Tummy Tuck Skin Necrosis Healing Process. (photos)

Question

I just had a TT 3 weeks ago and quickly attained skin necrosis. My PS has been checking it each week but as the time goes by the skin continues to harden and cause more pain, what can I expect in the coming weeks? My PS said he will be using a VAC to aid in the healing but did not go into detail about a time frame. Any opinions would be greatly appreciated!

Gary Lawton, MD, FACS · Answer

This can happen after tummy tuck but it is the most problematic of the potential complications.   You will need surgery to remove the dead tissue, and prolonged wound care.  You will also lily need revision surgery and the outcome will not be as you expected.  A wound VAC is a useful tool to help in this situation.  This is a long process.   It will take up to 6 months to heal, 1 year before the revision and several years  before things are settled.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures. This is a significant loss of skin. A VAC witll help. In my opinion this will take at least two months to close

Thomas Trevisani, MD · Answer

Although the VAC system has some wound healing benefits, in my opinion- it's totally not applicable in your condition. The black tissue is dead- and must be removed. However, as long as it is dry- it could be left in place and it may assist the underlying tissue to heal. In my opinion, the best thing to do is to leave it alone until it is very wet and almost sliding off by itself.

George Marosan, MD · Answer

This is an unusually large area of full thickness skin loss, rarely seen in cosmetic surgery. The reason is poor vascular flow to this area, whatever the cause. Your surgeon is right, that this large area to be healed in fairly short time (weeks) would require a wound vac system. This means, that your surgeon needs to totally excise the black eschar or necrotic tissue (can be done without anesthesia) and place a foam pad into the defect which is sealed and connected to a small portable vacuum machine. This will help shrink down the defect and help granulation tissue (red vascular healing tissue) fill in the defect. Once a clean vascular bed is attained, your surgeon will need to skin graft the wound. Depending on the size of the final wound with the skin graft, at a later date (1-2 years) this might be possible to be excised and end up with a better scar. Good luck, stay close to your treting surgeon.

Erik Miles, MD, FACS · Answer

You have an unusual pattern of skin necrosis. The necrotic tissue that you see on your lower abdomen will have to be removed surgically. This can often be done in the office under local anesthesia. A wound VAC is a device that will speed the healing time of the wound. The VAC dressing will need to be changed three times a week. Sometimes arrangements can be made for a home health nurse to do this for you.  This process typically takes a few months.  As for as the long-term outcome goes, only time will tell. These wounds will sometimes heal surprisingly well, and revision is not undertaken.  Sometimes it is necessary to excise the scar that forms which is often depressed compared to the surrounding tissue.  Your priorities now are to manage the current complication and achieve a healed wound.  Any revisions if necessary can be discussed in a year.

Richard J. Brown, MD · Answer

I am very sorry for your problem. It is a complication of the surgery that you have had. So nobody can tell you how long for sure that it will take. It is safe to say that it will be several months of healing. You will need the dead skin to be surgically removed. The nice thing is that the wound vac is a wonderful device that has revolutionized wound healing. It will speed up the recovery time tremendously.

Hisham Seify, MD, PhD, FACS · Answer

It is reasonable to wait as long as the area is dry. Eventually the dark skin will need debridement , wound VAC and closure. Best of luck.

Evan Sorokin, MD · Answer

You are unfortunately dealing with a tough problem but it sounds like your surgeon has a reasonable treatment plan in mind.   This could be caused by many factors and it is impossible to make conclusions without a full exam and history on the internet which is why direct medical advice cannot be given on the internet.  The necrotic skin will need to be removed and a VAC is a great type of wound care system.  Close followup with your surgeon is imperative.  He or she is in the unique position of being able to give you the best advise.  Good luck, and hang in there!

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photos and sorry for your complication.  Debridement and a wound vac are very appropriate treatments Dr Corbin

Maan Kattash, MD, FRCS, FACS - Account Suspended · Answer

Your wound needs to be debrided and the the dead tissue completely excised. This may require more than one session. When the wound bed is ready, a VAC therapy can be initiated. The new machines are portable and you may not need hospitalization for this, depending on your insurance. Wound will ultimately shrink and heal with proper therapy. When all settles down and your wound has completely healed with no skin breakdown, a revision surgery may be warranted. This is considered at least 6 months after healing is completed to address the scarring in the area. Good luck.

Tummy Tuck Skin Necrosis Healing Process. (photos)

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