I Had Fat Necrosis After Abdominoplasty. What Can I Do To Speed Healing and Reduce Scarring? (photo)

Question

I’m 4 wks post op after abdominoplasty. A week ago, my PS dx fat necrosis at the incision under my belly button most likely related to an underlying draining seroma. My PS removed the necrotic tissue. I have been showering 3 times a day, dressing with sterile dressings and antibiotic ointment. Is there anything I can do to decrease the healing time and insure minimal scarring? How long should it take to heal at this highly stressed portion of my incision?

S. Larry Schlesinger, MD, FACS · Answer

Your wound is very clean with a good bed of what is called granulation tissue.  Wounds heal by two processes. One is contracture which is what has to happen to bring the wound together.  Two is epithelization which occurs once the two edges of the scar are much closer together. 

	Your Real Self team of plastic surgical experts agree that Regranex topical and a wound vac will speed the healing.  These are both outpatient modalities which your plastic surgeon has access to. 

	Each plastic surgeon has his or her own techniques for wound healing,  What happened to you was a known complication, and retrospectively will just be a bump in the road once the wound is closed.  Stay in close contact with your plastic surgeon.  Tell him or her about your concerns.  When things go wrong, most Board Certified plastic surgeons give extra special care until things are righted.  I am sure your plastic is there for you.

Robert B. Louton, MD · Answer

Based on the photograph you provided it would appear that your wound is free of debris and on the road to healing.  The process of wound healing in a non smoker is around three months from the surgery date (over twice that for smokers).The wound should be allowed to heal on its own with just a simple gauze dressing.  All of the techniques used in wound clinics such as wound vacs and topical medications are unnecessary and tend to cause over manipulation.  This invariably slows the healing and should be reserved for problem wounds only (ie diabetic foot ulcer, etc..).The typical fallout from this complication is that a larger scar will form which can be dealt with after one year has transpired.Stay with your plastic surgeon as he or she is your best chance for an uneventful recovery.I hope this helps.

Remus Repta, MD · Answer

Hello Parker,

	Thank you for the question and the photo.  Your wound looks like its currently clean and healing.  It will take a month or so for the granulation tissue to build up and then for your skin to resurface.  As long as you do not smoke and take good care of yourself time will be the biggest component of your healing.

	All the best,

	Dr. Remus Repta

Jeffrey Zwiren, MD · Answer

An area of marginal necrosis in the middle is not uncommon. This is the area that is the furthest away from the blood supply and under the most tension. These areas generally take about 4 - 6 weeks to fully heal. Many times the scar will look just fine and other times you may require a relatively simple scar revision. If it is a large area such as yours a revision may be more complicated. The wound appears to be granulating which means it is beginning to heal. Treatment with antibiotics is only needed if you show signs of an invasive infection. Simple wound care is all that is required at this time.

Kris M. Reddy, MD, FACS · Answer

Your surgeon seems to be taking the proper steps. You may ask your surgeon if he/she would advise the use of regranex or a wound vac. Healing will occur in 4 - 6 weeks.

Todd C. Case, MD · Answer

The wound will heal with conservative measures (dressing changes), but will like take a month or two.  You may be able to enhance the healing process with either the use of Regranex ( topical) or a wound vac device.  Both of these may be covered by your insurance, but you would need to check with your carrier.  However, chances are that you will end up with a depressed scar in this area which you may wish to have revised 6-12 months after the wound is fully healed.  Time will tell.

Paul Gill, MD · Answer

Thank you for sharing your pictures. I think your plastic surgeon is treating everything correctly. I find the key to fast healing is meticulous aftercare and close followup with your plastic surgeons. The more frequently the wound is cleaned and monitored, adjustments can be made to help expedite closure. At this stage, you have a layer of healthy granulation tissue and I would recommend a wound vac to promote faster healing.

Darryl J. Blinski, MD · Answer

Appears as if you are receiving excellent care. Full healing of the area, as seen in the posted photo, will be done in 6 weeks.

Johan E. Brahme, MD · Answer

It sounds like your surgeon is doing all of the appropriate things. One thing which you may consider is adding a medication called Regranex, which has been shown to aid in wounding healing. However, the downside is that it is very expensive, however it does cut wound healing time in approximately half. If you have medical insurance your drug plan may cover the expense. You should inquire with your plastic surgeon whether he thinks this would be beneficial for you. Good luck

Brian Klink, MD · Answer

Aside from the care you have received, the most expeditious way to decrease healing time is with a wound vac. This applies negative pressure to the wound and improves blood flow and makes dressing changes much easier and less frequent. Good Luck

I Had Fat Necrosis After Abdominoplasty. What Can I Do To Speed Healing and Reduce Scarring? (photo)

Answers (12)