Black Spot Along Tummy Tuck Incision Necrosis or Just a Burn?

It looks like you have skin necrosis to the flap.  Being a diabetic puts you at a higher risk for necrosis.  It also places you at a higher risk for infection with necrotic skin.  I would be very conservative in your treatment and would see you quite regularly.  I would also have you check your blood glucose regularly to make sure you aren't running higher than normal.  If this is necrosis, you should be prepared for a somewhat lengthy recovery with wound care treatments.  Good luck and I wish you the best during your recovery. 

Thank you for your post. Diabetes is a disease that should demand a healthy respect from both surgeon and patient in plastic surgery. It is a disease that affects the immune system and can increase the risk of infection, a disease that affects the healing potential of a wound and can cause opening of a wound, and is a disease of the circulation that can lower the blood flow to the operated tissue and cause necrosis or tissue death. This needs to be managed as follows:1. Tight blood glucose control with diet, exercise, and medication. You need to see your internal medicine doctor regularly and make sure your diabetes is well controlled. 2. If you are overweight, then losing weight decreases your risk in tummy tuck surgery or any other surgery for that matter.3. If you have high blood pressure, this needs to be managed and well controlled by your internal medicine doctor as well.4. ABSOLUTELY NO SMOKING!5. Consider with your surgeon HyperBaric Oxygen therapy pre- and post-op.6. Make sure you understand from your surgeon and anesthisiologist what medications you should take or not take prior to surgery.It is very possible to have a great outcome as a diabetic following tummy tuck surgery, but minimizing the risk is the most rational way of accomplishing this.Best Wishes, Pablo Prichard, MD

This appears to be 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 you have problems with tissue necrosis. The dark areas are dead skin and fat and will not heal by alone.. You really need to see your surgeon ASAP because  you are at risk of things getting worse with infection and more tissue necrosis.

The news is not good. In my opinion, the dark areas are dead tissue with sharp borders (necrosis with demarcation). The management should include surgical removal of all dead and compromised tissue (debridement). Not quite sure why you need to "get drained every other day" that would imply that at 3 weeks after surgery you have a chronic seroma or worse. It probably would be best to confront the situation, take you back to the operating room and clean the whole area up. Delaying doing so may result in further necrosis and a possible serious infection.

Unfortunately, this looks like it is Tissue Necrosis.

I realize that this is being answered well after the fact, but I want to address the issue in case it applies to other people.

It looks that much of the triangle below the umbilicus (belly button, or BB) is compromised and will not heal well.  This complication is more likely to happen in smokers, in people who have small blood vessel disease (such as diabetes and other conditions) and other medical situations that have similar qualities.  It does look like that has affected you

The hallmark of the early care is removal of obviously necrotic tissue, followed by application of a VAC system to help the remaining tissues heal.  This process can take several months and, even after wards, additional procedures are likely to be necessary in order to address the resultant scars.  I am, of course, very sorry that this happened...of paramount importance is that you remain under the care of a competent plastic surgeon who can help get you through this difficult time.  The end result can be surprisingly good in view of what this may look like at its worst - but the process is unpleasant and you'll need lots of hand-holding in addition to surgical care.  If necessary, you can additional opinions on how to handle this.

Again, I'm sorry but I hope that this helps, and good luck,

Dr. E