Should I be worried about skin around wound that is turning hard and black? (Photos)

Question

Had TT one month ago skin around the dehiscence (that ps keeps saying will heal with time) is turning black and hard. Should I be worried?

Yucel Sarialtin, MD · Answer

Thank you for your question,
the most important in this case is to keep clean the area and follow your surgeon recomendations.
good luck,

Francis Johns, MD · Answer

Thank you for your question.In some cases, you can have problems with wound healing. At this point, you need to do everything you can to promote healing. If you are a smoker, that needs to stop!!! Keep the area clean and follow all wound care instructions from your surgeon. It is going to take a while for this area to heal and close up. If you start getting a fever or notice any odor/drainage from the wound you need to contact your surgeon immediately.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am so sorry to see your healing difficulties.  I would strongly recommend staying in touch with your surgeon regarding your skin loss and continued incision separation.  One needs to rule out an infection and to be prepared that the wound will continue to worsen before it starts to get better.  You may be a candidate for a woundVac application.  Best wishes.

Olivier Deigni, MD · Answer

Hello and thank you for your question and your pictures.
Wound healing problems can occur as a result of a variety of reasons and in addition to good surgical technique, it is important for your surgeon to understand what your personal risk factors are and help optimize any medical conditions that may be contributing (diabetes, massive weight loss, smoking, etc...). That being said, your pictures do not reveal any active infection. However, you seem to have some tissue that would benefit from some sharp debridement (removal/cleaning) in the office setting. That black hard skin around your belly button should be removed. Antibiotic cream can be applied to certain areas to help avoid infection and also hold moisture to help your body heal. Given the extent of your wounds, the healing process would likely take several weeks and there are several ways to treat these wounds. One way that can help accelerate the healing is with application of a wound vac. It is a device that helps promote granulation tissue in such wounds and helps heal them faster. The main objective is to keep the wounds clean and free from infection as your body heals. Once you have completely healed, any scar revision that is needed can be performed in the future with usually very good results.
Make sure you follow up regularly with your surgeon throughout this healing process.
Good luck!
Olivier A. Deigni, MD, MPH
Houston Plastic Surgeon

Kim Taylor, FRACS · Answer

You have quite extensive wound breakdown and the black areas are part of the reason why this has happened, as it seems the blood supply is inadequate at your wound edges.  The cause of this is usually multiple: possibilities are smoking, poor tissue handling, too much tension when closing the wounds, bleeding, infection, diabetes or a number of other reasons.  Continue to see your surgeon for wound care, but if you were my patient I would consider debridement and resuturing the wounds.  This would be done in a operating theatre setting.  All the best

John Sampson, MD (license obligations) · Answer

Hello and thank you for your questions and photos.You can apply Silvadene twice a day to prevent infections and treat the burn skin in this type of cases. I recommend that you keep in touch with your surgeon at all times and let him know what is happening.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
I am
sorry that you have experienced a complication of the abdominoplasty procedure.
During the procedure, the abdominal skin and soft tissues are dissected
from the underlying musculature from the ribs to the pubic area. If there is
impairment of the blood supply to the abdominal skin, the segment of the flap
the greatest distance from its blood supply may not survive (above the
mid-pubis). The cause of the blood supply impairment can range from effects
of smoking, diabetes mellitus, vascular disease, previous surgery in the
area (disrupting the normal blood supply), infection, or may totally
inapparent.  
At the
time your photograph was taken, I do not see significant infection, but
there is still significant residual unhealthy tissue in the wound.. Treatment consists of
removal of the unhealthy tissue, followed by intensive wound care. One looks
for the development of granulation tissue, a beefy red vascular tissue, to
develop, after which time the wound will begin to shrink. Many wounds of this
size will seal over a span of 2-3 months. In our practice, we consider
application of a temporary skin graft over the granulations if the wound does
not seal within this time period. Some advocate the use of a suction apparatus
(wound vac) to accelerate the process of wound shrinkage. Various
enzymatic topical creams are available. Some advocate hyperbaric oxygen
treatments.
Each
plastic surgeon has his / her own wound care regimen based upon years of
experience. Follow the advice of your surgeon and maintain close followup care. After
the wound seals, and after the scars mature and the inflammation
subsides, one would then consider revisional surgery if necessary (usually
6-12 months). I am often surprised how well these scars heal on their own!
Best
wishes...

Should I be worried about skin around wound that is turning hard and black? (Photos)

Answers (7)

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