Wound Seperation with Very Pungent Smell? (photo)

Question

Hi - its been 6 weeks into my tummy tuck / lipo. 3 weeks into the recovery my wound was seperated (approx 2 inch wide - 1 inch high). Showed it to my PS and he indicated it will heal by itself. Last week there is a very strong pungent odor that has been coming of the wound and with some fluid....called up my PS and indicated the same and per him not to worry. Just want a second opinion to make sure I am not missing anything....

Gerald Minniti, MD, FACS · Answer

Hello,

	Thank you for the post and the high quality photo.  It is not uncommon to have healing issues after a tummy tuck, some involving an opening of the incision.  The photo you have provided is clear enough for me to see suture material, necrotic fat, and a yellowish film indicating little care for the wound has been tended.

	You need to return to your doctor and tell him that you are not satisfied with the way that he has addressed this issue.  What needs to be done:  1. A specialized clean up of the wound called a 'debridement' that can only be performed by a surgeon.  2. Institution of a special dressing called 'wet to dry' dressing, which needs to be changed three times per day.  Either you need to be instructed on how to do it, or a nurse specialist needs to come to your home to do it for you (most people learn how to do it quickly and perform it themselves).

	If he does not want to do this, you need to have him transfer your care to another surgeon.  If this is the case, it should be a surgeon certified by the ABPS.

	Don't worry, your wound will heal well, but it is going to take a few months.

	Best of luck.

Matthew C. Camp, MD · Answer

Good question. This represents failure of healing, and colonization of the wound with bacteria. This needs to be cleaned up surgically, and then treated with wet to dry dressings to speed the healing. I do not agree with a hands off approach in the treatment of this wound. It needs to be addressed to prevent the worsening of the wound and possible infection. With time, this will close from the bottom up, but may take months to do so. In the end you may need a scar revision to make it look right.Good luckMatthew C Camp M.D.

Leo Lapuerta, MD · Answer

This isn't umcommon in patients who have a tummy tuck. The area should heal in by itself. It just takes time. I would recommend following up again with your plastic surgeon to see if the area should be cleaned more aggessively and if the doctor should remove some of the dead tissue.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you are experiencing. These types of complications can be quite distressing to patients; unfortunately, sometimes the wounds do look worse before they begin to look better.Close follow up with your plastic surgeon will be in your best interests; sometimes removal of a exposed suture and/or removal of any unhealthy tissue will expedite healing. In my opinion, a "wound care specialist" referral is not necessary assuming you are under the care of a well experience board-certified plastic surgeon.Wound care regimens will differ from one plastic surgeon to another. Generally, this will involve application of some type of sterile dressing ( in my practice I use a non-stick dressing covered by a sterile dressing). You should have peace of mind that these types of wound healing problems generally go on to heal over the course of the next several weeks, often without long-term sequelae. Also important to concentrate on a healthy diet, including good protein source. Sometimes (depending on the width of the open wound and the appearance of the scar in the longer term), scar revision surgery may be helpful down the line. Best wishes.

Remus Repta, MD · Answer

Hello,

	Thank you for the photo.  There are many reasons a surgical incision would open or not heal properly.  If there is any non-viable tissue (i.e. tissue with poor or no blood supply) it may benefit you to have that cleaned out as it will expedite healing.  If you are not really seeing progress in terms of wound healing than this may be the case.  Have your plastic surgeon take a look as examination is important to make this decision.

	All the best,

	Dr Remus Repta

Brent A. Buchele, MD, MBA (retired) · Answer

I agree with the other comments. In the long run this will turn out fine. BUT I think it can be sped up with more agressive care.  The bits of filmy debris and bits of fat and bits of suture material are obstacles to healing. And the oder suggests that bacteria are digesting some of this material. There is not a lot of redness so it is not likely infected, but is colonized.  EVRY PS has a favorite way to deal with this.  I often suggest cleaning it with Hydrogen peroxide, but only for a day or 2. I suggest tucking some gauze in to help pull out any debris and changing that gauze 2-3 times per day.  

	 

	You paid for this procedure and your PS should see the wound and guide you through the process of its healing. It could easily take 4-8 weeks for this to completely close. Hang in there!

Stuart B. Kincaid, MD, FACS (in memoriam) · Answer

Sorry to hear you’re going through a complication, in our practice we take care of these kinds’ of wounds by starting a Wet to Dry treatment with gauze. Every practice is different, to answer your question it will heal but it needs to be looked at specially if there’s a smell coming from it. Maybe antibiotics should be taken to prevent infection. You should get a second opinion.

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