Fat Necrosis After Tummy Tuck What to Do? Update (photo)

Thank you for the question and updated photos.

I think you and your plastic surgeon are treating the fat process appropriately. It may be that, given the new onset odor,  that further debridement will be beneficial. Your plastic surgeon will be in the best position to determine the need for debridement once he examines you.

Generally speaking, it is best to allow for the unhealthy tissues to “declare themselves” ( as yours has done). This will prevent unnecessary debridement of potentially healthy tissue.

You will find that after the debridement wet to dry dressings may be beneficial. The open won't will gradually heal. I would suggest paying attention to the protein in your diet as well.

I hope this helps.

Odor relates to bacteria residing in warm, wet, dead tissue. Better cleansing will eliminate this. To accomplish better wound care, you should perform more dressing changes per day, let the dried "stuff" stick to the gauze as you pull it away (in other words, do not moisten the dressing so it comes out easily), and feel free to gently scrub the wound with a soft-bristle toothbrush! This accomplishes what your surgeon did when he "cleaned the wound with instruments." Remember, if light bleeding occurs, healthy tissues bleed, whereas dead tissue does not, so don't let a little red ooze scare you!

Your instruments are a bit less metallic and sharp, but you can (and should) accomplish the same goal with daily wound toothbrush scrubs in the shower, more frequent wet-dry dressing changes, and follow-up with your surgeon as recommended. Please verify that your surgeon is in agreement with any recommendation from someone who has not seen your wound in person (all of us), but rest assured that this will continue to heal and leave a remarkably smaller scar than you now suspect.

BTW, hydrogen peroxide is sometimes recommended for an infected or contaminated wound. It is OK for once or twice, but chronic use can actually slow healing, so stick with soap, water, scrubbing, and bandage changes per your surgeon's advice. Good luck!

When there is fat necrosis it means a strip of fat is dead. Your ps has debrided or cleaned the dead fat out which is good. But there is always still a little patchy bit of fat necrosis left which will take time to separate and come out on the dressings. This is the reason for the packing. If you change the packs often it will lessen the odor which will diminish over time anyway. You are being well and appropriately managed all the right things are happening but it's a slow and frustrating period fo you. The wound will close and it will be a nice result when that happens. You will be surprised how the scar looks thin once the defect shrinks down and closes. This might take up to 2 months.
Good luck.