Will my necrosis heal on its own? (Photos)

Question

3 weeks PO. My doctor acted as if the are would "fall off" and heal? It looks terrible and it very worrisome to me. I'm apply a silver cream daily as well ask keeping a padding on it because it is leaking fluids which he said is also normal. I just want to be sure! Everywhere else is healing nicely.

Daniel Barrett, MD · Answer

Dear c.ward27,based on your photos, you have an area of necrotic skin which should be removed in order to clean the wound properly and to allow it to heal properly. I would suggest you to consult your plastic surgeon and get it done. Keep your wound clean. It will probably need a longer period of time to fully heal.Daniel Barrett, MD, MHA, MS
Certified, American Board of Plastic Surgery 
Member, American Society of Plastic Surgery

Thomas Fiala, MD, FACS, FRCSC · Answer

Hi.  Another option to explore with your surgeon might be the idea of "debridement", which is a fancy way of saying "surgical removal of the unhealthy tissue".  This would remove the black scab, and any unhealthy tissue, and allow dressings to start working on the wound base, to allow it to clean up.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph and I am sorry to see your area of necrosis.  Regardless of depth of tissue loss your body will fill this area of compromised skin in slowly over time.  It is important to maintain close follow up with your surgeon to ensure appropriate local wound care advice as the tissue declares itself and starts to evolve and mature.  Hang in there as this will take several weeks to months to fully heal.  Best wishes.

Ven Erella, MD · Answer

Thank you for your question. I am sorry for this complication. You need good local wound care and I believe it will heal by itself. Please follow instructions from your PS.

Tiffany McCormack, MD · Answer

The Silvadene cream you are using will help chemically debride the area.  We commonly use this for burns.  If it is not effective then we would typically debride the area surgically/mechanically.  This step would lead to an open wound usually that would require dressing changes on a daily basis.  Close follow up with your surgeon is very important throughout this time to ensure proper healing.  You may need some scar revision later, after everything is healed.  Good luck!

Darryl J. Blinski, MD · Answer

Appears a surgical debridement is indicated now to speed the healing process. Best to seek in person opinions.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced.  The area of compromised tissue may “look worse, before it looks better”. 
In my opinion, the most important “factor” involved  with successful treatment of the complication will be close follow-up with your plastic surgeon (or seek to follow with another surgeon in your area).   He/she will be able to monitor for signs of infection and decide whether or not removal of unhealthy tissue and/or removal of exposed sutures is indicated.
 Yes, it is perfectly fine to leave the dry/dark tissue alone to "demarcate".  You will likely find that it will come off on its own and that you will likely have an open wound present. Dressing changes may be necessary for a period of time. The open wound  should go on to heal over the course of  several weeks,  hopefully without long-term sequelae.  However, sometimes, depending on the final appearance of the scar, scar revision surgery may be helpful. Also, concentrate on a well-balanced ( good protein source) diet  and avoid nicotine in all its forms.  Best wishes.

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