I have a wound separation after tummy tuck April 12 2018, advice on what is going on? (photos)

Question

Why should I still have drainage after almost 3 months after my surgery I also periodically get what feels to be a lot of pressure for a day that burns a sharp pains on the incision that goes away unpredictable when it happens or why I have had 2 ultrasounds 1 that showed a pocket of fluid my surgeon near the incision and relieved but now 2 weeks later still lots of drainage 2nd ultrasound showed no more pockets of fluid any advise would help with what’s going on.?

Robert P. Schmid, MD · Answer

Thanks for your question! Based upon your photos (thanks for sharing them!), I’d say that you’re going to need to have that area cleaned out, irrigated with antibiotic solution, any remaining stitch material removed, then you’re probably going to need a negative pressure dressing like VAC wound therapy. That should close the area up in 4-6 weeks. If you’re a smoker, that could’ve led to this open wound for sure. If you’re not, then I’m sorry; bum luck! Best of luck to you moving forward from here!

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and sorry for your struggles.  Unfortunately wounds can occur for various reasons.  The most important thing is that your surgeon appears highly involved in addressing it.  Ask him/her about silver dressings,  I have had some acceleration in wound healing times using them, good luck.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  Your wound is at the area that would be most expected if you did get one. It is at the area with the most tension, at the middle of the incision, along with the most compromised vascularure after such a procedure. Fluid collections are another reason that you may experience a wound.  On your photos, i do not see any signs of infection and it appears to have some good granulation areas without necrotic tissue, indicating adequate healing. It sounds as if you have a combination of the two. Your wound should heal with good hygiene and local wound care. I would discuss with your surgeon as the modalities for ultimate closure include allowing the wound to heal by itself, wound VAC, or surgical closure.  While, the first would be desired, and then scar revision if needed in future for poor scarring, surgical procedure vision would be warranted for persistent seroma/drainage, infection, or worsening of the wound. In meantime, I would continue with good wound care. Hope that this helps. Best wishes for what appears to be a wonderful result.

Himansu Shah, MD · Answer

Thank you for the question and photos. It is difficult to answer your question without examining you however from reviewing your photos you may benefit from applying a wound VAC. This may help expedite the closure. It is best to discuss that with your board certified plastic surgeon. Good luck.

Daniel Barrett, MD · Answer

Dear  robbinrobinson,this type of wound is not uncommon after tummy tuck. It is usually caused by poor blood flow. I would suggest you to consult your plastic surgeon, follow your surgeon's instructions and keep your wound clean and covered. It can take few weeks or months for wound to fully heal. Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Curtis Wong, MD · Answer

but what are you doing for yours to help it along?  Your surgeon should be advising you on how best to care for you wounds and seeing your regularly to evaluate your progress and to clean up the wound if indicated.  Wound packing is a must if there are sinuses and tracts under your tummy flap.  And use of a wound VAC can only help once your wound is clean of necrotic tissue and debris.  This will heal but your surgeon needs to identify the problems involved here and address them.

Douglas J. Mackenzie, MD · Answer

My guess is that you have some permanent stitching in your fascia (deep layer) that is chronically contaminated, and acting as a foreign body.  In this situation it will continue to get inefected, drain, then seem to get a bit better, then start the cycle over again.  Ultrasounds, MRIs, wound healing centers, etc are a waste of time and money if this is the case, as the only thing that will solve the problem is for the surgeon to open up the area and clean out the non-healing tissue and remove the offending stitch material.  Get a second opinion if necessary.

John J. Obi, MD · Answer

Thank you for your inquiry and photos.  It appears that you have a delayed wound healing problem in the lower midline of the abdomen.  This is where the majority of problems with wound healing occur and usually has to do with the blood supply to the flap.  Be patient and follow your surgeon;s advice on wound care.  Fortunately most of these areas of delayed healing actually heal  very well and I expect that if, after a suitable period of healing and maturation of the scar, the area is undesirable that your surgeon would be happy to offer a revision.Best wishes.

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem and I would discuss the use of a wound vac with your surgeon to speed closureDr Corbin

I have a wound separation after tummy tuck April 12 2018, advice on what is going on? (photos)

Answers (9)

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