Necrosis after tummy tuck and PS doing nothing. What can I do about it? (Photo)

Thank you for your pictures. Wow, it looks like he had suffered from some skin loss but it seems to be improving. I would recommend debridement of the dark areas to get down to healthy tissue to allow for quicker resolution.

Unfortunately you do have necrosis of your skin.  There is not much that can be done at this point, but you should be reassured by the fact that the areas are small and will heal.  Debridement could help.  There may be a reason why your surgeon does not wish to do this, please ask him.  The best person to treat this is your surgeon.  Please continue to see him for your follow up care.

Sorry to see that you're having this complication. Unfortunately skin loss and wound healing complications are a risk with tummy tuck surgery. Because it has been only three weeks, I think your surgeons advice is good. It is typically best to allow the body to heal as much as possible prior to debridement. This will allow the necrotic areas is to "declare" themselves. A more focused debridement can then be performed. Skin and underlying tissue that is obviously necrotic or infected needs to be surgically removed to facilitate healing, however it does not appear that you're at that point based on your pictures. Of course it is difficult to make this determination without a physical examination. Your recovery will now be lengthened, however you will get through this and heal adequately over time. Try to maintain a positive attitude. Best wishes.

Keep listening to your plastic surgeon.  It seems that you are improving with conservative treatment.  That is the best thing to do at this time.  There are many wound care options to choose.  Seems you are on the right track.  I agree with Dr Pousti that you most likely will need additional surgery in the future.  

You certainly have necrosis, although the deep extent cannot be determined from photos alone. Removal of the dead tissue will improve the rate of healing. Cocoa butter is not going to help heal this wound. While it is likely to heal, appropriate wound care is necessary. It is likely to take several weeks if not months to completely resolve. Keep close follow up with your surgeon in the meantime.

You need weekly in person care. I use PRP + AFSC infusions to speed healing. You can see me or any of the over 80 boarded PSs in South Florida for appropriate care for for postop issues. 

It appears that you have some necrosis of the skin. You will need to have the area debrided at some point. But I agree with your PS that you need the heal the area before any further surgery. Any attempt at closure too early could bringire tension to your incision line and cause more necrosis of the skin. Unfortunately this may take up to 3-6 months before any revisional surgery. You have to be patient and maybe speak to your PS and have him give you a time line on healing and expectations. 

 I am sorry to hear about the complication you have experienced. Generally speaking, I think that your plastic surgeon is giving you good advice. Although additional surgery will likely be necessary (for example to remove unhealthy/nonviable tissue), it will be in your best interest to allow for your tissues to “recover” as much as possible thereby avoiding the potential removal of healthy tissue… Unfortunately, things may look worse before they look better but I would suggest continued (and very close) follow up with your plastic surgeon who will always be your best resource. Best wishes.

As plastic surgeons it is always difficult to go through this alarming complication with a patient because there is nothing better than wound care and time that will heal the damage.  It appears from your photos that you are improving and what may have been a much larger problem is turning out to be less than may have been feared initially.  The black parts you see are called eschar and as your body starts to push them away they can be removed in the office fairly painlessly.  Your surgeon may then switch you something called a wet to dry dressing.  For awhile the wound may look worse, but you will then start to see pink tissue starting to form around the edges of the wound.  As the dressings pull away the little bits of remaining dead tissue and "icky yellow stuff" more and more of this tissue (called granulation tissue) will develop.  This is what is going to start filling in the defect and pulling the edges together.  It takes weeks; usually 8 or more to heal completely. Later the scar can be revised.  I know your are thinking there must be something more that could be done, but there really isn't for wounds this size.  Believe me, you surgeon is privately agonizing over this and wishing he/she could do anything more.  All you do is take it one day at a time. Good luck!

There is no doubt that you have had some circulatory compromise to the skin of the abdomen below the navel,  it some of the circulation still must remain adequate to see some recovery of the skin color.  I would culture any discharge fluid that may be formed and treat the infection properly with antibiotics.  Surface wounds need to be treated with proper cleansing and application of Silvadene or Bactroban ointment.  Any dark tissue on the skin surface will require deridement.  This will be a delayed process for you to eventually heal up.good luck to you.FrNk Rieger M.D.  Tampa Plastic Surgeon