Abscess After Tummy Tuck. How is This Treated?

Question

I am six weeks post op and my belly button is seeping dark, smelly fluid. I have a 2 inch opening at the scar that is taking a long time to heal even though I maintain it with clean gauze. Today I went in and told him that I felt that there was a lot of fluid retention. When he checked a large amount of puss was extracted. He sent this away for a culture. My doctor didn't use drains because he used a suture method to prevent fluid build up. I am now worried that this caused an infection.

Brent Moelleken, MD · Answer

Infections can occur after any surgery.

	It is easy to say you should have used drains, but each surgeon's practice is different.  Was a fibrin sealant used in lieu of drains?  Most surgeons do use drains.

	The treatment now will involve thorough removal of all infected materials, usually by exploring the wound and cleaning it out well.

Amy T. Bandy, DO, FACS · Answer

I agree, the sutures that you surgeon placed were not the cause of an abscess. You likely had a fluid collection (seroma or hematoma) that became infected. Depending on the size of the abscess and other factors, you may need only debridement and opening and draining the abscess (which it sounds like was done), up to possible re-operation and hospitalization. All of this depends on the extent of the abscess, the result of the culture and how sick you are, if at all. I would thoroughly discuss this with your surgeon.

Otto Joseph Placik, MD · Answer

Occasionally fluid collections will get infected and more rarely the sutures may get infected. When it is a permanent suture it may need to be removed. Howeer, the surgeon may wait If cultures are pending appropriate antibiotics may be prescribed.

Pablo Prichard, MD · Answer

Thank you for your post.  Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak.  The whole point of drains is to keep a seroma from happening in the first place.  If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent.  If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening.  If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat.  An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel.  Occasionally, a seroma can also become infected, especially if a permanent braided suture was used.  This will have a hot, red appearance, and will eventually open up.  I have never seen an infection from sterile aspiration of fluid.Best wishes,Pablo Prichard, MD

Darryl J. Blinski, MD · Answer

Standard of care no matter techniques is use of drains. So unfortunately you have experienced the result of poor techniques. You need IV antibiotics and possible re exploration with debridement with excision of any infected materials (sutures) and tissue and DRAINS. Sorry for your issues maybe find another surgeon. I bet this has "never" happened to your chosen surgeon using this technique of suturing the flaps ( one I do not recommend unless some form of drain is used). I have personally operated on 5 of these issues from this techniques over the last year. From MIAMI Dr. Darryl J. Blinski

Peter A. Aldea, MD · Answer

Your surgeon's not using Ribiero-Pollack sutures did NOT cause an infection. Infection is seen in up to 3% or so of tummy Tucks (meaning 97% do NOT have it). In your case, it sounds as if residual blood and seroma fluid has become infected.

	The treatment MUST involve complete removal of the infected fluid followed by allowing the skin wound to heal by itself. Depending on your anatomy, you MAY need an ultrasound to see if there are pockets of fluid which do not communicate with the pocket he did empty. If such pockets are present you may require them to be drained by the radiologist or a trip back to the operating room to wash and clean the entire contaminated area. Once this is done you should heal rapidly.

	Good Luck.

	Dr. Peter Aldea

Robin T.W. Yuan, MD · Answer

This is either treated by irrigation and drainage, or if severe and extensive situation, a return to the operating room to evacuate what sounds like a hematoma and the pus, and a thorough washing out of the cavity. But your surgeon should be the one determining the specific treatment.

Peter E. Johnson, MD · Answer

Infection is uncommon after tummy tuck, and usually will be noticed after the first week, though late infections can be related to sutures, a fluid collection such as a seroma, and by medical risks such as smoking or diabetes. When there is drainage and odor from the incision line cultures to guide treatment, antibiotics to match the 'bugs', and daily cleaning and care of the incisions is key. Drains do not increase or decrease the risk of infection. Work closely with your surgeon to get through things.
	Best of luck,
	peterejohnsonmd

Karol A. Gutowski, MD, FACS · Answer

An infection or fluid collection can happen after a tummy tuck regardless if drains were used or not. In most cases, draining the abscess or fluid collection (which is what your surgeon did) will take care of the problem.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Drains are a must following tummy tuck surgery as there is an accumulation of fluid called seroma that will form regardless of tacking sutures that your surgeon used. This seroma can be a nidus for infections as you have unfortunately experienced.

Abscess After Tummy Tuck. How is This Treated?

Answers (11)

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