What causes necrosis in tummy tucks?

Skin necrosis can occur if the skin is made too tight it if the patient is a smoker.  Large areas of necrosis are rare.  Most are minor areas along the incision that go on to heal gradually on their own.  A pulmonary embolism starts as a clot in the leg that may then travel to th lungs and us a serious complication.  Avoidance includes the use of compression stockings at the time of surgery and early walking to keep the blood flowing in the legs.  Some surgeons may also use blood thinners during and after tummy tucks in high risk patients.

You clearly are doing your homework. Good for you. The more educated you are on your procedure the happier you will be with your results.Necrosis is caused by compromised blood supply and tension. We raise the skin knowing where the key blood supply to the abdominal skin is and preserving it. Tension is also monitored with closure. If the blood supply is compromised during surgery or there is a variation in the anatomy blood flow to the skin can be compromised leading to healing problems. Too much skin removed placing increased tension on the wound can lead to healing problems. Garments that are too tight or poorly placed can lead to compromise of blood supply as well.Pulmonary embolism is caused by pooling of blood in the legs. Compression stockings are used during surgery to minimize this from happening and early ambulation post surgery is important after. There are risk factors which are unique to individuals and your surgeon would determine those during your consultation.Seek out a board certified plastic surgeon for consultation to give you all the information you need to make a great decision.

Large flaps are elevated during an abdominoplasty which compromises the blood supply to the skin. If the compromises too much skin can be lost resulting in what is called necrosis.

The major items that cause necrosis are #1 smoking, #2 diabetes, #3 caffine, #4 over dissection of the tissues.Here are the major points of smoking Tobacco or Marijuana before or after surgery:1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke. Hookah also does not decrease nicotine.2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.Best wishes,Pablo Prichard, MD

skin necrosis during a tummy tuck occurs when not enough blood supply  is getting to the skin after tummy tuck.There are a variety of factors that can increase the chance of skin necrosis during tummy tuck.  Tobacco smoking is one of the prime risks for skin necrosis.  The nicotine causes the blood vessels to the abdominal skin to contract spasm and reduced blood flow.  Other potential causes are any type of blood vessel disease such as autoimmune disease, diabetes, high blood pressure, all influence blood supply and can impact the chance of skin necrosis after tummy tuck.  Extensive liposuction during a tummy tuck can also damaged blood vessels and lead to skin necrosis.  Prior abdominal surgery that has disrupted blood supply can also precipitate skin necrosis.Pulmonary embolism can follow thrombophlebitis or blood clots in the legs.  Any surgical procedure increases a theoretical risk of thrombophlebitis.  That is why pneumatic boots that massages the legs and encourage venous return during surgery are routinely used.  In addition compression stockings and ambulation or walking to increase muscular activity in the legs is routinely done in an effort to prevent thrombophlebitis.

Tissue necrosis means areas of dead fat and/or skin.  During many plastic surgery procedures, the surgeon needs to cut the normal blood vessels and nerves that supply the skin to be moved.  This maneuver is necessary to accomplish the surgery.  We count on the secondary blood supply (the subdermal plexus) to keep the skin and fat that have been moved alive until new blood vessels grow in at about two weeks.  If the blood supply in the subdermal plexus is not strong enough, the furthest edges of the tissue can die.  Smoking is one very strong factor that increases the risk of necrosis.  Bleeding underneath the skin (hematoma) can contribute to necrosis, as well.  Obesity and certain medical conditions, like diabetes, are associated with an increased risk of necrosis.