Fleur De Lis Tummy Tuck, Do I Have Necrosis?

I'm glad you are not a smoker or are around anybody that smokes, as this area of dead skin would likely have been significantly larger and more difficult to manage. Poor circulation can occur in tummy tuck flaps even in non-smokers, which is why it is so important to avoid all tobacco products when doing this procedure for the "casual" smoker or non-smoker exposed to nicotine gum, patch, spray, or even second-hand smoke!

You do have dead skin--that's the black area. It's not a scab, that is dead, dry skin beneath which there is a zone of dead fat. Warm, wet, and dead is a culture broth for bacteria so you should be on antibiotics to protect the living tissue adjacent to the dead tissue, and should have debridement sooner rather than later to allow marginal tissue to survive rather than suffer additional loss. You will have to do dressing changes for some time, and while the vac system can help clean up a wound faster, it can cost  a fair amount if not covered by insurance.

You will have additional scarring, but it will be surprisingly less than you think after seeing the debridement wound. Please be aware that the small black "scab" becomes a huge deep hole in some cases, which is why many surgeons will hold off surgical debridement as long as possible (sometimes too long, and then these patients end up going to other plastic surgeons or end up in the emergency room). Don't be that patient; see your surgeon as often and as soon as recommended. Good luck; it will take a bit longer and may require one or two minor procedures, but you can end up with a nice tight abdomen and good result!

Thanks for posting pictures - it makes it much more informative for other patients and easier for us to answer your question.  Yes, it does look like you have a small area of necrosis.  If you post a before pictures, it may be even more informative to see how extensive of surgery you had.  From looking at your pictures, there does not appear to be any surrounding erythema or signs of infection.  My advice would be to follow closely with your surgeon.  While it will take some time to heal, the area is small enough that once healed, it will be minimally noticeable.  

 

Good luck.

You do have an area of full thickness skin loss.  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.  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.

Unfortunately, it appears that you do have necrosis of tissue.   There are elements of both skin and fat loss.   Conservative wound care will heal the wound.  Management of this wound should be under the care of the surgeon who performed the surgery.   You should heal and if necessary, a revision or touch up   I editton this involved area can be performed.   It is not unreasonable to believe that you will have the tummy tuck results that you wanted.   It will just take a little longer.   

yes you do. take the tape off, start wound care. your surgeon will get you through it. the ultimate result may require a revision to be maximized. for now it is important to not let an infection extend the area of necrosis. good luck

Hello,

 

From what I see you have likely a little bit of necrosis at the junction of the Fleur De Lis where you would expect it might form after such a tummy tuck. You need to have your surgeon see you frequently. These can heal over weeks or months. I would not disrupt it but do what your surgeon advises.

 

Good luck.

 

Best Regards,

 

John Di Saia MD

 

It looks like you may have an area of necrosis at the "T".  More than likely this can heal in on its own but may take several weeks.  Smoking certainly can increase the risk, but it can happen to non-smokers as well.

You do have some necrosis, which can happen in non-smokers but is much more common in smokers. The area should heal surprisingly well with time and may not even need a scar revision. You will need serial debasements until clean and can use a wound vac but that is expensive and hard to lug around everywhere with that noisy machine. It is just as effective to use good wound care with daily betadine wet to dry dressing changes. After there is healing, the area can be assessed for a possible scar revision.

Yes you do have necrosis and this involves the skin and a degree of the underlying fatty tissue.  When this complication occurs it is related to circulation issues and you do not need to be a smoker to have this happen.  Fortunately, with good care, this can heal and sometimes patients will need a revision and other times it heals well enough not to.  Let your plastic surgeon take care of this for you.

RE : "had a FDL TT 16 days ago and I am concerned I have necrosis. First let me say, I am not a smoker, never have been, nor am I around smokers. At the T intersection, I have one area that turned black and bubbled up, after the bubble up area popped and that skin came off it turned into a hard black scab that is sunken. The skin around that area is also hard. It doesn't hurt and it is not weeping but I am concerned that when that black scab comes off there will be no skin there. Treatment???"

You are correct. You do have tissue death at the intersection. It is hard to asses how extensive the process is because of the tape but you appear to have some fat death under the skin along the right side of the photo.

Dead tissue does not have a blood supply and as such cannot be treated with antibiotics. On the other hand, bacteria live well in dead flesh and can repeatedly invade the normal flesh next to them. For this reason, the next step would be to take you to the operating room and remove all the clearly dead and borderline tissue in that area. Most surgeons would then either put you on aggressive dressing changes or use the VAC - a suction device which removes dead flesh and fluid from the wound leading to quick wound filling and healing.

Your questions do concern me. Where's is your surgeon? Why hasn't he answered these questions and cleaned the wound already?

Dr. Peter A Aldea