I had surgery almost 4 weeks ago, a tummy tuck with a fleur-de-lis incision and a breast lift/augmentation. As you can see in the photos I still have open wounds at the incision area and under the breast that just won’t close. They leak fluid badly so require a cover and are painful. My doctor says that its not ideal that the main sutures are still present so they shouldn’t be reclosed. Help?
Hello, having a delay in the healing of wounds is a common situation. Unfortunately, the retardation in this normal process ( healing) is almost related to other factors: smoking, diabetes, etc.
Having an open wound is equal to have a contaminated surface on the wound. So, I think, it's advisable to treat those open wounds in a conservative manner instead of trying to RECLOSE them.
Scars won't be the ideal, but they can be greatly improved in the future, in a better scenario.
Agree with Dr. Quintero. These non healing wounds should not be closed but treated conservatively unless other complication occur. However your surgeon should spend sometime removing any offending suture and make sure the wounds are cared for including the consideration of wound vac. and close follow up twice a week by the Doctor and not an assistant. That is what I would do for my patients.
At the moment, I would recommend conservative dressing changes and letting the wounds heal naturally on their own. They will take at least a few weeks to heal. You should keep in close contact with your surgeon to make sure the wounds are not infected. You could consider a revision at a later date if you are not satisfied with the scars/result.
You have undergone a couple of very large operations and are suffering known complications of wound healing.
I think all plastic surgeons with a lot of experience have had these complications with patients at some time or another, and I too have experience with them.
If you were my patient, I would not attempt to close the wounds due to the high risk of infection and possibly, loss of more tissue. I would give you local wound care instructions, follow you closely, and if needed (not always needed), would plan for a scar revision in about a year after the wounds close.
You didn't mention the wound care protocol your doctor put you on so I can't comment.
If you are producing a lot of fluid, and the dressing changes are truly painful and not sustainable, you may want to ask your doctor about a VAC negative pressure device as an alternative. This would be for you and your doctor to determine, but is an alternate thought for you.
This isn't as bad as it looks!nPatience
No, the wounds should not be closed at this time. If there is not an implant exposure then it should heal by self with dressing changes but will take quite some time. You have some suture spits around the areolas and I would remove the rest of them to heal better and faster. This is a complication that sometimes happen with the surgery that you had and every ABPS certified surgeon is familiar with this and knows how to treat it and I hope you had an ABPS surgeon. There is one thing that in my opinion should help ant that is the use of a vacuum dressing or PICO. This will heal the wounds a lot faster but it could be expensive. The machine would cost about $500 or so and will last for only one week. Insurance may help this. You probably would need about 2 weeks of this. Your surgeon is not required to pay for this but sometimes the surgeon may be willing to help with this. Ask your surgeon what he or she thinks about the vac dressing.
As your doctor said it is time to wait for the healing process.
I would resume: Patience, VAC and patience. In the end it will look much better that it is now and after all the scars can always be reviewed.