Had DIEP Flap Surgery - Incision on Belly Splitting Badly

Question

I had DIEP flap surgery 4 weeks ago, breasts are fine, some issues with the tummy incision. my incision started to separate 3 weeks later. saw my PS and he saw infection, so I am on an anti-biotic now, and he said to keep a dressing on it, keep an eye on my temp. I see him in another week to take a look I am an ex-smoker, quit a few weeks before surgery. I have searched everywhere for information but have come up dry. about 1/2 inch deep and 6-7 inches along my incision

Martin Jugenburg, MD · Answer

Wound dehiscence, wound breaking open after surgery, is a potential complication after DIEP or tummy tuck (or any surgery). It is not a life-threatening problem, but an annoying one. At this time the treatment is wound care. Use of VAC therapy can be helpful and speed up your healing. Google VAC Therapy and ask your surgeon if he thinks it would be helpful.

Sincerely,

Martin Jugenburg, MD

Sincerely,

Martin Jugenburg, MD

Nia Banks, MD, PhD · Answer

It sounds like you and your plastic surgeon are on top of things.  You have quit smoking and your infection is being managed.  Whatever the dressing change, a clean, moist (not wet) wound heals best.  You can consider a scar revision once things have healed in but it's doubtful that you'll need it.  DIEP flap reconstruction is a highly complex operation and it's wonderful that your breasts are doing well.

Paul Gill, MD · Answer

This is an unfortunate complication seen more commonly in ex-smokers.   In order to optimize wound healing, I recommend multivitamin, protein supplementation, and a well balanced diet. 

	 

	In regards to wound care, it may be necessary to undergo a debridement procedure to remove any nonviable tissue or fat necrosis.   As described by my colleagues, a wound vac may be helpful to speed up the healing process.  

	 

	Lastly, be careful of excess tension on your incision.   Aggressive pull on the closure can quickly turn a small wound into a large wound.  

	 

	I wish you a safe and healthy recovery.

Robert Whitfield, MD · Answer

It is an unfortunate complication with the low transverse incision used for tummy tucks and the DIEP flap.  This wounds have a tension when they are closed in the operating room.  In most instances this area relaxes over the next several week.  Breakdown most often occurs near the middle of the incision over the pubic area.  This point is now further from the blood supply and is usually under the most tension.  ALTHOUGH IT IS GREAT THAT YOU STOPPED SMOKING.  This happens even in patients who don't smoke although far less frequently.  Follow the instructions of your surgeon and with dressing changes and time this wound will heal.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.

If
you are interested in being seen in Austin please give us a call.  I know
this is a difficult time for you.  The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Kamran Khoobehi, MD · Answer

you have a common complication after abdominal surgery on smokers. Do not worry and your wound will heal. May need to start wound vac. This a special wound care after the infection is resolved.

Steven Wallach, MD · Answer

Welcome to the bad world of smoking,. Even when you quit, there are high risks of wound complications from surgery. In all likelihood this will go on to heal conservatively, but you should follow closely with your surgeon.

David Greenspun, MD, MSc · Answer

I agree with the other surgeons who have responded. Wound complications and infections can occur after DIEP flap surgery and it sounds like your surgeon is working to help get the wound closed. The human body has a remarkable ability to heal in situations like this. Make sure you continue to see your surgeon regularly. It sounds like this will take some time to fully heal, but in most cases, it will not compromise your results in the end.

Samir Shureih, MD · Answer

With suvh an extensive surgery, history of smoking, these complications are not uncommon. You seem to be treated very well, with a responsive plastic surgeon. Wound care and antibiotics and follow up.

	You may want to discuss the addition of wound vac, and home health care coming to the house to change the dressig on the wound vac.

Darryl J. Blinski, MD · Answer

Sounds like your surgeon is providing acceptable care. But you may need more in person observation. Ask for home nurse care for dressings changes daily or every other day. Or ask to be seen in office 3 times a week. This will alleviate some of your anxiety. From MIAMI

Had DIEP Flap Surgery - Incision on Belly Splitting Badly

Answers (9)