Tummy Tuck Open Wound Healing
During a tummy tuck, your surgeon will create an incision in your skin and the underlying structures so they can remove excess tissue and sculpt a firm and flat abdomen. Once the procedure is complete, the incision will be closed with sutures or staples, and you’ll be sent home to recover.
With wound dehiscence or separation, the edges of the incision pull apart before the area is completely healed. It’s a serious complication that requires immediate medical attention – but it’s also one that can be avoided with proper care from your surgeon. read more tummy tuck wound care and tummy tuck wound dehiscence healing time.
Tummy Tuck Open Wound Healing
There are two types of wound dehiscence: partial and complete. If you have a partial separation, the superficial layers of the tissue will reopen. With complete separation, all of the layers reopen, revealing underlying tissue such as the abdominal muscles.
Depending on the severity of your wound dehiscence, you may notice the following symptoms:
- Bleeding at the incision site
- An open wound
- Broken sutures
- Pain in the area
- Pus and drainage
What causes wound separation after a tummy tuck?
A number of factors can cause wound separation after a tummy tuck – and almost all of them are preventable. That’s why it’s so important to select a highly skilled surgeon who can ensure that your wound heals properly and without any complications.
Poor Closure. In many cases, wound separation after a tummy tuck develops due to problems with the way your tissues were closed. For example, if an inadequate number of sutures are placed. Additionally, it could be due to the fact that only superficial tissues were sutured, but underlying layers which bear the most tension were not.
The removal of too much skin. If the surgeon removes too much skin from the area, it places undue tension on the closure, which can cause the wound to eventually separate. To prevent this from happening, Dr. Rahban uses a conservative approach when performing his tummy tucks, and will leave just enough tissue to allow for an ideal closure. If your surgeon feels you will not have enough tissue to remove, he will deny your candidacy for the procedure.
The premature removal of sutures. While most of your sutures should be deep and absorbable, there are often superficial sutures that also need to be removed. Your plastic surgeon needs to remove your sutures once the area is fully healed. If they are taken out too soon, wound dehiscence can develop.
An infection. If you acquire an infection after a tummy tuck, the wound edges may separate. As such, preventing an infection is a critical part of your aftercare guidelines. To that end, Dr. Rahban takes multiple precautions before, during and after surgery to lower that risk.
A chronic medical condition. Certain conditions – such as diabetes, heart disease and anemia – can lead to poor healing, which increases your risk of developing wound separation.
Excess pressure at the incision site. Excess pressure due to strenuous exercise, vomiting, excessive movement, straining, constipation, sneezing and coughing may prevent your wound from healing properly. As such, Dr. Rahban will talk to you about reducing pressure in the abdominal area as you heal and uses a very specific abdominal binder to assist with your healing.
Smoking. The use of nicotine has been shown to greatly affect wound healing often leading to separation. Smoking reduces the circulation in small blood vessels. Dr. Rahban will insist that you refrain from smoking for 4 weeks prior and 2 weeks after your surgery.
In addition, certain factors increase your risk of developing wound separation after a tummy tuck. They include being obese, increased age, and poor nutrition. If you possess any of these risk factors, Dr. Rahban will offer personalized guidance regarding steps you can take to improve your chances of enjoying a complication-free recovery period.
How is wound separation treated?
Wound separation is a serious surgical complication that requires immediate medical attention. To begin, antibiotics will be administered to prevent a new infection from developing. Surgical debridement will then be performed to clean the area, remove dead tissue or infected tissue, and encourage the wound to heal properly. From there, the incision will be carefully closed once again.
Over the next several weeks, you will be monitored closely for any signs of a recurrence. You’ll also be advised to change your surgical dressings frequently as you recover, as this will prevent an infection and allow healing air to reach the area.
How to prevent a recurrence
Once a patient experiences wound separation, a recurrence is always a possibility. However, there are steps that you can take to encourage your wound to heal optimally, thus preventing dehiscence from developing again. They include:
Follow your surgeon’s post-operative instructions. This is one of the most important steps you can take to prevent a recurrence of wound separation. Taking all medications as directed, cleaning your wound regularly and changing your dressings as instructed are all very effective ways to promote proper healing.
Stay healthy. Your overall health also impacts your body’s ability to heal. As such, it’s important to maintain a proper diet and stay hydrated. These steps will not only keep you healthy, but they’ll also prevent constipation, which can cause you to bear down when passing a bowel movement and may increase your risk of a recurrence.
