff and that it is just opening more? Should I be worried about the opening and the white stuff?

Stewart Wang, MD, FACS · Answer

Thanks for providing photos. Based on the photos, you have a small opening of your incision where the whitish drainage is coming from. It's probably devitalized tissues underneath the skin. You do have small and limited amount of redness at edge of the incision. It's good to quantify it by using a marking pen to outline the edge of the redness and see if it's expanding. The small opening should heal with proper local wound care. You should have your surgeon looking at it to make sure it's a minor delayed wound healing and nothing major. Typically when a surgeon goes on vacation, there is another surgeon who's "covering" for the vacationing surgeon. If the wound is separating more or redness is expanding then you should be seen sooner rather than later. What you are experiencing is not uncommon with an Inverted-T scar and usually appears near the T junction. The reason to see your surgeon is to make sure that there is nothing else going on beneath the skin.

	Best Wishes,

S. Larry Schlesinger, MD, FACS · Answer

Dear Audrey, Thank you for your photographs and this very appropriate question.  The good news is except for the white material you refer to, there are no other signs of infection on your abdominal incision.  Normally, if you were infected, there would be redness around the open wound.  The white material you are referring to, and that is seen in your photograph, is more than likely a dissolving stitch or a dissolvable staple that has failed to dissolve.

	All good plastic surgeons in abdominoplasties, just below the skin surface, place either dissolvable stitches or dissolvable staples or both.  The process that dissolve these stitches creates a white creamy substance similar to pus, however the difference is no bacteria is present.  Due to normal tensions and the dissolving of these sutures, sometimes lead to small wound openings that normally cure themselves.  This is more than likely what is going on with you.  

	All that being said, you need a face to face evaluation by a physician.  I am sure your doctor has left another physician to follow his or her practice while he or she is out of town.  Online evaluations by plastic surgeons may be useful, but nothing beats an in person evaluation.  If I were you, I would call the doctor's nurse and ask to be seen before the holidays are over.  

	In my practice, any patient who calls concerned about an infection gets seen whether the doctor is out of town or not.

Dhaval M. Patel, MD · Answer

Thank you for your questions and sharing your pictures. This does not look too serious. However, the incision looks like it is opening up. It is very important to keep your incisions clean and covered to avoid serious infection. Best of luck!Dhaval M. Patel Double board certifiedPlastic surgeonHoffman EstatesBarringtonOakbrookChicago

Richard J. Bruneteau, MD · Answer

Your
pictures suggest superficial wound breakdown. Wound breakdown can be seen following abdominoplasty surgery for a
variety of reasons. It’s often related
to poor blood supply to the skin flaps, excess tension on the wound closure,
fluid collections, primary infections and patient non-compliance. Each of these factors can significantly
increase the potential for this type of problem.Once this type of problem has
developed, aggressive local wound care is indicated.This may require surgical debridement and
dressing changes.In some cases, a VAC
suction system may be indicated as well.If infection is present, antibiotics may also be necessary.With appropriate local wound care,
this type of wound should heal without difficulty.Initially granulation tissue will grow in the
base of the wound.Eventually the skin
will grow over the top of the granulation tissue in an inward direction as the
wound margins pull themselves together.Unfortunately, this might take several months to occur and a touch up
scar revision may be necessary as well.It’s important that you maintain
close contact with your plastic surgeon.Your surgeon should be able to formulate a treatment plan that addresses
your concerns.

Robert M. Lowen, MD · Answer

Optimal medical care is provided by the ready availability of the healthcare provider. In cases where the patient has had a surgical procedure, a physician knowledgable in the same specialty should examine the patient when the patient notes a post-operative complication.

	All plastic surgeons have a colleague backing them up when they are not available or out of town.

	You should ask to be referred to that person for evaluation and treatment now, even though as many colleagues have noted, the problem is not uncommon and usually heals fine. But it does require in person evaluation, and it is possible that a more serious infection could result if this local area is not opened and cleaned up, of either a stitch or some small amount of devitalized skin or fat.

Vincent N. Zubowicz, MD · Answer

The situation in the photograph does not look like a serious problem.  However, it's just a photograph.  I would recommend having the wound examined by a surgeon soon.

Vishnu Rumalla, MD · Answer

Thanks for your question and excellent pictures. You do not look like you have cellulitis (infection of the skin itself) and barring that you having fever or chills, I think you just have some wounds that are in the process of healing. I am a big advocate of keeping clean dressings over draining wounds.

Kenneth Hughes, MD · Answer

The opening may be just a little delayed wound healing, and the white material may not be pus. You should always be worried about infection, but, in the absence of an area of redness or fever or fluid collection or pain at the site, oral antibiotics and observation is appropriate. My suspicion is that you will heal wihout any repercussions as a result of this. However, keep in contact with the surgeon if anything changes.

Jourdan Gottlieb, MD · Answer

This does not look particularly alarming, as there seems to be little or no inflammation around the incision. It seems likely that this represents a "stitch abscess," a localized infection at the site of an undissolved suture, and the suture needs to be removed. 

	You really need to be seen by a doctor. Your surgeon should have a cross covering surgeon if he/she is away. If no other options you may need to try an urgent care center or ER. "Come back in a few weeks if not better" doesn't fly. If things get worse (redness, fever, chills, etc), do go to an ER.

	Thanks and best wishes.

Darryl J. Blinski, MD · Answer

You have skin edge necrosis that needs in person medical attention. I "hope" your chosen doc has a cross cover doc not just a nurse. DEMAND to be seen by a doctor!

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