Pilonidal Wound Drainage

Most wounds will have some kind of drainage, it’s a normal part of the healing process. There is a wide range of types of fluids that your wound may discharge, a few are cause for alarm, but most are a good sign that the body is working hard and building/repairing tissue. In a wound that is healing well, the amount of drainage will reduce over time.

Blood

A small amount of bleeding is normal, especially during packing/dressing changes. There are lots of new blood capillaries being built in your wound and those can be disturbed when you pull the old dressing off to clean the wound and place new dressing. For Open Healing patients who are packing, it is fairly common to bleed some during the first few weeks of packing changes. This should lessen over time.

Gushing blood or large clots are not normal, call your doctor.

There have been cases where an excision went too close to a larger vein and this can be scary if the vein opens up during a packing change. Anything more than about a teaspoon of blood should be checked by your doctor or nurse. For large amounts of blood that aren’t stopping, go the the nearest Emergency. Cover the area as best you can to contain the bleeding and have someone else drive if possible.

Sutures bleeding one week after surgery is normal, bleeding after about two weeks is not normal (unless it is from individual stitch holes that are too tight).

Exudate Fluids

Wound exudates are draining fluid secreted by an open wound. The amounts can be very high during the Inflammation Phase and should taper off as healing progresses and completes. The amount of exudate depends on the size of the wound and may come in a variety of consistencies from chunky to liquid. Exudate can be white, yellowish, grayish, greenish or light brown, it can also have a slight odor (strong, foul odor is NOT good.)

Closed Healing patients will see more liquid drainage of various colors, usually just on the dressings. In the first week after surgery it will mostly likely be clear, tinged with blood. It may become more cloudy as healing progresses and should all but disappear as you finish healing. Closed wound patients should watch out for Serous Fluid build up in the wound; this fluid can build up inside the surgical site and when it finally emerges through the top of the wound it can be a large (scary) amount of yellow/orange fluid.

Usually nothing needs to be done other than to change dressings and protect clothing, but your surgeon should still be contacted because similar fluid can come out of the wound in the case of a rare but more serious wound complication. Your doctor will most likely want to take a closer look when large amounts of Serous Fluid are present.

Open Healing patients will see a lot more of types of drainage because the healing process is in full view (not covered by sutures) and building tissue from the bottom up is a more involved process. Most will start seeing a change in wound drainage at about 5 days post-op, when the fluids from the Inflammation Phase have subsided and the body’s repair crews are getting down to the work of healing.

What exudate may look like for an open wound is little gobs of “gunk” in your wound that have a more “pudding” like consistency since it is full of of dead cells and other materials discarded as your body heals itself. This gunk needs to be gently flushed out of the wound twice daily. Exudate can be rinsed out of the wound bed with a hand-held shower sprayer, just flush the entire wound out. You may go though periods of very heavy exudate drainage (lots of healing going on) or minimal exudate drainage (healing slowing down).

When to be concerned

• If wound fluids are soaking through your dressings.
• Pus – this is NOT normal. Pus coming from either a closed or open incision needs immediate attention from a doctor. Pus is produced by inflammatory bacterial infections and is part of the body’s immune response. Presence of pus indicates infection that needs treatment ASAP.
• Strong odor with pain, redness and swelling usually indicates infection, call your doctor ASAP.

Color Guide

Pus – grayish to greenish to whitish. Pus is generally dense and has a consistency of glue since it is composed of immune cells and other debris from the infection battle raging in the wound. It frequently has a distinctive smell. Since it is dense, it flows slowly.
Wound Exudate – clear, whitish, greenish to brownish. Exudate can have the consistency of pudding in an open wound. Might have a slight smell. Usually, you can dislodge it easily with a q-tip or gauze.
Serous Fluid– light yellow to pinkish to clear. Serous drainage is watery and flows easily.

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This page last updated: February 9, 2016