What actually CAUSES incision breakdown and necrosis?

Ok, after 6 weeks I am getting really, really tired of washing and re-packing this hole in my belly from where my reverse TT incision broke down and turned necrotic.  I'm sick of trying to find clothes that will hide the bandages.  It is slowly healing, and my PS is pleased with the rate of healing (even if I am not).

What I really want to know, though, is what causes it.  I have heard it blamed on poor skin condition (this is the same skin area that got cut for my open RNY two years ago and for a hernia repair last year, though, and I had no problem after that surgery), on nutritional deficiencies (I doubled my vitamins and significantly upped my protein several weeks before surgery, and all fo my labs except my Vit D have been great ever since my RNY), on poor blood circulation (again, no problem with the RNY or hernia repair in the same area), and  -- suggested by another surgeon -- the PS pulling the skin too tight when he closed me up (but the same surgeon did my mons lift and my arms and I had no trouble with either of those).

I am happy with the care from my PS, and am NOT trying to find a way to blame him for this... I just honestly want to understand what happened... or if it was just one of those surgical complications that sometimes happen.  Is it possible that it was a result of having too many surgeries in such a short period of time?  Without some idea of WHY this happened, I'm going to be paranoid about ever having surgery (even medically necessary surgery) in the future!

Can any of the docs on this forum shed some light on this? ( Google has not been particularly helpful!)

Lora

That's a very interesting question. I want to hear the answer too. Thanks for asking.

I feel your frustration.

I had an extended tummy tuck with anchor cut and  had wound sepreration/breakdown, necrosis. and it took almost 4 months of packing the dang thing before it closed .

My PS was/Is great. I don't blame him either, I have had 2 c-sections and Hysterectomy and never had an issue. But with the amount of stretch marks I had, and the amount of skin being removed I think that all plays a factor into wound issues a bit.  I have never smoked, I upped all my protein and vitamins over a month before surgery.  I guess it is just bad luck for some of us.

I will have to have a revision as mine healed all weird.  I am scared to death that this will happen again  when I have my revision in May.  I am trying not to worry, but we all know how that goes.

Good luck to you and it will close, it just takes a long time depending on the size of the opening, Mine was the size of a fist.

Kelly

I hope it doesn't take 4 months for mine to heal!  The main portion of mine is a triangle shape, 6 inches across the top and under the edge of one breast (it's pointed at the bottom) and about 5 inches long, and it started out at almost 1 inch deep at the top and 1 and1 /2 inches deep at the bottom (point of the triangle).  After 6 weeks of extra vitamin C and E (I had already doubled my multivitamin before the TT) and even MORE extra protein (now drinking 2 supplemental protein shakes per day), it is about half it's original depth.

I'm really hoping one of the docs on here, or someone with a medical background can shed some light on this...

Lora

I was going to ask the same question, so I'm glad you did.  Hopefully someone will come up with something good.  My feeling, though, after reading up on it is it's just something that doesn't have a good explanation.

One question I do have, though, is when does this all start to occur?  Do you notice the wound separation/necrosis right away or is it something that happens weeks after surgery?  I'm a little over a week post-op from TT and BA and that's my main concern.  My mother had this problem after her hysterectomy and had to pack that thing for it seemed like ever.  I attributed hers to smoking and morbid obesity, but I could be wrong.

Thanks for bringing the question forward and I'll be checking back to see the responses. 

My necrosis had already started when I went in for my one-week post-op visit.  It was another week or so before he cut everything out (it took 2 rounds of debridement and then some minor trimming after that).  My PS did indicate that the necrosis usually does not appear quite so quickly, though.  I had my reverse TT on January 26th (almost 9 weeks ago), and it has been almost 6 weeks of healing time so far.  Since this is my only experience with this, I don't know how long it takes before you are beyond the danger of having it happen.

Lora

You listed all the answers - you've had surgery that invaded that vasculature two times already - the RNY and more importantly the hernia repair - and the LBL has as it's more significant challenge the tension forces that are simply part of the surgery - and gravity - it is not at all like healing from other procedures.    To do an LBL the surgeon has to completely disrupt all connective tissue attaching your skin to the underlying fascia - all the way around......it severs all the normal lymphatic and circulatory structures and takes a long time to heal even with pristine skin (no previous insults)........ad to that the issues you listed and it takes longer.   I too went nuts packing my wounds - I developed a seroma - and now I'm wearing drains for a few days longer than I expected (I had a thigh lift last Thursday)......because while I don't have any swelling typical of that procedure - my drains are doing their job.......and I want them out!      You have to be patient.........our bodies are amazing in what they can do - but once we've 'insulted' the original structures with surgery etc. - it simply takes longer.    I'm a couple of months out from my LBL and while everything is closed up well by now - the scars all swelled after my breast augmentation (swelling in the upper body actually drifted down to the previous area)......I am still not normal.......and it's simply going to take a while for everything to settle down.........  If the surgeon is happy.........be content with that..........and feel better.   Susan

Smoking is a big problem for wound healing.

I personally don't smoke and never have, so that doesn't apply in my case, but the pre-op info from both my RNY surgeon and PS included pretty strong wording about patients needing to quit smoking before surgery.

Lora

I, too had to go through what you are going through. After three months I still had an area that had not closed completely. At that time my surgeon was able to do a little revision to the area and stitch things back together and then I healed completely with no other problems and my scar looks normal. (done in  the office so no cost to me).

I have recently had brachioplasty along with removal of tissue from under my armpits down to my BL incisions. This time no necrosis, no healing problem.

Doctor had no answers to why I had problems with first surgery except for history of morbid obesity in the past .I did not smoke, was not on steroids, my nutriton was excellent. I believe from what I know that the skin had been so streched out that when excess skin is removed and edges  stiched back together the blood supply can be compromised and that can cause skin necrosis. I also had umbilical hernia and inguinal hernia repaired at the same time which caused additional trama to the tissue area.

Things will get better, just keep up what you are doing.

Sher