2 weeks post op Tummy Tuck, open wound and discoloration (lack of blood supply). Any suggestion? (photos)

Based on your photos only, it appears that you have an area of necrosis (the pale greenish color) which means that this tissue has not survived the surgery. This can happen following a tummy tuck when the blood supply is not sufficient to keep the tissue alive, and necrosis in the area that yours has occurred is unfortunately not uncommon after an abdominoplasty. Skin is typically hardier that the underlying fat so the final size of the injured tissue may still take a while to demarcate, or show a distinct border between the healthy and necrotic tissue.The Santyl ointment is helping the superficial dead tissue to come off, and it is likely that your surgeon will also perform sharp or surgical debridement along the way to help keep the area clean and promote healing. The necrotic tissue does not have sensation, so typically this is not painful for patients.I use the analogy that the area of concern is like a cut flower in a vase, and regardless of how many times you change the water or add sunshine, the flower is going to wilt and die. You will see things appear to be getting worse before it looks like it is getting better (very typical healing stages) and this is why close follow up with your surgeon is essential.This whole precess is going to take a while, maybe months. My best advice is to forge a strong relationship with your surgeon, because you are going to be seeing a lot of each other. Try as hard as possible not to let anger or depression get in the way, because this is going to get better. Believe me, your plastic surgeon will want this to heal well and as quickly as possible too. Plastic surgeons deal with complicated woulds as part of their training, so they will have lots of recommendations that may change frequently as you heal.I'm very sorry you are going through this, but these are the kind of things that can happen with big surgeries. With good care you can still expect to get a great result. You will gain all kinds of wound care skills, will likely become a favorite patient at your plastic surgeon's office (some of mine have even become long term friends), and staying positive will absolutely impact your final result.Hang in there!Sincerely,

Based on this one photo alone, it appears you have suffered skin and soft necrosis in the lower mid portion of the abdominal skin flap- which is the most common area for this to occur. You should be following up with your plastic surgeon regularly to keep a close eye on how this area progresses. It may require surgical debridement, which means a trip to the operating room to clean up the wound edges and possibly remove any unhealthy tissue. If there is pus in the base of the wound it may even need to be packed with sterile gauze dressings or closed with the assistance of a wound VAC. I'm not sure topical ointments will heal this however you should consult regularly with your plastic surgeon.Best wishes,Dr.Bruno

Hello,I am so sorry this happened. It has happened to all of us who do enough of these surgeries.  I know you're the one with the complication, but your surgeon is probably just as devastated.  I hope he has the courage to tell you himself.  Now, lets get down to business.  Ditch the garment. Your surgeon should be certain there is no other causes of interstitial pressure like a seroma or hematoma beneath the skin flap.  Although Santyl is good, you should push your surgeon to begin sharp debridement of the thick white material on the surface of the wound, which can be done painlessly in the office without anesthesia.  This will accelerate healing and give him preliminary assessment of the extent of fatty necrosis below the skin, which unfortunately may be extensive and possibly accounting for the larger area of skin discoloration.  I prefer serial debridements with very conservative removal of fatty tissue, unless it is absolutely grey and translucent in color.  I have found that this abnormal fat can support healing, called 'granulation tissue' despite looking abnormal in color or appearance. Based on this photo, you will probably have some form of open wound for the next two months.  After an appropriate amount of time afterward, usually about a year from closure, scar revision can be entertained.Keep your head up, this too shall pass. Talk to your surgeon.  Best of luck.