What's That Coming Out of My Incision? Stitch, Gauze, or Mesh

People keep sending me videos of patients who found something near their incision after surgery and concluded it was a piece of an instrument or a dressing working its way out of their body.

I understand the panic. But almost every time, it's one of three ordinary things. Here's how to tell them apart.

There are two kinds of stitches, and they misbehave differently.

The stitches you can see right after surgery are typically removable, though not always.

Sometimes when we remove them, or when they're dissolvable skin stitches like a chromic, not all of it dissolves. The top part falls off and a bottom part stays under the skin. Weeks later your body pushes that remnant up to the surface, and suddenly you're looking at a little piece of stitch.

What you see tells you which kind it was:

• A dissolvable stitch almost never still looks like a stitch by then. It looks like a little bit of goo.
• A non-dissolvable piece genuinely looks like a little thread, and those are typically black or bright blue.

The stitches under your skin are designed to dissolve, and as they do, they turn into goo.

Two competing forces are at work:

1. Your body dissolving the stitch
2. Your body pushing foreign objects toward the surface, because that's what bodies do

If the pushing wins, it pops through the skin, usually as a combination of a little piece of stitch and a wad of goo. That's a stitch abscess, also called a suture abscess, and I've written a full guide to what they are and how to treat them.

There's a clear pattern to who deals with this:

• Young people. The younger you are, the more likely you seem to be to spit stitches to the surface.
• People with a high suture burden, meaning lots and lots of stitches, so your body has a lot to process. Think big incisions: breast lifts, tummy tucks, that kind of thing.
• Areas that don't heal well, where healing is slow, like the lower extremity and the undercarriage.

Here's the category that produces the most alarming videos, and it's the one where nothing came out of your body at all.

When we close an incision, we also use dressings. That often includes Steri-Strips, little tapes placed over the incision, and we use something sticky to get them to adhere, plus gauze bandages on top.

It is really, really common for:

• Little pieces of gauze to get stuck underneath the Steri-Strips
• Pieces of gauze or thread, sometimes from your own clothes, to stick in the leftover adhesive after the Steri-Strip comes off

It looks like it came out of you. It's just stuck on you.

The tell: look closely. It clearly looks like a piece of cloth, with a weave and frayed ends.

A real example from my own practice: I had a patient years ago with black "stitches" she was certain were coming out of her skin. They turned out to be fibers from her sweater, stuck to leftover adhesive from her Prevena vac.

This is the one generating the videos where someone holds up what looks like a tiny flower.

If you look closely and see that the piece is woven, a bunch of little circles knitted together, then it's a woven product, and there are two likely candidates.

We often cut surgical mesh or scaffolding to fit during an operation. In the process of placing it, a small piece can end up stuck to the skin or sitting in the incision. It might work its way out, or it might just be stuck on you.

Surgicel is a woven product we place to help stop bleeding. Little edges of it shed easily, even just from handling it.

This one fools people, and fairly, because it's made out of stitch-like material, so a shed piece really can look like a stitch. The giveaway is the same: it's woven, in little circles, knitted together. A stitch is a single strand.

This is the part I most want to land.

Everybody assumes that a spitting stitch, or a bit of mesh or Surgicel near their incision, means something has gone horribly wrong. It hasn't.

• These are very common things to happen after surgery
• They are not dangerous
• Stitch abscesses are largely genetic, and young patients get them more

They're genuinely annoying, and they can sometimes make a scar look less nice than it otherwise would. But nothing bad happened to you. You will be fine.

Always ask your surgeon to look at anything you're concerned about. They know exactly what they used in your operation, so they can solve the mystery quickly.

One detail patients don't realize: sutures come in different sizes, so we can often identify what you found just from the size of the thing in your hand, let alone the color and texture. That's not a diagnosis you should be attempting alone on your bathroom counter, and it's one more reason post-op follow-up visits matter.

If something turns up at your incision, run it through this list:

• Looks like goo → a dissolving stitch
• Looks like a single black or bright blue thread → a leftover piece of non-dissolvable stitch
• Clearly looks like fabric → gauze or clothing fiber caught in dressing adhesive, and it never came out of you
• Woven, like a bunch of little circles → a piece of dissolvable mesh or a hemostatic product like Surgicel

None of these means a piece of an instrument is in your body. All of them are common, none are dangerous, and your surgeon can tell you exactly which one you're holding.