Some patients may experience a prolonged wound healing time. Delayed
wound healing may increase the risk of
infection, extrusion, and
necrosis. Depending on the type of surgery or the incision, wound
healing times may vary. Smoking may interfere with the healing process.
Nicotine is the root cause of the decreased blood supply in that it
causes constriction of the capillaries and small blood vessels that feed
the skin with its required oxygen.
You should contact your surgeon
immediately if your wound does not heal within the period of time he or
she has discussed with you.
Cosmetic Surgery Procedures at Risk for Delayed Wound Healing
Delayed wound healing is
not very common after
breast enlargement surgery. Because the incisions
are relatively small, and with proper technique the breast tissue is not
de-vascularized - and the problem is rarely seen in healthy patients. Nicotine
use, poorly controlled diabetes, chemotherapy, radiation therapy,
vascular disease, immunosuppressive therapy or disease, use of
corticosteroids may all lead to delayed wound healing.
Tissue loss and delayed
wound healing can sometimes occur along the portions of the incision
that was made for the
breast lift, especially
in smokers or diabetic patients or where there has been an extensive
procedure. The anchor lift procedure poses the most problems with
the junction of the Inverted-T incision.
Diabetics, smokers, obese
patients and the elderly are all at increased risk for delayed healing
after breast reduction. Among all patients having breast reduction
surgery, up to 21% will have at least minor problems with delayed
healing. The most common area that tends to get some wound disruption or
delayed wound healing is at the junction of the
Areas of the skin or nipple/areola complex are also subject to delayed
healing as well.
Breast Reduction patients
who experience delayed healing will require frequent dressing changes or
possibly more surgery to remove the non-healed tissue. Individuals who
have decreased blood supply to the breast tissue from past surgery or
radiation therapy may be at increased risk for wound healing and poor
surgical outcome. Smokers have a much greater risk of skin loss and
wound healing complications.
TRAM Free Flap
Breast reconstructive patients might have delayed wound healing,
especially with Flap Surgery. It is possible to have areas of the chest
wall skin or some or the TRAM flap die. This may require frequent
dressing changes or further surgery to remove the non-living tissue. Some areas of the chest or muscle flap skin may heal abnormally or
slowly when there is reduced blood supply to tissue from prior surgery
or radiation therapy treatments.
smoking significantly increases the risk of multiple flap complications,
flap infection, and delayed wound healing. Women who smoke are even more
vulnerable to tissue necrosis and other complications in the area of the
TRAM Pedicle Flap:
Reconstructive patients who elect to have a TRAM pedicle flap
performed, total flap loss is rare, however it is not uncommon to for a
partial flap loss due to delayed wounds. This procedure has a higher
rate of delayed wound problems than a TRAM free flap or reconstruction
with a breast implant.
Latissimus Dorsi Flap: This
method of breast reconstruction is highly reliable and therefore delayed
wound healing is a very rare occurrence. However, since the
Latissimus Dorsi Flap
is being taken from another part of the body, the patient is healing
from two different surgical areas.
Because of the amount of
stretch the skin undergoes during a
tummy tuck, sometimes there may be
areas along the incision that has delayed healing. Usually this is in
areas with the most tension or around the belly button. Delayed wound
healing may require more frequent dressing changes until the wound
heals. Rarely will revision surgery be needed to repair wound healing
Delayed wound healing with
a face lift procedure can be critical, as with most delayed wounds, a
larger wider scar might happen. As with all surgeries,
have the highest percentage of delayed wound healing time, and most
plastic surgeons will tell the patient that it is advised to stop
smoking before this procedure – and not to start again, until the wounds
have finally healed. Patients who also have medical conditions such as
diabetes, is directly related to delay wound healing.
Because the surgery with a
face lift takes a long time to heal in some areas the wounds might not
heal normally. If the patient is a smoker, the nicotine causes the blood
vessels to constrict, decreasing the blood flow to your wounds. Oxygen
and nutrients are needed for wound healing, so your healing may be
delayed if you are a smoker or you could even end up with some tissue
loss which could be caused by infection or bleeding complications.
The less smoking you do
for 4 weeks before and after a face lift or cosmetic procedure, you will
probably decrease your chances of delayed healing or infection.
essential factor to good health and especially to healing. A patient who is too
thin or is obese can have an impact on healing. Radical diets that patients
might have been on to lose weight before the procedure, sometimes can lead to
malnutrition and result in poor healing. Weight factors can influence wound
complications due to the fact that there is a decreased blood supply in fatty
areas of the body.
Personal Hygiene can attribute to wound healing as well. The cleaner a patient is, the less
likely inflammation or possible
infection will happen.
Patients who have diabetes or any chronic medical disease may adversely impact
wound healing. Diabetes is well documented with the fact it has the tendency to
prolong the healing process and have higher risks of wound healing and
of Steroid Medication:
Patients with Lupus or other autoimmune diseases are normally put at a higher
increase of risk regarding healing from cosmetic surgery. Some autoimmune
diseases include the use of steroid medication, and taking this type of
pharmaceutical drug can increase the chance of delayed healing time or other
Much of the healing potential for a specific patient is for the most part
genetically determined. Genetic predisposition controls whether or not a person
hyper-trophic scars, have prolonged bruising and other
healing problems. There are some unusual and rare genetic diseases such as
Ehlers-Danlos syndrome, Marfan’s syndrome and others that can contribute to poor
post operative healing.
Tobacco use increases
chronic health risks associated with smoking, and does have a direct correlation
with nicotine causing blood vessels to constrict which result in less blood and
oxygen going to the surgical site to help healing.
For some procedures, smoking has even more risks associated with it and these
include breast reduction, tummy tuck, and facelift. These procedures have
complex and extensive wounds that the body needs to heal and impairing this
healing ability can cause real problems. Compared with nonsmokers, smokers have
a higher incidence of insufficient healing after face-lift surgery, as well as a
greater degree of complications following breast surgery.
Cigarette smoke contains
these Toxic Chemicals:
Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin,
resulting in tissue ischemia and impaired healing of injured tissue. Nicotine
can also contribute to blood cell platelet gumminess, raising the risk of thrombotic micro-vascular obstruction and tissue ischemia (an inadequate supply
of blood to a part of the body, caused by partial or total blockage of an
artery). In addition, production of red blood cells, fibroblasts, and
macrophages are all reduced by nicotine.
Monoxide binds to the hemoglobin in red blood cells and prevents it from carrying oxygen.
This causes less blood to be delivered to the metabolically demanding healing
tissue and once the smaller amount of blood arrives, it has greatly decreased
oxygen which is needed to help the healing process progress.
inhibits the enzyme systems necessary for oxidative metabolism and oxygen
transport at the cellular level.
Some plastic surgeons have various opinions about the issue of smoking and
having cosmetic surgery, but most will agree that the patient should stop
smoking for a period of time before the surgery and up to three to four weeks
after the procedure.
Plastic surgeons are making impressive steps in finding better ways to heal
Below are some of the
newer trends in wound healing:
significantly increases the
oxygen saturation of plasma, raising the partial pressure available to
Surgical wound debridement
can help remove excess fluid from the wound, to increase healing.
Stem Cell Therapy
- plastic surgeons may have found a workable scaffold that will allow them
to mold and hold stem cells prior to injecting them into the body, allowing
patients to "grow" their own tissue graft right on the wound site.
Low-frequency magnetic fields
are directed at the wound with a small, portable device to aid cells in
healing the body.