TT Infection? What should I be putting on this wound? (photo)

Question

This wound showed up several days after surgery. I've been putting silvadene (sp?) on it, cleaning it with iodine. Last night I put xeroform medicated gauze on it then switched to medicated honey and covered it with a small gauze . I had SX in the Dominican and can't get an answer from my actual surgeon. The wound isn't ozing it doesn't have a smell. Any advice would be greatly appreciated.

Jed H. Horowitz, MD, FACS · Answer

Within a few hours following surgery, abdominoplasty patients will walk in a slightly bent-over position. Strenuous activity and lifting of more than 10 pounds should be avoided for six weeks after surgery. Most patients are able to return to work and daily activities within two weeks of surgery.Swelling can persist for several months and will gradually improve and will look better at three months, six months, and even one year. Frequently the pubic area and the scrotal and penis area for men can become very swollen and discolored during the first two weeks due to gravity as this is the lowest area for swelling to accumulate. You can return to full activity without restrictions at 6 weeks.It may take several months for a tummy tuck patient’s scars to soften, for sensation to return, and for relaxing of the tight sensation in the abdomen. In the case of extensive surgery, abdominoplasty recovery can be uncomfortable and may take longer. Scars may stay red, become thick or widen. It can take 12-18 months for the scars to settle.These can be improved with topical treatments such as BioCorneum, Scar Guard, Scar Fade and Mederma. Redness can be improved with laser treatments and the scars can be kept narrow with products such as Embrace.  On occasion, keloids or hypertrophic scars can develop and will need treatment including Kenalog, 5FU and laser.As questions arise with the healing process, regarding swelling, scars, infections or others, it is always best to visit your surgeon to have the area examined and make sure that healing is progressing as it should. There is always the potential for a problem and your own surgeon knows your personal case the best and can give the most experienced advice. Good luck.

David Shifrin, MD · Answer

Here in lies the issue with going to the DR or any other medical tourism destination. While you saved money up front you have no real follow up. You need some TLC with wound care and debridements and a scar revision later. I'm sorry you are in this predicament. Call around to get follow up in your area or go to the emergency room. You may have to pay a local plastic surgeon for ongoing follow up care or just accept whomever is on call at your local ER.

Scott E. Kasden, MD, FACS · Answer

Hi TsonFirst, this does not appear to be infected, it appears to be dead tissue resulting from inadequate circulation.  Therefore, get that compression off of it.  The Silvadene with twice a day showers should be OK until....I think you can forget about your D.R. doctor, he obviously isn't interested in you anymore.  I recommend most strongly that you get with a plastic surgeon locally to guide you during your complicated wound healing.  If you are unable to get plastic surgeon to assist you, ask your family doctor for a referral to a wound care center.  Do this tomorrow.sek

Luis A. Fernandez Goico, MD · Answer

Hello, Thanks for your question and photos. Truth is, the aspect of the wound does not look infected, but most of the dermis is gone (the yellowish tissue you see is fat) and it needs to be addressed for two main reasons: 1) avoid an infection and 2) it can still be save and you have a nice tummy tuck scar. I would seriously advice you to contact your surgeon. Have a nice recovery, Dr. Fernandez Goico

Ven Erella, MD · Answer

Thank you for your question. Recommend deride locally in the office . Please talk to your PS for evaluation.

Karol A. Gutowski, MD, FACS · Answer

This does not appear infected but you really need an in person evaluation for proper assessment and treatment recommendations.

Daniel Krochmal, MD, FACS · Answer

I recommend you have a consultation with a local plastic surgeon who will evaluate the wound. You may need a wound debridement procedure to cut out the dead tissue.

And please tell all of your friends, if you travel for plastic surgery, it is essential to have a back up plan once you get home if you have a complication.   Surgery in the DR is cheap partially because they don't need to provide any aftercare, which your surgeon locally would include as part of the procedure.

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