Dealing with Skin Necrosis After Tummy Tuck

Question

I had full abdominoplasty a little over a week ago.  I am a non-smoker (never smoked ever), healthy 5'4" 130 pd mom of 4 kids.  I developed skin/tissue necrosis in front. My PS cut out a big chunk of dead tissue, (4 in. long and 2 in. deep) and packed it, I'm to continue and follow up in a week. How is my skin going to grow back together if it is stuffed with gauze and so wide?  Shouldn't I be on an anti-biotic? Very scared and unsure.

Richard J. Bruneteau, MD · Answer

Unfortunately,
patients occasionally suffer skin necrosis following abdominoplasty.This situation occurs for a variety of
reasons including diabetes, collagen vascular diseases, infection, tension on
the wound closure and vascular compromise.The incidence of skin necrosis following surgery is higher in patients
with a history of cigarette smoking.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.When patients have relatively small
superficial wounds, scabs will eventually lift off the wound surface revealing
granulation tissue.Once this has
occurred the wound will contract as the skin grows over the top.This process typically takes four to six
weeks to reach completion.During this period, it’s important
that the wound be monitored by your plastic surgeon.When this approach is taken most wounds heal
nicely.

Kurtis Martin, MD · Answer

Skin necrosis can occur in any surgical procedure. It occurs when the skin and fat has loss of blood supply and therefore "dies". First we debride the area which removes all the dead tissue. Then dressing changes are used until the area heals up. You don't need antibiotics unless it is infected. Once healed, you may need a revision.

Otto Joseph Placik, MD · Answer

Unfortunately, even with well planned surgeries in patients at low risk, problems can arise such as skin necrosis. Before the wound can heal, all dead tissue must be debrided (removed).
Given the unexpected events that you suffered, packing of the wounds: 1)  allows ongoing evaluation of the tissues to assess the need for ongoing debridement. 2) Furrthermore the gauze itself can act as a debriding agent. 3) Lastly,, keeping the wound open actually treats an infection in the sense that it allows the wound to drain.
Your wounds will heal with wound care and may require scar revision at some later date.

Ricardo A. Meade, MD · Answer

You sound like a great candidate for an uneventful abdominoplasty. Not sure what went wrong but rest assured that the area of non healing will heal. Assuming you have no medical  conditions (you didn't mention any) then in the course of the next 4-6 weeks you'll see huge improvements. What has to happen first is granulation tissues need to bud in the base of the tissue. You'll know because they're red. Once the entire base of the tissue is clean and budding, the wound will start to contract super fast. You'll be very happy to see it do that. Just keep doing your dressing changes, all of that has to happen before the skin closes.
Best wishes,
DoctorMeade

Scott C. Sattler, MD, FACS · Answer

The wound that your describe sounds like it fairly deep, and perhaps a full-thickness region of abdominoplasty flap necrosis. The classic method for healing such wounds includes sharp debridement and dressing changes with gauze. The wound will likely heal more quickly with the use of a Wound VAC. This special dressing is changed every few days by your MD, rather than daily. When the wound is ready, it can be eventually closed primarily, or with a skin graft.

Jeffrey Zwiren, MD · Answer

An area of marginal necrosis in the middle is not uncommon. 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. If it is a large area such as yours a revision may be more complicated. Treatment with antibiotics is only needed if you show signs of an invasive infection. Simple wound care is all that is required at this time.

Peter A. Aldea, MD · Answer

Do not be scared. This is totally fixable but will take some time.
Necrosis (death) of the lower tummy tuck skin (flap) occurs because there is not enough oxygenated blood flowing through it. Although it is most commonly seen in smokers (active or second hand), it is seen when there is too much tension on the wound, too much pressure on the skin (a tight garment or a prolonged period of being folded or leaning forward), diabetes, Lupus and others.
The first thing that needs to be done is for all the dead tissue to be removed before an infection sets in. Tissue that does not have a blood supply will never circulate antibiotics and will serve as a large source of unbeatable bacteria. Once the debridement (dead tissue removal) was done, the remaining wound is treated to get it to clean up and form GRANULATION TISSUE - a tissue that looks like a cut strawberry surface (granular) which will pull the wound walls together. This can be done with serial gauze dressing changes or faster with the use of a suction device called the VAC. In 2-3 months, the walls of the wound will come together and heal. In 8-10 months after-wards, when the scar is soft, you may, IF you need or want to, make the scar look nicer.
Good Luck.
Dr. P. Aldea

John Whitt, MD (retired) · Answer

Skin necrosis following a TT is fairly unusual in a nonsmoker, but it can occur. Patience, although difficult to achieve, is important. If there is no obvious infection, I would treat the wound conservatively, removing dead tissue only after it has demarcated. It may take a very long period of time, but a reasonably satisfactory result is ultimately possible.

Richard P. Rand, MD, FACS (retired) · Answer

It is very unusual for this to happen in a non-smoker. But once the dead tissue is debrided, dressing changes will help the wound heal without getting infected (you don't need antibiotics with an open wound as long as it is well debrided). You will take a long time to heal because of the tension in the area. A wound vac might be considered to speed the healing along. You are in for a longer process than you would want but it will eventually heal.

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