Blackening of Skin Around Tummy Tuck Lower Procedure Site. If There is No Infection Does the Skin and Dead Tissue Still Removed?

Perfectly healthy 5'5" mom of 2. Don't smoke and never have. Just got a huge amount of skin and fat removed. My plastic surging on said it didn't need to be taken care of but the hospital did emergency we surgury and I have a huge open wound now. Just wondering if it Could have healed on its own without surgury?

Doctor Answers 3

Blackening of Skin Around #TummyTuck Lower Procedure Site. ANS:

It sounds like you had some tissue loss from your tummy tuck, which unfortunately can happen and that you somehow ended up at the hospital and someone there surgically cleaned up the tissue, leaving a large defect. If that is the case, your surgeon was right, that you did not need a "surgery" per se. We Plastic Surgeons are used to this type of wound care and after a time, the dead tissue needs to be cleaned up and in almost all cases can be done in the office, not a surgery center...But trust your Plastic Surgeon...they know what to do and in the most economical way as well.

Phoenix Plastic Surgeon
4.6 out of 5 stars 44 reviews

When there is dead skin and fat, it should be removed BEFORE it becomes infected.

Although lack of circulation causing dead fat and skin in tummy tuck patients who do not smoke is quite rare (<1%), it can occur. In smokers, and even in patients exposed to second-hand smoke, the risk of circulation loss from nicotine vasoconstriction leading to dead skin occurs in as many as 15-20% of patients! That is why we all ask if a patient is a smoker, using nicotine gum or patches, or has a smoker in the household whenever we see dead skin or belly buttons. The central skin just above the pubis is furthest from blood supply, and also under the highest tension, so this is where the problem is seen when it does occur. Since the umbilicus has a cut around the entire circumference, its circulation comes only from the stalk of the belly button, which can be scarred from previous surgery or just how it was tied off at your birth. Thus, this area is also susceptible to decreased circulation with tummy tucks, especially in smokers!

Realize that once any skin is dead, there will gradually be a natural demarcation between still-living tissue and truly dead tissue, with only a small zone of marginal-circulation transition between them. The dead tissues are warm and moist, and exposed to bacteria in our environment and on the surface of your skin. Removing marginal and possibly-still-recovering tissue is avoided to minimize the residual wound, scarring, and extent of corrective surgery later. But what is dead will never recover, and allowing it to increase the damage to tissues that otherwise COULD recover is not a good plan.

Thus, once the dead skin is clearly demarcated, and hopefully BEFORE it becomes infected and potentially increases the zone of tissue loss, good surgical practice indicates that the dead tissue should be removed. Some surgeons may wait longer than others, but eventually it must come away, with help or without. Removal surgically usually hastens the healing and reduces the extent of tissue loss.

Healing this wound is now your surgeon's priority, and it will heal and granulate closed with scar tissue more rapidly when your body doesn't have to fight bacterial contamination from still-attached adjacent dead skin and fat. Dressing changes, VAC system usage in some cases, and continued follow-up with your doctor will be needed.

Your doctor has done the right thing in the face of this unfortunate complication. Good wound care practices will help this open wound to heal, contract, and soften. You will be surprised how much it will contract and become smaller than the present open wound size.

After an appropriate waiting period for scar tissue to mature and stretch, excision of the scar and reclosure will be possible. Other techniques may be discussed at that time also. Be patient and things will turn out fine in the long term. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Dead tissue after TT must be removed despite abscence of infection

I'm sorry to hear about your complication. Your doctor did well by removing the dead tissue. Your wound will now have to heal from the 'bottom-up'. It will be a slow process but rest assured it will heal if properly taken care of. I don't know if your PS is utilizing the help of the VAC sponge. This acronym stands for the 'vacuum assisted closure' system. It essentially speeds up the healing process by literally sucking the wound edges closer together. Once the wound edges are close enough for closure, your PS can take you back to surgery and stitch the wound together instead of waiting for the wound to granulate and heal from the bottom-up.

Hope this helps.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.