Hi, I'm 36 years old and in good health. I had tummy tuck 15 days ago and am concerned with the nature of the area between the naval and incision. My doctor is keeping close eye on it and thinks it's just the skin as I've recently had a 120lb weight loss, and will heal. Im currently on antibiotics and silvadene cream to area. I'm so scared and would like other opinions. Thank you!
Will This Heal on Own? (photo)
Doctor Answers 5
Unfortunate skin ischemia and possible necrosis
First of all I'm very sorry about the complication however this things happen. Not frequently but still the risk is always there. Thus if your doctor did everything right and you did nothing wrong then it is how it is. No doctor would want any complications in their patients.
Don't be scared, be under control. Even if all of the pink purple area goes to necrosis (hope not!) there's no such a big open wound that plastic surgeons can't close.
According to the picture the black colored area seems to be a skin necrosis area. Usually defects of such diameter heal by secondary intention and the pinkish and purplish surrounding areas seem to be ischemic. It feels like that area will deepithelialize (shedding of the upper skin layers) subsequently reepithelialize. To rescue the ischemic region from going to necrosis some urgent interventions such as adequate hydration, short acting blood thinners(?) or volume expanders such as rheomacrodex should be started. Any compression should avoided. Daily wound cleaning, rinsing and dressing change is required. Prophylactic antibiotherapy should also be considered.
Stay with your doctor and obey his advises.
Hope your problem resolves as soon as possible.
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Close follow up with your surgeon
You are correct that you need to keep a close eye on this. Your surgeon should be seeing you frequently and I cannot see the photo closely enough to give you a definitive recommendation although I worry you may need surgery to debride some skin that may not survive. If you were my patient I would be seeing you every day or at least every other day to keep an eye on this so make sure you see your doctor frequently. Also, make sure you are not smoking and if diabetic your sugars are controlled as this may be a factor here. Good luck, and keep in close contact with your surgeon as they can give better advise than anyone on the internet who can't really examine you.
Will This Heal on Own?
Unfortunately it looks like you have an area of skin loss along the incision, and another area on the ?left side where it is quite darker than the rest. Antibiotics and silvadene is appropriate, and it may be that this will heal on its own, but most certainly some trimming of non viable tissue will be needed at some point. It may be that the problem can be resolved most speedily by a return to surgery.
Your surgeon's close follow up and recommended wound care as I note seem correct at this time. We don't like to trim the non-viable tissue too soon in most patients lest normal tissue be unnecessarily trimmed. Keeping the injured but still viable tissue healthy is accomplished with a moist environment, provided by the silvadene.
Best wishes to you.
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Patience Is The Only Solution For Now
The viability of the discolored tissues is questionable and it sounds like your physician is doing the right thing. Careful observation and debridement of the non-viable tissues will allow this area to slowly heal from the inside out. You have to be brave as this process may take several months. Once you've healed, your PS can re-evaluate your abdominal wall and perform a scar revision or whatever else is necessary to give you a great result...be patient...
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