Symptoms of Skin Necrosis After Tummy Tuck?

Tissue necrosis is a well known complication of
abdominoplasty. This complication occurs
when tissue has inadequate blood supply and subsequently dies.The area that’s most vulnerable to this type
of problem lies directly above the abdominal incision.This is the point that blood has the furthest
to travel.Skin necrosis initially presents as
skin discoloration which progresses from a light pink to a dark purple
color.Eventually the tissue turns black
and becomes firm with the consistency of leather.In some cases, areas of necrosis can become
secondarily infected.When patients undergo abdominoplasty, the skin and fat are
elevated away from the underlying abdominal muscles.This means that blood has to pass through a
flap that consist of fat and skin to reach the incision site.Anything that compromises this blood supply
can result in tissue necrosis.Several
conditions have been associated with skin necrosis in abdominoplasty
patients.These include diabetes,
collagen vascular diseases, infection, tension on the wound closure and
cigarette smoking.All of these
conditions compromise the small blood vessels that flow through the abdominal
skin flaps.This poor blood flow can
result in tissue necrosis.Once skin
necrosis has occurred, treatment varies from patient to patient depending upon
the severity of the problem.Many wounds
require debridement, followed by dressing changes and eventual scar revision.In some cases necrotic tissue may become
infected and antibiotics may be required as well.By carefully
evaluating patients in the pre-operative period, the incidence of this
complication can be minimized but never totally eliminated.It’s important that patients stop smoking six
weeks before and after surgery.

Hello, and thank you for your question about the symptoms of skin necrosis after a tummy tuck. I’m glad you’re reaching out because it’s very important to recognize potential signs early.

Skin necrosis, which means the death of skin tissue due to poor blood supply, can happen after a tummy tuck — and smoking dramatically increases that risk. Smoking reduces oxygen delivery to healing tissues, making it harder for your body to heal properly and much easier for parts of the skin to die off.

The common symptoms of skin necrosis after a tummy tuck include:

Darkening of the skin: Areas may turn dusky purple, gray, black, or very dark brown instead of healing pink or red.

Delayed wound healing: Incisions may start to open up, or scabs may not heal properly.

Hardness or dryness: The skin can feel very dry, leathery, or stiff instead of soft and pliable.

Loss of sensation: Necrotic skin may feel numb or unusually insensitive compared to the surrounding skin.

Foul odor: If the tissue becomes infected, a bad smell may come from the wound.

Drainage: You may notice thick, yellow-green, or dark drainage from the incision site.

If you notice any of these signs, it’s important to contact your plastic surgeon immediately. Early treatment can sometimes save the tissue or at least minimize how much needs to be surgically cleaned up. Delaying treatment could lead to infection, wound breakdown, and a much longer healing process — sometimes even requiring additional surgery later.

Even though you started smoking again, it’s never too late to stop. Quitting now, even temporarily, can still help reduce further complications and give your body a better chance to heal.

Wishing you strength and a safe recovery ahead.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Please make sure you stay in close contact with your surgeon, attend all follow-ups, and act quickly if you suspect any problems. Early intervention can make a big difference.

I encourage you to reconsider your decision to resume smoking. Nicotine in any form will constrict blood vessels, increasing risk of complications. Necrosis is only one of them. You are also increasing risk of poor wound healing and infection. Necrosis presents as a progressive change in skin color, darkening as it progresses.

Necrosis is the medical term for death of tissue. The most common cause of tissue death following surgery is lack of blood supply. All of our bodily tissues require sufficient blood flow to keep it alive. During the course of surgery blood flow to the tissues involved is decreased to some degree. If the blood supply is decreased sufficiently the tissue at the end of the blood supply may die. Necrosis of the skin and fat can occur at the edges of a tummy tuck, breast lift, breast reduction or any other area where the skin and fat layer has been lifted off of the underlying layer. Cigarette smoking is known to decrease the blood supply in the skin and fat layer. If a wound is showing signs of necrosis it is important to stop smoking immediately.
Although it is unlikely at 3 weeks that necrosis would develop, it is possible. You would initially notice areas of redness in the area followed by a darker color to the skin ending with black skin. The skin and some of the underlying tissue would then slowly die leaving a wound that wouldn't need to heal itself over time. This healing process could take up to 3-4 months.

An area of marginal necrosis in the middle is not uncommon.  Blistering is the most common early sign.   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. Simple wound care is all that is required at this time.

in general if you have to ask, you don't have it. it is not subtle. having said that even if you "got away ' without complications this time, smoking in general but especially in the perioperative period is simply poor judgement. if your addiction is too powerful, seek professional help. good luck.

Although it is risky to continue to resume smoking following a tummy tuck procedure, I think you need to be honest and open with your plastic surgeon. I would inform he/she immediately as there are some simple steps that can be instituted to avoid poor wound healing, which may lead to skin necrosis and other complication. It is all about you, and you need to optimize your chances. Please make an appointment and discuss this soon as possible.

My colleagues and I think you are REALLY missing the point.
Nicotine consumption (smoking, inhaling someone else's, chewing, patch efc) causes narrowing of blood vessels providing essential oxygen to the cut areas held together by stitches. Were the flow of oxygen to be reduced or stopped, as is seen with smoking, the healing process begins to derail. In the LEAST, your wound will not heal properly, the scar will widen and be ugly. But in many cases, the tissue which is most distant from the blood supply, in tummy tucks the area over the privates extending to the belly button, begins to die.
This is seen as a bluish discoloration which begins to slowly look mottled and eventually becomes extremely bruised and dark. As noted by one of my colleagues, the whole area will have to be removed surgically because gangrene sets in. With no effective blood flow, bacteria multiply and then can invade the normal skin areas causing a life threatening infection. By the way, none of the subsequent surgeries will be paid by insurance and you will be totally responsible for them.
The cosmetic result is poor.
The reason why most Plastic surgeons feel so passionately about this is that while some complications cannot be prevented, this one is TOTALLY preventable. Don't do it.

So you've decided to spend all this time and money on a tummy tuck and now decide to risk it all just to smoke. BRILLIANT!! Wow that's about the most foolish thing I've heard in a while. But I guess you didn't smoke the night of surgery. STOP SMOKING PERMANENTLY!! A dead, black skin flap or belly button not to mention heart and lung disease isn't worth it. And don't use nicotine patches or gum because they also cause the vasoconstriction problems that will kill the tissue.

Doctors in general do not like smoking due to health reasons. (Everyone knows about the detriment to your lung function, and the increased risk of cancer.) Plastic surgeons have another reason to dislike smoking - the decreased blood flow that it creates interferes with healing and can lead to surgical complications (healing problems, wide scars, fat necrosis, skin loss, etc.) This is partially dependent on your history of smoking (how much you smoke per day and how long you have been smoking), as well as if you are smoking around the time of the operation. If your stomach looks healed from the outside at 3 weeks, you must still consider that healing is going on in the inside. Fat has a less robust blood supply compared to the skin, and fat necrosis is still a possibility. You may end up with hard lumps under the skin near the incision, and sometimes these can even "work their way to the surface" as your body tries to get rid of non-living tissues. This will create a wound that will require some care to heal. With actual skin loss (necrosis) typically the skin becomes dry, firm, non-blanching (if you press on normal skin, the redness of the blood disappears for a second, and then returns. Necrotic skin does not have this color change.)
Don't take the chance! Quit smoking for good... (or as long as you can after surgery...)