32 days post-op TT. Are these scabs normal? (photos)

Question

Hi, I am 32 days postop tummy tuck and I still have these thick black scabs, sometimes they leak a little orange fluid. Is this normal, will these scabs fall off , or should I be concerned?

Richard H. Tholen, MD, FACS · Answer

At a month post-op, no, this is definitely NOT "normal." Wound edges like this are related to localized ischemia causing poor/slow healing or, in your case, localized wound edge necrosis. At this point, careful wound care is necessary to prevent dehiscence (wound breakdown) and a much larger wound, and bigger problems. Since serous drainage is leaking out, there are multiple locations where bacteria can get IN, allowing the warm, wet, and dead tissues to become infected, which will in turn cause more wound edge tissue death and continued scabbing with eventual dehiscence. This should show you that doing nothing may lead to wound breakdown. Allowing the leaking fluid to be the points of bacterial access to the zone of poor healing (no or poor circulation) will increase the risk of infection which could spread and cause more dead tissue and wound dehiscence.I would suggest oral antibiotics to minimize the risk for bacterial contamination becoming a full-blown wound infection, topical agents that penetrate dead or marginally-perfused tissues (like the old drug Mafenide--Sulfamylon, or the more common Silvadene), and avoidance of stress that could lead to mechanical dehiscence.Do you sense a common thread here? At one month post-op you COULD have enough healing that things won't fall apart if ignored. Or, not. So go see your surgeon, who should likely recommend similar to what I have above. You have to keep your wound clean to avoid infection, but softening the tissues in the shower (please do NOT take a bath until your wounds are completely healed) might lead to (you guessed it) would dehiscence. That doesn't mean to avoid showering, but to be gentle and quick. Avoid ointment like Neosporin, as this can not only weaken/soften the scabs, but can also stimulate an allergic response with repeated use.Although some physicians endorse the use of hydrogen peroxide, especially since it can release oxygen in a wound that is caused by decreased circulation and decreased oxygenation, as well as killing bacteria (that's all good), hydrogen peroxide can also kill healthy cells (that's not). So for a grossly purulent wound, a wash or two with peroxide is OK, but yours is not infected (yet). And you really don't want to do anything that decreases wound strength.Bottom line--go see your surgeon for expert care, and awareness of your issues by your surgeon if things fall apart. These "scabs" may be the "tip of the iceberg" of dead fat below the skin surface, and like pressure sores, once the skin breaks down, there is a large zone of dead or compromised tissue beneath. At some point in the future, scar revision may be necessary to remove dead tissue and/or excessive scarring. Good luck and best wishes! Dr. Tholen

Douglas Leppink, MD · Answer

During an Abdominoplasty the skin of the abdomen is elevated from the normal blood supply, and during closure of the incision, after the excess skin has been removed, the wound is under tension. Occasionally the incision line will be slow to heal in response to this tension and changes in normal blood supply. The usual approach to this situation is to continue meticulous care of the incision line, keeping the area clean, washing the “scabs” with hydrogen peroxide, and applying antibiotic ointment or Aquaphor. If the scabs fall off and the wound is raw or bleeding, then Xeroform gauze is applied to protect the incision and encourage healing. Usually the wound will heal well with these interventions, but occasionaly a scar revision will be necessary later to improve the appearance of the scar. When performed later the revision takes advantage of restored blood supply and minimal tension to achieve a better scar.

32 days post-op TT. Are these scabs normal? (photos)

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32 days post-op TT. Are these scabs normal? (photos)

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