Avoid straining. Until you are fully healed, it’s important to avoid placing any unnecessary tension on your abdominal area by refraining from heavy lifting, strenuous exercise and aggressive vomiting and coughing.
Tummy Tuck Wound Dehiscence Healing Time
Wound dehiscence is a surgery complication where the incision, a cut made during a surgical procedure, reopens. It is sometimes called wound breakdown, wound disruption, or wound separation.
Partial dehiscence means that the edges of an incision have pulled apart in one or more small areas. Complete dehiscence is when the entire cut reopens through all layers of skin and muscle.
Signs of Wound Dehiscence
Wound disruption is most common within 3 to 10 days after a surgery. Symptoms at the incision site start getting worse instead of better and may include:
- Pain
- Redness
- Swelling
- Bleeding
- Drainage of other fluids
You may also have a fever. You or your doctor might be able to see broken stitches or a gap where the edge of the incision used to meet.
Causes of Wound Dehiscence
Wound healing involves three phases:
- Inflammatory: The body rushes fluid and healing cells to the incision site, causing swelling, redness, and pain. The goal is to clear out dead cells and bacteria so that repair of the wound can begin.
- Proliferative: Special cells called fibroblasts pull the edges of the wound together. The body makes new tissue to repair the cut.
- Maturation: The new tissue gets stronger and less fragile.
Wound separation can happen at any phase and can be caused by one or more of the following.
Infection. When a wound is infected, healing cannot move past the inflammatory phase. The body must focus on clearing bacteria from the area. Infection also limits the number of fibroblast cells that are able to move to the area. Any repair tissue that is able to develop will be weak and fragile.
Pressure on sutures. Vomiting, severe coughing, or heavy lifting can strain the stitches or staples used to hold the wound closed while it heals. If one or more of the sutures break, the incision may pull apart at that spot.
Poor suture technique. Wound disruption may be caused by stitches or staples that are improperly applied. Sometimes wound separation will occur when sutures are removed too early in the healing process.
Decreased blood flow. Good blood flow is important to move oxygen and healing cells to the wound and to clear away bacteria and dead cells. Anything that decreases blood flow puts you at a higher risk of wound breakdown. This includes smoking and conditions such as diabetes, obesity, and heart disease.
Complications of Wound Dehiscence
Even minor wound disruption needs to be treated right away to keep it from getting worse. An open wound is easily infected, and infection can lead to further separation.
Complete wound dehiscence is a medical emergency, as it can lead to evisceration, where internal organs protrude through the wound.
Treatment for Wound Dehiscence
Call your doctor if you notice signs of wound breakdown. Possible treatment options include:
Pain management. Your doctor may prescribe medication if you are in pain because of the wound disruption, dressing changes, or infection. They may tell you to use a different kind of dressing or explain how to care for the wound in a way that causes less pain.
Antibiotics. If you have an infection or are at high risk of infection because of the open wound, your doctor may prescribe antibiotics. This is a kind of medicine that stops or slows the growth of the germs that cause infection.
Management of risk factors. Your doctor will work with you to improve any risk factors that helped cause the wound separation. For instance, if you have diabetes, they will help you get your blood sugar levels under control. If the wound breakdown was caused by blood or pus collecting under the sutured area, the doctor can put in a small plastic tube to drain the fluid.
Removal of dead tissue. Dead or damaged cells can keep the wound from healing properly and increase your risk of infection. Your doctor may give you a special kind of wound bandage to help the body remove dead cells. If there is a lot of dead tissue and the wound separation is deep, you may need further surgery to remove it.
Negative pressure wound therapy. Negative pressure wound therapy (NPWT) is used to treat wounds that are not healing well, especially if there is a lot of fluid draining from the wound. It can help prevent infection, increase blood flow, remove extra fluid, and encourage the growth of new tissue. The wound is covered with a special dressing that has a small opening. A tube is attached to this opening and hooked up to a pump. When the pump is turned on, it gently draws fluid and infection out of the wound.
Tummy Tuck Wound Care
Tummy tuck scar gel, scar creams and scar moisturizers are one way to promote good-looking scars. First, they keep the skin moisturized. Hydrated skin functions better than dry skin, helping skin repair itself as you heal. The highest quality tummy tuck scar creams have ingredients like centella asiatica to promote scar healing. Fragrance-free vitamin E cream or Vitamin E serum may also be beneficial.
