Is it possible the body can't heal on its own after tummy tuck? (photo)

Question

Any advice would help, should I seek a wound care person? I had a tummy tuck, breast lift and augmentation 7 months ago and have had areas on my tummy tuck open since month 1, my doc has had to open areas and clean out, he has blamed it on spitting sutures, old blood (irritation from drains) and fat necrosis, he has opened areas and left them open for me to pack and allow it to heal from the inside out, but some of these areas healed and closed and re open again. Scar looks worse

Brian E. Rosett, MD · Answer

Hey Rafe-
Everything that your surgeon has said is very reasonable.  It is very important that people realize that wound healing complications do happen not totally infrequently to some degree.  While it seems that yours was at a larger degree than we generally desire everything that he has done to get you healed up to this point is totally correct.  That being said I would talk to your PS and see what his long term goals are for you.  Generally most plastic surgeons will want to wait a few months to allow the skin to relax a bit and then either under local in the office or in the operating room cut out the areas that had to heal with packing and sew them up nicely.  Generally the more relaxed skin and smaller amount of skin removed allows for less tension on the sutures and it heals very nicely without any long term complications.  It is also important that you are not smoking and taking care of yourself with a good diet or vitamins if you are dieting so that you can heal optimally.  Best of luck; you’ll get there!

Anthony A. Admire, MD, FACS · Answer

I would let the body and scar fully heal before any revision is undertaken, despite how bad you think it looks at this point. The exception to this is if there is an active infection which it doesn't appear you have. You might be having a reaction to permanent sutures which I have seen, sometimes causing the incision to re-open as the sutures act like a foreign body. I would ask your surgeon if you have any of these still in place. Once fully healed, then a scar revision can be done to give you a much better appearance.

Daniel Barrett, MD · Answer

Dear RafeRChris,this type of wound is not uncommon after tummy tuck. It is usually caused by poor blood flow, spitting sutures. Most of these wounds heal within a few weeks or months but hey can leave some unwanted scars. If you are worried, you can discuss this with your plastic surgeon. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Tim Sayed, MD, MBA, FACS · Answer

Your surgeon's management so far sounds very appropriate. Sometimes reactions to sutures lead to a "nidus" (focus) of inflammation or infection that resists letting the wound heal. This may continue to be a periodic issue until all suture has dissolved or extruded. Sometimes the nonhealing segment needs to be cut out and open wound packing or a wound VAC device used in order to help it heal from the inside out. The wound should be cultured, if it has not already been, in order to see if any resistant organisms may be retarding the healing process.

Camille Cash, MD · Answer

Wounds can be frustrating and slow to heal.  It sounds as though you are keeping in good contact with your surgeon and you are both actively trying to heal the openings.  There is no harm seeking a second opinion, but I would also mention your concerns to your surgeon to see if he has any other interventions he would recommend first.

Matthew H. Steele, MD · Answer

Thank you for your question.  Sorry to hear about your issues with healing.  Typically this is caused by slow dissolving sutures and eventually the wounds will heal.  Perhaps the tissue has not had time to lay down enough collagen for enough scar strength to resist tension or pressure in the area.  At 7 months, you may ask your surgeon to consider a scar revision to cut out the old areas of scar and re-close the incision in an attempt to get the wound to finally heal.  Good luck.

Gary L. Ross, MBChB, FRCS · Answer

As long as there are no foreign bodies or mesh then it would be very rare for this wound not to heal. At this point might be worth having an USS to check there aren't any foreign bodies. If not this will heal.

Is it possible the body can't heal on its own after tummy tuck? (photo)

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