2 weeks post op Tummy Tuck, open wound and discoloration (lack of blood supply). Any suggestion? (photos)

Hello,I am so sorry this happened. It has happened to all of us who do enough of these surgeries.  I know you're the one with the complication, but your surgeon is probably just as devastated.  I hope he has the courage to tell you himself.  Now, lets get down to business.  Ditch the garment. Your surgeon should be certain there is no other causes of interstitial pressure like a seroma or hematoma beneath the skin flap.  Although Santyl is good, you should push your surgeon to begin sharp debridement of the thick white material on the surface of the wound, which can be done painlessly in the office without anesthesia.  This will accelerate healing and give him preliminary assessment of the extent of fatty necrosis below the skin, which unfortunately may be extensive and possibly accounting for the larger area of skin discoloration.  I prefer serial debridements with very conservative removal of fatty tissue, unless it is absolutely grey and translucent in color.  I have found that this abnormal fat can support healing, called 'granulation tissue' despite looking abnormal in color or appearance. Based on this photo, you will probably have some form of open wound for the next two months.  After an appropriate amount of time afterward, usually about a year from closure, scar revision can be entertained.Keep your head up, this too shall pass. Talk to your surgeon.  Best of luck.

Based on this one photo alone, it appears you have suffered skin and soft necrosis in the lower mid portion of the abdominal skin flap- which is the most common area for this to occur. You should be following up with your plastic surgeon regularly to keep a close eye on how this area progresses. It may require surgical debridement, which means a trip to the operating room to clean up the wound edges and possibly remove any unhealthy tissue. If there is pus in the base of the wound it may even need to be packed with sterile gauze dressings or closed with the assistance of a wound VAC. I'm not sure topical ointments will heal this however you should consult regularly with your plastic surgeon.Best wishes,Dr.Bruno

The discoloration and open wound are not a normal part of the healing after a tummy tuck. This discoloration will take weeks before it goes away and also the open wound, may require some surgical debridement to avoid an infection and allow a faster healing, even that the healing will take several weeks. You need to follow your surgeon advice and be in contact all the time.

I am sorry that you are having this complication. Unfortunately I think you should be prepared for a much larger open wound in the area that is discolored. The body is demarcating the viable and nonviable tissue.  The area where you are having a problem is the most common location for wound healing issues after a tummy tuck.  This is the area that is typically closed under the highest tension and has the longest distance for the blood flow to travel for healing.  You will likely need a debridement of the nonviable tissue. The good news is that the area typically heals very well over time, however you should expect a fairly long course of healing that will require wound management for several months. The fact that you don't smoke and are in good health are all very favorable for wound healing.  Unfortunately these complications sometimes occur in very healthy patients who are good surgical candidates. You will get through it. Best wishes to you!

I am sorry to hear about your complication. Local wound care like you are doing is a good early treatment. At some point, there will be a demarcation between the non-viable tissue and the tissue that will recover and you may benefit from surgical debridement at that time. Be prepared for this to be a process that will take several months to heal. If you are a smoker, you need to limit your nicotine use as this decreases blood flow and can cause ischemic tissue to not survive.

Based on your photos only, it appears that you have an area of necrosis (the pale greenish color) which means that this tissue has not survived the surgery. This can happen following a tummy tuck when the blood supply is not sufficient to keep the tissue alive, and necrosis in the area that yours has occurred is unfortunately not uncommon after an abdominoplasty. Skin is typically hardier that the underlying fat so the final size of the injured tissue may still take a while to demarcate, or show a distinct border between the healthy and necrotic tissue.The Santyl ointment is helping the superficial dead tissue to come off, and it is likely that your surgeon will also perform sharp or surgical debridement along the way to help keep the area clean and promote healing. The necrotic tissue does not have sensation, so typically this is not painful for patients.I use the analogy that the area of concern is like a cut flower in a vase, and regardless of how many times you change the water or add sunshine, the flower is going to wilt and die. You will see things appear to be getting worse before it looks like it is getting better (very typical healing stages) and this is why close follow up with your surgeon is essential.This whole precess is going to take a while, maybe months. My best advice is to forge a strong relationship with your surgeon, because you are going to be seeing a lot of each other. Try as hard as possible not to let anger or depression get in the way, because this is going to get better. Believe me, your plastic surgeon will want this to heal well and as quickly as possible too. Plastic surgeons deal with complicated woulds as part of their training, so they will have lots of recommendations that may change frequently as you heal.I'm very sorry you are going through this, but these are the kind of things that can happen with big surgeries. With good care you can still expect to get a great result. You will gain all kinds of wound care skills, will likely become a favorite patient at your plastic surgeon's office (some of mine have even become long term friends), and staying positive will absolutely impact your final result.Hang in there!Sincerely,

Thank you for your question. It will take several weeks to heal. Please closely follow up with your PS. 

You are correct that this is a blood supply problem and this requires close follow up with your surgeon.  This will take time to heal.  It is unfortunate, however it is something that we see occasionally with tummy tuck surgery.  Hope this helps.Dr. Ali Mosharrafa

 Unfortunately you have a significant process of the abdominal flap. The necrotic or nonliving tissue  must be debrided or removed either with regular dressing changes or surgical debridement. Once the nonliving tissue is gone the remaining open wound can be closed with surgery or allowed to close naturally.  The only options not mentioned in the prior answers for you our referral to a dedicated wound care center and hyperbaric oxygen treatment.  I suggest you discuss these options with your plastic surgeon.

Thank you for the photos and sorry for your complication.  Follow up closely with your surgeon and be prepared for weeks of slow healing.  The good news is this area will heal nicely if cared for appropriately Dr Corbin