Laser scar treatments after tummy tuck
Laser Genesis is a revolutionary laser that reduces the number of blood vessels at the wound site. Blood vessels cause the scar to have a red appearance. With Laser Genesis, patients can easily reduce scar redness and speed scar healing. It is perfect for making tummy tuck scars blend in with the surrounding skin better. Laser Genesis is painless, non-invasive and can be done on your lunch break with no downtime. Doctor Bernard highly recommends it.
Silicone strips for scars
Silicone strips are a smart choice after tummy tuck surgery. These strips help keep the wound moisturized, which is beneficial for scar healing. Silicone strips also take tension off the wound so the incision stays protected as you move. Dr. Beldholm recommends wearing silicone strips for 8 to 12 hours per day starting 4 weeks after tummy tuck surgery.
Avoid sun exposure on the wound
Avoid sunning for at least one year after tummy tuck surgery, or until the scar has matured fully. Sun exposure makes scars look worse. The damage can be permanent. Even mature scars will be more obvious on tanned skin since mature scars lose pigment and can’t be tanned.
Keep the tummy tuck scar covered when you’re outdoors. If you’re wearing a light-color shirt or thin material, it is possible that some UV rays may get through the fabric. For example, a white t-shirt is said to provide only a 7 SPF rating.
Thicker fabrics and darker materials do a better job of keeping UV rays out. When in doubt, it’s a good idea to apply SPF 50+ sunblock. You can wear swimwear, but a one-piece or high-waist swimsuit is preferred so that your surgical scars stay covered. This is easy when you have well-placed surgical scars.
Days 1 – 5
- Apply a thin layer of antibiotic ointment to incision for first three days only. Stop using the ointment after three days as it can irritate the skin or cause a reaction.
- If you have a subcuticular skin closure or skin adhesive (dermabond), you do not need to apply ointment.
- If you had a keloid surgery and you are undergoing radiation, do not use ointment.
- It is ok to shower 24 hours after your surgery and is encouraged; Allow water to run over the incision and pad the area dry. Do not scrub or pick at the wound
- If steristrips or paper tape has been placed, keep them in place, if they appear moist or if there is drainage from the wound, please call the office or nurse practitioner
- Swelling and discoloration is expected and typically begins to subside at day three or four
Days 5 – 7
- Remove steristrips and tape on day 7 and reapply weekly for the first 4 weeks;
- Swelling and bruising should be resolved or nearly gone
Weeks 2 – 4
- Scar therapy – if wounds have healed; start scar massage, massaging scar cream into the incision in a circular motion two to three times daily;
- For best results, scar therapy should be continued for the first 6 – 8 weeks
- Scar cream can be purchased in our office and contains special ingredients including Vitamin C and E, and sunscreen
- Also recommend using a silicone- based product such as (Scar Away); aids in wound healing and optimizing scar appearance
- FOR SILICONE SHEETS
- Ensure wound is clean before applying and dry of any creams, lotions, or ointments
- Wear daily for 6-24 hours, remove once daily to allow site to be washed and dried
- If gel sheet becomes dirty or loses adhesiveness, wash gently with mild soap and water. Allow to air dry before reapplying
- FOR SILICONE SHEETS
- Follow-up appointment with Dr. Nicholas Jones; all patients should be seen by Dr. Jones within the first two weeks after surgery
- If you had a facial procedure or neck procedure, your sutures need to be removed within 5-6 DAYS
- Avoidance of the sun when possible, and sunscreen to protect the surgical site from UVA/B; aids in preventing discoloration
- OK to gently cleanse wound (directly)
Weeks 4 – 6
- Critical period for wound remodeling
- No strenuous activity including sexual activity;
- Continue scar therapy
Months 6 – 12
- Follow-up appointment with Dr. Nicholas Jones to reassess healing and scars; during this time, wounds some times need to be revised
- Sunscreen with protection against UVA and UVB
V-Beam After Treatment Instructions (KELOID PATIENTS ONLY)
- You may apply ice, cold packs, or frozen peas to the treated area for 20 minutes each hour for 3-4 hours to avoid swelling
- You may apply polysporin antibiotic ointment twice daily should any area blister, do not use more than 4 days.
- A bruise usually occurs from this treatment and can last 10-14 days or more, depending on the setting of the laser