Is my wound getting better with applying Silvadene twice a day? Does it need debridment? (photos)

Hello. Great question. Thank you for your pictures. Based on your images it seems as you need to following up with your surgeon and following his or her instructions. Best of luck with your recovery. Congratulations on your tummy tuck.

Dear Kind4160,
this type of wound is not uncommon after tummy tuck. It is usually caused by poor blood flow and increased tension. Based on your photos, it looks like you have an area of necrosis and you will need a debridement in order to remove all the dead tissues. Once it is removed, your wound will start to heal and close. 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

thanks formyou question. Silvadane is enough  ı think. There is significant difference between these photos. Get well soon.

I'm sorry you are having issues after your tummy tuck.  The necrotic tissue of your wound will need to be removed.  This wound should be followed closely by your surgeon who will advise you on the proper care.  I encourage you to discuss any changes and all concerns so that you may feel confident in the recovery process.

I am sorry to hear about the complication you are experiencing.  These types of complications can be quite (understandably) distressing to patients;  unfortunately, often the area will likely look worse before it begins to look better. The area of necrosis tends to occur where incision lines come together (where there is the greatest tension and least blood supply).

Close follow up with your plastic surgeon will be very important; sometimes removal of exposed sutures and/or removal of any unhealthy tissue (debridement) will expedite healing. Timing for debridement will depend on how you are doing clinically; online consultants will not be helpful in this regard. In many cases, as long as there is no sign of infection, leaving the eschar in place ( which may serve as an "biological Band-Aid" may be the best course of action.  This course of treatment may also help when it comes to avoidance of removal of healthy tissue during the debridement process. There may be different treatment modalities recommended; best to "stick with" your plastic surgeons recommendations. Generally, this will involve application of some type of sterile dressing ( in my practice I use a non-stick dressing covered by a sterile dressing once a wounded is clean).  If/when an open wound is present, "wet to dry" dressing changes may be helpful when it comes to gently deriding the wound. It is likely that eventually you will end up with a wound that is "beefy red" (granulating) in appearance;  at this stage, you will find that the wound will heal relatively quickly. 


 These types of wound healing problems generally go on to heal over the course of the next several weeks (possibly months depending on wound size). Also important to concentrate on a healthy diet, including good protein source.   Obviously, avoid nicotine, in any form,

Sometimes (depending on the width of the open wound and the appearance of the scar in the longer term), scar revision surgery may be helpful down the line. Best wishes.

Thank you for your question. I’m sorry that you are having problems. This is an area of full thickness necrosis. Eventually, this area will need to be debrided and later revised. This should not be done now as the wound will become larger. All the necrotic area to fully declare its extent and then allow your PS to o determine when is the right time for debridement. Be prepared that the wound will look much worse before looking better. Once debrided, it will look large and deep until heathy granulation tissue is allowed to start filling in the defect. At that point the wound will begin to contract. This will be a fairly lengthy process that may take up to 3 months to completely heal. Rest assured, however, once things are healed the scar can be revised.