Had a TT 10 Days Ago and Still Draining Dark Red in my Drain, Should I Worry?

Question

FULL TT without muscle tightening or liposuction 10 days ago and my drain is still draining dark red blood where 99% of the time I have to strip the line to get it through. Total CC's are 50-75 per 24 hour period. What could be a possible reason for the fluids not getting lighter or changing colors? As well as why is it clogging constantly and not free flowing?

Adam Tattelbaum, MD · Answer

What you're describing is not uncommon, but it is something that you should  check in with a plastic surgeon about.
	Initially after tummy tuck the drainage coming out of the drain is a bloody color.  Over time, it begins to clear to a lighter or more yellow fluid.
	Sometimes the drainage can stay darker longer if there has been oozing under the skin. Each patient is slightly different. Significant oozing can lead to a bulge called a hematoma.  Sometimes small amounts of hematoma are barely noticeable under the skin and go on to liquefy and come out the drain.  In this case the bloody drainage is a good thing because it allows old hematoma to get out.
	The drainage numbers that you describe don't sound scary but their little bit high and may indicate that you had a small amount of oozing or hematoma under the skin at the time of your surgery.
	The safest thing to do would be to check in with your plastic surgeon and follow his or her recommendations.  In my own practice if there is no evidence of a big bulge large hematoma I usually leave the drain in a bit longer until the volume of fluid decreases or the drain begins to clear.
	Good luck in your healing process.

Pablo Prichard, MD · Answer

Thank you for your post.  Whenever there is a potential space in your body, your body tends to fill that space with serous fluid (the yellow type of fluid that also comes out of a 'weeping wound'.  This is similar to when you get a blister: the layers of skin separate and fluid is deposited in to the space.  In a tummy tuck, the space is in between the skin/fat layer and the muscle layer.  Most surgeons will place a drain to remove this fluid while your body is secreting it until the fat layer grows back together with the muscle layer.  At that point, no more fluid is secreted into the area, because there is no more space for fluid.  The length of time that this takes varies from patient to patient.  Some patients heal much faster, thus the layers seal together much faster.  Also, the more twisting motion you have in your belly area, the slower the two layers grow back together because they are moving in relation to each other.  The fluid coming through the drain can be initially dark red, and eventually clears to pink then yellow.  This is because it takes just a little bit of blood to make the fluid dark red.  Also, initially, there can be a large amount of fluid (few hundred cc's in the first day is not out of the range of normal) and this should slow down substantially over next few days.  Once the fluid slows down to the amount that your surgeon is comfortable with (usually 25-50 cc in 24 hours) then they will be pulled. There is minimal discomfort in pulling the drain in most patients.  More recently, 'drain free' surgery has become more popular. Fat layer is sutured down to the muscle layer starting at the ribs and progressively down to the lower incision.  This makes the space for the fluid to collect much smaller, and in many patients can have surgery without drains.  However, I have seen multiple patients come from other surgeons because they developed a seroma despite the suturing of the tissue.  This is not the surgeon's fault, but some patients just do not heal fast enough or put out too much fluid for the body to absorb.  Best wishes,Pablo Prichard, MD

Robert Stroup, Jr., MD, FACS · Answer

Most likely you had a small hematoma (blood collection) under the skin which has now started to dissolve and liquefy, allowing it to start coming out the drain.  This should be self-limited and resolve within a week or so.  You can help things along by using some heat to your abdomen about 3-4 times daily.

	If the drainage doesn't slow down or actually increases, or if it turns bright red, let you surgeon know immediately.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Although what you are experiencing is probably normal, it will be best for you to check with your plastic surgeon to rule out complications. As you know, the color of the drain output should gradually change to a yellowish tinge (serum). It is not uncommon for drains to &ldquo;clog";  sometimes drain "stripping"  is necessary to unclog the tubing.

	Again, continue to follow with your plastic surgeon for  the most accurate advice.

	Best wishes for the remainder of your recovery.

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