After surgery my surgeon said I would need wound care.Skin where the two incisions met was already black.It has been 3 weeks & now there are several areas that are black,open, or seeping. The surgeon said she would see me back in a week, told me to use DMSO & vaseline.Keeps getting worse, I asked her if she was going to cut off the black skin, she said no it acts as a barrier. Should I seek another opinion? Or does it get worse before it gets better? Very concerned since I am a type I diabetic.
Tummy Tuck - Skin Necrosis and Wound Care (photos)
Doctor Answers 6
Different wounds require different care
Thank you for the photos. If your wound necrosis (poor blood supply to tissue) is limited to the skin only then yes local wound care alone would suffice. If there is dead tissue under the skin such as dead fat wound healing may take a long time and may increase your chance for infection especially if your are a diabetic. Its hard to know what the right answer is but sometime it is better, although requiring more time and money, to go back in and remove the dead tissue and re-repair the incision. Have a heart to hear with your plastic surgeon about your options. Also, there is never anything wrong with getting a second opinion. It simply allows you to get the information you need to make an educated decision.
All the best,
Dr Remus Repta
#TummyTuck - Skin Necrosis and Wound Care (photos) ANS:
It sounds right. It is not uncommon for such a big surgery and with Diabetes. And it may get worse before it gets better but your treatment sounds right and at some point your surgeon may want to trim out a little of the black stuff....But you should ultimately heal fine!
Necrosis after abdominoplasty (tummy tuck)
Marginal skin necrosis is more common in patients with diabetes. Conservative measures are indicated as long as the tissues are dry. When the dead tissue turns from dry to wet and when the eschar (black area) starts weeping and separating then debridement is indicated. If you experience spreading redness, fevers, or suppuration (pus) call your surgeon: debridement should be performed.
Ultimately you will heal. A scar revision may be necessary.
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It looks like you had a complex surgery (both a vertical and horizontal component to you abdominoplasty) and have some superficial wound separation and necrosis. From what is apparent, it looks like conservative treatment like your surgeon is recommending is the correct short term course as long as you do not develop an infection of the area. After the area is allowed to heal secondarily, you may then consider a scar revision. However, this should all be carefully monitored and coordinated by your plastic surgeon.
Area of full thickness skin loss
An area of marginal necrosis in the middle is not uncommon. This is the area that is the furthest away from the blood supply and under the most tension. These areas generally take about 4 - 6 weeks to fully heal. Many times the scar will look just fine and other times you may require a relatively simple scar revision. If it is a large area such as yours a revision may be more complicated. Treatment with antibiotics is only needed if you show signs of an invasive infection. Simple wound care is all that is required at this time.