How does it look to you? Where am I at in this necrosis battle? (photo)

Hello:Necrosis of the abdominoplasty flap is a well recognized problem. Unfortunately, it happens from time to time and everyone is sorry for this outcome, even those that had nothing to do with it. Fortunately, After the wound is debrided, it usually heals in with a well vascularized scar which can be revised in the office under local anesthesia, if necessary. Sometimes, it can be closed primarily.  It will screw up your social calendar and sometimes increase your time away from work and fun. But hang in there. Stick with your plastic surgeon who has a vested interest in your improvement.  It/you will get better in the end. 

Dear brodybret,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

Hi brodybret,I'm sorry to see your wounds are healing slowly.  It appears that your wounds will need continued care.  I usually see my patients every 2-3 days until i'm confident that things will heal well.  Please continue to see your surgeon and follow their instructions.  I'm sure you will do fine.Best,Dr. B

It appears the area that is very red is trying to establish more blood vessels to repair the necrotic area.  You have some mild area of skin necrosis which should be cleansed and debrided.  The area of partial necrosis may develop some fat necrosis which will cause the tissues to harden.  Time will be the determining factor.  The tissues will define what's viable to what is not.  You should continue to use silvadene as well as have your doctor trim the necrotic tissue.  Waiting for the necrotic tissue to fall off will delay healing.  Hope this helps.  Dr. Chu

is the best management at this time as you are trying to make sure all viable tissue survives.  What can you expect?  Eventually the scabs will fall off and if significant tissue damage has occurred, that will have to be debrided during your weekly visits as all dead tissue must be gone before real healing starts.  The size of your defect will be determined by just how must tissue is necrotic.  Wound care continues and eventually the wound starts shrinking and filling in and it heals over time.  So do things only when indicated... and some docs use wound VAC's to expedite the healing process but it usually adds cost unless covered by insurance so you can go without if you are patient.

The degree of necrosis shown in the photo looks relatively mild and limited to the edge of the wound rather than a large territory of the tissue between belly button and the incision. Often the surgeon will allow this tissue to start demarcating and separating the dead black scab from healthier fat. This will then be lifted off (debrided) by the surgeon and the deeper healthier tissue allowed to "granulate" to closure. Sometimes this is treated with Silvadene cream or other topical antibiotic ointments for prophylaxis against infection but in other cases, simple dry dressings until the eschar lifts may be best. Follow your surgeon's recommendations.

Although I understand your concerns, sometimes it is best to "do nothing" and allow the dark tissue (as long there is no sign of infection) to serve as a "biologic band aid".  You may be pleasantly surprised once the eschar lifts and the underlying tissues are healthy. Sometimes, when the eschar lifts, wounds look "worse before they look better";  some patients benefit from dressing changes for a period of time. Overall, I think that  the area of involvement in your case is quite small and you should do very well long-term. Best wishes.

Thank you for your question and the photo. It is very important to discuss with your surgeon an effective protocol for wound healing that you will be able to apply everyday. Hopefully you will not lose a lot of skin during the process . Best of luck

you may lose some of that skin, hopefully just the superficial portion.  Ultimately, with wound care that will heal and may need a small revision later.