When Will This Necrosis After Tummy Tuck Heal?

Question

Hello, I recently had a tummy tuck (never smoked in my life) and at 7 days post op I developed a blood filled blister. It was removed while removing my tapes and now looks like a black crusty necrosis. 11 days post op, hte black part was scraped off (debridement I assume). I am using silver sulfadiazine, and my PS is seeing me regularly. How long will this take to heal? Is debridement necessary or can this heal on it's own? Thanks!

Ryan A. Stanton, MD · Answer

So far so good, your plastic surgeon is doing the right thing for this not so infrequent complication after TT.  Be patient, it can take 2+ months for complete healing.

Jonathan Saunders, MD · Answer

this has happened to all of us at some time. it is important that everyone remain patient and calm. it looks like all the correct things are being done. i always warn patients that silvadene is a great drug, but it does look like pus after12 hours or so. this is normal. time frame can be lenghy but these things do heal remarkably well.

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. 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.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	The delayed wound healing  you are experiencing can occur after tummy tuck surgery.  It seems that your physician is treating it appropriately.  Generally, I suggest conservative management allowing the  on healthy tissues to &ldquo;declare  itself&rdquo;. This will minimize removal/debridement of healthy tissue.

	It may require several weeks to months to heal completely-  patience  is critical. If the area heals with a wider scar scar revision surgery may be beneficial down the line.

	I hope this helps.

David Bogue, MD · Answer

The time to heal varies slightly between patients and depends on infection, size of the wound, depth of necrosis, and removal of the dead tissue. Debridement of the tissue is standard wound care and has many positive effects. By removing the dead tissue, your surgeon decreases the infection rate and hastens the healing process. This necrosis occurs due to a lack of blood supply. This can be from too much tension on the closure, an underlying blood collection, previous surgical scars, or exogenous factors such as smoking. Although it can be very distressing, it usually heals in a very predictable fashion. Once clean, the wound will have a beefy red appearance and the area will contract in. Once the red tissue is up to the level of the skin, the skin will regrow and close the wound. The final scar is usually much smaller than the original area of necrosis.

David L. Abramson, MD · Answer

The speed at which this will heal can depend on the size of the necrosis as well as other factors such as smoking and diabetes? Be patient and it will heal

Steven Turkeltaub, MD · Answer

Unfortunately, necrosis is a complication of a tummy tuck even when though you have never smoked. Fortunately, from you pictures this appears to be relatively limited and small. Your plastic surgeon is doing exactly what should be done in order to treat the area and allow it to heal as best as possible. Typically, you can expect this to take 1 - 2 months, sometimes a little more. Once full healing occurs, you may be pleasantly surprised that the area is not as large as it had once seemed.

	For scar revision, if necessary, I generally recommend waiting at least one year before considering it.

Larry Fan, MD · Answer

Dear Naty's Mommy,

	I am sorry to hear about the problems after your tummy tuck. Unfortunately, even in the best of hands, complications such as tissue loss and delayed healing can happen. It sounds as if your plastic surgeon is providing good care. The wound may eventually need to be debrided. These wounds are often able to heal with proper wound care. The healing time is typically one to three months. I would be sure that you keep the wounds clean, watch for signs of infection, and see your plastic surgeon regularly.

	Best wishes,

	Larry Fan, MD

Stephan Baker, MD · Answer

Healing will take about 3 months, when managed properly.

	It will take several weeks until the extent of the necrosis has defined itself.

	Debridement should be done only on clearly necrotic tissue.

	Frequent visits with your plastic surgeon are key.

	Any revisional surgery, if needed, should wait at least 1 -2 years.

Francisco Canales, MD · Answer

Hang in there during this difficult part. The area in question is relatively small and the Silvadene you are applying is excellent for this problem. It may be 2 months before it is completely healed and it may need a modest debridement in the office, but hang in there. Many times these situations heal without need for revisions at a later date. It sounds like your PS is right on it.

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