Dear jr_leggett2001,It can be very discouraging to watch wounds continually worsen when you feel like you are doing everything correctly, but there is an explanation. The size of the surgical wound is essentially from the incision up to the rib cage, and the blood supply keeping the flap of skin and fat alive comes in from the above the rib cage and the sides. The hole made to bring up the belly button, as well as any pre-existing scars, excessive tension, fluid or blood collections under the skin, and excessive pressure can all compromise the blood supply somewhat, and the area most vulnerable to injury is the lowest center portion of the incision. Other physiologic factors can also come into play (diabetes, poor nutrition, vascular disease, connective tissue problems, anemia), and smoking or nicotine use is a huge problem.When the tissue is compromised, the underlying fat is far less hearty than the skin. If you see the skin start to die back (form a scab), you can be very sure that the injury the underlying fat is much more extensive. It can take several weeks for the wound to demarcate, or give a clear border to what tissue is viable (alive) or necrotic (dead). If there was no skin or wound edge necrosis, the seroma (fluid under the skin) may have built up enough pressure to compromise the deeper tissue and ultimately forced the incision open to drain.The body will gradually clear the dead tissue, but surgical debridement can speed this process. The dead tissue serves as a nice home for bacteria, so it is best to not let too much sit around for too long. Other ways to remove the dead tissue are wet to dry dressings, enzymatic debridement ointments, silver impregnated dressing, and harsher products (like peroxide or bleach solutions) serve kill bacteria and keep the wound cleaner. The wound will start to heal once the dead tissue is gone and the healing cells can take over. Continuing to use harsh products can kill these healing cells, so wound care choices often change to maintain a moister and less disruptive environment. Alginate dressings are great, and now that there is less necrotic tissue the risk of infection drops significantly. Wound Vacs (negative pressure dressings) are absolutely amazing at closing wounds quickly, but can be cost prohibitive for cosmetic procedures. Now the dressings may be changes far less often (depending on the products used) as the wound continues to improve. It is important that the wounds heal from the bottom up, and sometimes you can see the skin start to contract and close faster than the bottom, and it is helpful not to let that happen. Over packing a wound can actually stop the wound from starting to close in, so again instructions often continue to change as things heal.That was kind of a long description, but hopefully it was helpful. Your wife's wound looks very healthy at this point, and I would expect it to continue to progress nicely. It may have a wider scar or contour change compared to the other areas, and this could easily be revised longer term with local anesthesia.
