What is the best treatment of my necrosis after tummy tuck? Will I need a skin graft or only a small scar revision? (photo)

This case presents many issues. First, the initial posts concerning the wound edge issues and posted photos appeared as a very minor healing issue. But seeing the results from a combination of events the skin surface issues hid the deeper fat necrosis problems. Now you have a full thickness open area in the central TT scar. As for cause - I doubt the reason given as compression from a to tight garment really flies well here. It might have been a contributory minor issue. But to me it appears as a major vascular compromise to oxygenated blood flow to that area. From either over dissection or other compromising issues. In any regards you now have the larger deep open area. That needs in person care, maybe a wound vac therapy. Why have you NOT seen the original surgeon very frequently? Which leads to the second issue. You appear to have had surgeon in Columbia? Options are either fly back for care from the original surgeon or try to find a local boarded PS to offer care. Expect to have to prepay for local care thousands of $$s. Also seek Wound Care Center evaluations. One final option is doing at home local wound care and this hole will close over the next 4 months +/-. The issue needs immediate care in my opinion...