XP: Incision Necrosis

I am 26 months post RNY and 3 weeks post op from Fleur De Lis Tummy Tuck and Brachioplasty.

The day after my fleur de lis tummy tuck the surgeon told me I had some circulation problems where my vertical and horizontal incisions intersected, in pubic area.

At my three week post op visit yesterday - the area was triangular - 1 inch each side - black, leathery, like a scab.

First he aspirated fluid from my R arm (I had brachioplasty at the same time as TT) and then pulled 40cc fluid from my belly - which he said wasn't bad.

He asked me to lay down and proceded to debride (remove) the necrotic tissue described above - which left me with a 1 inch by 1 inch - 1/2 inch deep HOLE in my incision line.  It was "packed" with damp saline gauze and a dry dressing on top.

I'm instructed to shower 2 times a day - letting the water gently wash out the area and then pack with wet saline gauze and top with a dry dressing.  This will have to heal from the inside out.  I still need to wear my abdominal binder, not lift over 5 pounds and take it easy (but I can drive now.)

The edges of the "crater hole" are nice and pink, no foul smell, no fever, etc - no sign of infection.

Any advice from those that have "been there - done that!"

Thanks so much.

This happened to me with my breast reduction.  The place was about 2x2 and very very deep.  Don't remember how long I had to pack it but it did rebuild the skin and flesh. Make sure the gauze is moist before you remove it, the nurse told me to do that because otherwise you were removing the new cells.  I let it fall out from the flow of the water in the shower, which I took with my back to the water.   Just follow the directions to the T and it will be okay.  There is a scar but not too bad.

This is a problem when moving skin esp with an anchor incision, I have dressed many of them as a visiting nurse.

It sounds like it is a small area-that's great!  It still will take probably a month to heal (sorry)  If the sides are clean then no more necrosis is happening and that is also great.  The surgeon has ordered wet to dry/damp dressings, that is to allow the gauze to gently debride the wound of any exudate and allow the new tissue to fill in.

You want the wound to be filled with beefy red granulation tissue (bumpy reddish tissue)  if there are yellow streaks or spots those will have to come off before new skin will grow.  They have to come off gently with the gauze rather than picking which will deepen the wound.  The wound will gradually fill from the base and get shallower before it gets too much smaller in width.

Good luck in healing, if you have any questions please ask.

Pup