What causes necrosis in tummy tucks?
Doctor Answers (6)
Smoking and surgery
Here are the major points of smoking Tobacco or Marijuana before or after surgery:
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke. Hookah also does not decrease nicotine.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Pablo Prichard, MD
Tummy tuck complications
Causes of skin necrosis during tummy tuck
There are a variety of factors that can increase the chance of skin necrosis during tummy tuck. Tobacco smoking is one of the prime risks for skin necrosis. The nicotine causes the blood vessels to the abdominal skin to contract spasm and reduced blood flow. Other potential causes are any type of blood vessel disease such as autoimmune disease, diabetes, high blood pressure, all influence blood supply and can impact the chance of skin necrosis after tummy tuck. Extensive liposuction during a tummy tuck can also damaged blood vessels and lead to skin necrosis. Prior abdominal surgery that has disrupted blood supply can also precipitate skin necrosis.
Pulmonary embolism can follow thrombophlebitis or blood clots in the legs. Any surgical procedure increases a theoretical risk of thrombophlebitis. That is why pneumatic boots that massages the legs and encourage venous return during surgery are routinely used. In addition compression stockings and ambulation or walking to increase muscular activity in the legs is routinely done in an effort to prevent thrombophlebitis.
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Necrosis after tummy tuck
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Necrosis is caused by compromised blood supply and tension. We raise the skin knowing where the key blood supply to the abdominal skin is and preserving it. Tension is also monitored with closure.
If the blood supply is compromised during surgery or there is a variation in the anatomy blood flow to the skin can be compromised leading to healing problems. Too much skin removed placing increased tension on the wound can lead to healing problems. Garments that are too tight or poorly placed can lead to compromise of blood supply as well.
Pulmonary embolism is caused by pooling of blood in the legs. Compression stockings are used during surgery to minimize this from happening and early ambulation post surgery is important after. There are risk factors which are unique to individuals and your surgeon would determine those during your consultation.
Seek out a board certified plastic surgeon for consultation to give you all the information you need to make a great decision.
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.