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.