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

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?

Doctor Answers 12

Localized drainage from tummy tuck incision

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,

Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Is The White Stuff In My Abdominal Incision A Sign Of Infection?

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.   

My Incision is Opening at 19 Days

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. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

White Stuff in Incision after Tummy Tuck

                  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.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Superficial Wound Breakdown

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.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Drainage of pus from a wound after abdominoplasty should be examined by the surgeon.

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Small wound infection following an abdominoplasty

You have more than likely developed a small suture abscess under the scabbed area of your incision.  This is not unusual and will require the suture to be removed.  The antibiotic will make it better but it will continue to drain until the suture is removed.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Purulent drainage from wound

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.

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 197 reviews

Open Incision after Tummy Tuck

Based on your pictures, and assuming you aren't having signs of infection (significant fevers, chills, increased skin pain and redness), you should heal fine but it may require some time. You surgeon should have another surgeon who will "cover" for him or her while out of town, so if things get worse, ask to be seen by someone else.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 reviews

Incision opening after 19 days

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 certified
Plastic surgeon
Hoffman Estates

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 93 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.