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Delayed Wound Healing

 

 

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.

Full Anchor Lift Photo of Delayed Wound Healing / Wound Separation



 

 

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 Inverted-T incision. 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.

Breast Reduction Photos of Delayed Wound Healing / Wound Separation



 

 

TRAM Free Flap Reconstruction:  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. 

The risk of total flap loss due to clotting in the nutrient vessels in the first post-operative week in free TRAM flaps is 5%. Obesity and smoking significantly increase the risk of complications following transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction.

Active 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 reconstruction.

 

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.

 

Reconstruction with a Breast Implant: If the reconstruction involves using a breast implant, a wound that will not heal can result in exposure of the implant or (extrusion), also causing the surround area to become infected. If this happens, the implant will be removed until the infection is cleared up.

Using a vacuum-assisted closure (VAC) system has been found safe and effective in assisting the closure of large and complex wounds without skin grafting.

 

 

 

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 problems.

Photos of an Abdominoplasty patient with Delayed Wound Healing




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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, cigarette smokers 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.

Read more about Smoking and Cosmetic Surgery Procedures

 

 

 

Delayed Wound Healing is caused by:

  • Infection or bleeding

  • Poor skin circulation

 

Who is at RISK for delayed healing time?

  • Weakened immune system – patients receiving chemotherapy or drugs to suppress the immune system

  • Patients who have auto-immune diseases

  • Other medical conditions – such as diabetes, etc.

  • Poor nutrition and or hygiene

  • Age

  • Genetics

  • Conditions that interfere with blood clotting or wound healing

  • Patients that smoke cigarettes

  • Reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments

  • Excessive heat or cold therapy

  • Use of steroid drugs
     

 

 

 

Factors related to Delayed Wound Healing

  • Nutrition: 

Nutrition is 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: 

Personal Hygiene can attribute to wound healing as well. The cleaner a patient is, the less likely inflammation or possible infection will happen.

 

  • Chronic Medical Conditions/Diabetes:

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 infection.

 

  • Autoimmune Diseases/Use 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 risks.

 

  • Genetics: 

Much of the healing potential for a specific patient is for the most part genetically determined. Genetic predisposition controls whether or not a person will develop keloid or 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.

 

 

 

 

Delayed Wound Healing and Smoking

  • Tobacco:  

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: 

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.

 

  • Carbon Monoxide: 

Carbon 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.

 

  • Hydrogen Cyanide:

Hydrogen Cyanide 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.

More about smoking and cosmetic surgery


 

 

 

Plastic surgeons are making impressive steps in finding better ways to heal wounds.

Below are some of the newer trends in wound healing:

  • Hyperbaric oxygen significantly increases the oxygen saturation of plasma, raising the partial pressure available to tissues.

  • 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.

     

 

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