Four weeks post surgery and the wound is still open and has black spots. (photo)

Dear Dinah,I am so glad that Realself can provide a way to really provide guidance to folks after surgery. Alaska to San Diego...you really worked for this surgery! I think it was a good decision to post your photos here.What I see in your photo is not so much frank necrosis as it is...in simple terms...a scab (okay, on a scientific level, there are some necrosed epidermal cells, but I also see areas of healing.) Yes, a bit of the epidermis has lost its blood supply, and it isn't alive anymore. But from your photos, it is minimal, and I think you will recover well. I see general signs that indicate collagen synthesis and healing, and this looks like your body is taking care of the epidermal layer that needs to be discarded. Ultimately, this layer will be replaced by healthy scar tissue. Don't be concerned if things look yellow or gooey for several days as the necrosed tissue sloughs off. (Foul smell or frank pus would be concerning, but I doubt you will see that.)The secret to wound care is: not too dry, not too wet. Bathe normally, pat dry, don't pick and I think this will heal well.Please feel free to update us on your progress, and I hope you feel reassured, as I think things look okay. Congratulations on your surgery, and I hope your recovery is a good one.

It's very common to have some separation after surgery.  Just make sure your plastic surgeon is following you to ensure adequate healing.

From the photographs I don't see anything to be particularly alarmed about. It's important to keep the area clean and protected. You should be in contact with your plastic surgeon by phone or the Internet however.

You do have some minimal necrosis of the wound edge, which is not uncommon after surgery.  This can happen even when the surgery goes perfectly.  This will heal with appropriate wound care.  Please send your surgeon some photos and his office will be in contact with you on how to care for the area.  It should heal with time and you should be fine.

I'm sorry to hear about the concerns you have after tummy tuck surgery. Incision line separation and/or wound healing problems may occur after tummy tuck (or any other type of plastic surgical procedure).  After tummy tuck surgery, these incision line wound healing problems may occur anywhere along the incision line but tend to be more frequent along the midportion of the tummy tuck incision line. This area is where the greatest amount of skin/tissue has been removed, where the greatest tension exists, and where the blood flow is the “weakest”.   You may find that  it will take several  additional weeks to heal with dressing changes.   Sometimes, the  incision lines may “look worse, before it looks better”.    Careful attention to a well-balanced diet may be helpful.   Although these incision line healing problems are understandably anxiety provoking for patients, generally, (in the longer term)  patients do well; some may benefit from scar revision surgery down the line.I would suggest that you continue to keep in communication with your plastic surgeon and continue to be patient  through the process.Best wishes.

After a tummy tuck there may be some areas of redness and even skin necrosis.  It is important to keep this area clean and apply an antibacterial ointment or cream.  Be certain to let your surgeon know about this and send the photos to them.  They will be able to help give you a wound care program that should help this heal.  I think you should be able to take care of this without returning to San Diego.  But if you develop a fever, chills, or significant drainage, be certain to seek medical care ASAP.  Best wishes.