What causes skin to lose circulation during or after surgery?

What can a doctor do to reduce the risk of necrosis?

Doctor Answers 5

Skin necrosis

Great question.  Anything that reduces blood supply to the skin can contribute to wound healing issues and necrosis.  Smoking before or after surgery can significantly impact on wound healing after surgery.  Other factors include, infection, hematoma, extremely tight closure which causes pressure on the sutures, and conditions such as diabetes.  Risks are minimised by closely following your surgeons pre and post operative guidelines.

Sydney Plastic Surgeon
4.7 out of 5 stars 48 reviews

Body lift - causes of skin necrosis

Thank you for asking about your body lift and skin necrosis.
  • If you have had a body lift and have some skin necrosis - I am sorry you are going through this.
  • There are many many reasons for skin necrosis - they include -
  • the patient being a smoker, obese and diabetic, all of which affect skin blood flow.
  • Or infection after surgery, excessive swelling after surgery, excessive pressure on the suture line after surgery and tension on the body lift suture line, usually as it crosses the lid line, in front or back. 
  • The surgeon can reduce the risk by doing her/his best to avoid these and other factors that increase the risk.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Skin necrosis

During body contouring surgery, flaps of skin and soft tissue are elevated, pulled taut, careful tailored, and then sutured closed.  During the dissection that elevates the flap, some of the blood supply to the tissue is compromised, but our understanding of anatomy has allowed us to design procedures that leave sufficient blood supply to permit healing in most cases.  Anything that further compromises blood supply can lead to wound healing problems, dehiscence, and necrosis.  As my colleagues have noted, pressure on the flap due to a tight closure, hematoma beneath the flap, or excessively tight garment could alter blood supply.  Nicotine is a potent constrictor of blood vessels to the skin, as well.  Ice packs and dehydration will lead to decreased perfusion of the skin.  Furthermore, patient factors such as microvascular disease from diabetes or severe anemia can compromise perfusion.  Hope this explanation is helpful!

Larry Lickstein, MD
Fairfax Plastic Surgeon
4.3 out of 5 stars 39 reviews

Losing skin circulation during or after surgery

Thank you for your email. There are many causes for losing circulation of skin either during or after surgery. I suggest all my patients to stop smoking which had detrimental effect on skin circulation. If the stitching is done under tension then, the skin can lose its circulation. If there is a blood clot underneath the skin pocket , it can increase the chances of losing skin circulation. Tight compression garment and excessive movement can also compromise skin circulation in the postoperative period.It is very crucial to avoid such complication in body contouring procedures. With best wishes,

Shailesh Vadodaria, MD
London Plastic Surgeon
4.4 out of 5 stars 7 reviews

Skin necrosis

Pulling skin so tight that it decreases perfusion will cause tissue necrosis. If patients use nicotine products before or after surgery they will be at high risk for skin necrosis.

Mark Deutsch, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.