Seroma under necrotic skin. Should it be debrided first and then drain or can it be drained without touching necrotic skin? (Pho

Question

So the surgeon said I should leave the necrotic skin to slough off and heal on it’s own. I should expect it to turn very black and then to let the body do its work. But now I have a seroma. And she seems to be scared to remove the fluid from the site (she isn’t telling me this, but I can tell). Should the necrotic skin be debrided first and then seroma drained or can the seroma be drained without touching the necrotic skin?

Yannis Alexandrides, MD, FACS · Answer

There are different approaches to this but in my opinion the best treatment would be debribement and treatment of the seroma at the same time.

Richard Baxter, MD · Answer

If you have a seroma, it will complicate the healing of the necrotic skin so it should be drained. Hopefully this could be done without going the through the necrotic skin.

Douglas Taranow, DO, FACOS · Answer

Astarr,This is very straight forward...you must drain the seroma ASAP.  This can be done right through the black area of skin, or the normal area around it.  The fluid puts pressure on your abdominal flap which is already showing huge signs of vascular insufficiency (poor blood supply).  You also have areas of either blood supply issues or bruising.  The black areas will eventually separate from healthy skin and you will need a revision surgery to close the wound once your belly gets softer.Good luck with your continued healing.  Follow your surgeons instructions and see them OFTEN.Dr T

Kim Taylor, FRACS · Answer

If you have a seroma then it would be straightforward to drain that through your scar or unaffected skin.  The amount of necrosis you have is quite significant and it is likely to take many weeks to heal.  Once it has clearly demarcated then I would likely recommend debriding it & resuturing your tummy.  This would need to be done under anaesthetic, in theatre.  Continue following up with your plastic surgeon.  All the best

Seroma under necrotic skin. Should it be debrided first and then drain or can it be drained without touching necrotic skin? (Pho

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