Black Threads in Post-Surgical Drainage: What You Need to Know

Unidentified black line?

Hello Dr.
Lee! I underwent surgery for appendicitis with a fistula on August 18 of this year.
The affected area was treated by excision and suturing without resection of the bowel.
I passed gas on August 20, had my first meal on August 26, and was discharged on August 30.
On the day of discharge, the drainage tube was removed, and I have been disinfecting the wound and changing the dressing daily as instructed by the hospital.

After the surgery, there was a drainage tube opening at the right flank, but after discharge, there was no more discharge from that opening, and it closed within a week.
During my first follow-up on September 6, the doctor said the wound was healing well.
However, around September 12, I noticed severe redness and swelling in that area.
During my second follow-up on September 13, the attending physician incised the area, and a large amount of purulent fluid was released.
Since then, there has been ongoing discharge of purulent fluid from the wound (I have been returning for follow-ups every three to five days).

On September 19 and October 1, I noticed that the purulent fluid contained black threads.
This has caused me anxiety, and I have been hesitant to discuss it with the surgeon (but I continue to attend follow-up appointments on time).
I am unsure if this situation is normal, what the cause might be, and how I should respond.
I kindly ask for your guidance, thank you.

Guo, 30~39 year old female. Ask Date: 2000/10/01

Dr. Li Junde reply Surgery

Dear Mr.
Kuo,
I apologize for the delay in responding to your email due to the hospital's computer system update.
Regarding your question, it is unclear whether you are referring to a fistula resulting from appendicitis or a complication from appendicitis itself.
In cases of general appendicitis or infection in the cecal area, it is possible for adjacent intestinal structures or tissues to undergo necrosis, which can ultimately lead to perforation and the formation of a fistula.

Typically, after the acute phase, a fistula may be managed with surgical resection.
If it is a case of uncomplicated suppurative appendicitis, surgical removal followed by drainage can lead to the formation of a drainage tube fistula.
This type of fistula can heal over time if the drainage function is adequate.
The presence of fibrous strands in the pus may indicate a reaction to the material, which could be causing rejection; removing these strands should lead to improvement.
You should discuss your condition with your physician during your next follow-up appointment, and they will provide you with a reasonable explanation.

Reply Date: 2000/10/01

More Info

After undergoing surgery for appendicitis complicated by a fistula, it is understandable to have concerns about the presence of black threads in the drainage from your wound. Let's break down your situation and address your concerns regarding the black threads, as well as provide some general information about post-surgical care and healing.

Firstly, the black threads you are observing in the drainage could be remnants of the sutures used during your surgery. In many cases, surgeons use absorbable sutures, which are designed to dissolve over time. However, if these sutures are not fully absorbed or if they become exposed due to the wound healing process, they can sometimes be expelled from the body, especially if there is ongoing drainage or infection. This can lead to the appearance of threads in the discharge from the wound.

In your case, since you mentioned that there was a significant amount of pus and that the area became red and swollen, it is possible that the presence of these threads is related to the inflammatory response your body is having to the infection. When there is an infection, the body may attempt to expel foreign materials, including sutures, which can lead to the discharge you are seeing.

It is important to note that while some degree of drainage can be normal after surgery, especially if there was an infection, the presence of a significant amount of pus and the need for repeated visits to the doctor indicate that your wound is not healing as expected. The fact that you are seeing black threads in the pus could be a sign that the sutures are not dissolving properly or that there is a foreign body reaction occurring.

Given your situation, it is crucial to communicate openly with your surgeon about your concerns. Do not hesitate to bring up the presence of the black threads during your next appointment. Your surgeon can assess the wound, determine whether the threads are indeed sutures, and decide if any further intervention is necessary. This could include removing any exposed sutures or addressing the ongoing infection more aggressively.

In terms of post-surgical care, it is essential to follow your doctor's instructions regarding wound care, including cleaning and dressing changes. Keeping the wound clean and dry can help prevent further infection. If you notice any signs of increased redness, swelling, or discharge, or if you experience increased pain or fever, it is important to seek medical attention promptly.

Lastly, the healing process can vary significantly from person to person, influenced by factors such as the type of surgery, the presence of infection, individual health conditions, and overall immune response. If you have any underlying health issues, such as diabetes or a compromised immune system, these can also affect healing and the body's ability to absorb sutures.

In summary, while the presence of black threads in your post-surgical drainage can be concerning, it is essential to discuss this with your healthcare provider. They can provide a thorough evaluation and determine the best course of action to ensure proper healing. Remember, open communication with your medical team is key to addressing any concerns you may have during your recovery process.

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