Outcome study of the surgical management of panniculitis.

Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Annals of plastic surgery (Impact Factor: 1.49). 05/2011; 68(2):194-7. DOI: 10.1097/SAP.0b013e318212f39a
Source: PubMed


Patients with panniculus morbidus have an abdominal panniculus that becomes a pathologic entity, associated with the development of candidal intertrigo, dermatitis, lymphedema, and ischemic panniculitis. Panniculectomy is a standard treatment for this problem. The objective of this study was to determine risk factors for complications associated with panniculectomy surgery to lower the complication rate. We performed a retrospective chart review of patients who underwent panniculectomy between 1999 and 2007 by looking at data related to surgical complications, comorbidities, age, and gender. In 563 patients, we recorded the incidence of the following complications: wound-related (infection, dehiscence, and/or necrosis), hematoma/seroma, respiratory distress, blood transfusions, deep venous thrombosis or pulmonary embolism, and death. Overall, 34.3% of patients suffered at least 1 complication. In patients with wound complications specifically, there was a significantly higher body mass index versus those with no wound complications (43.7% vs. 30.7%, P < 0.0001). Smokers also had a higher rate of wound complications (40.5% vs. 19.5%, P < 0.0001).

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    ABSTRACT: Background Panniculus morbidus is a large abdominal apron found in morbidly obese patients. This condition creates a cycle of weight gain and functional incapacity. Our study assessed the functional improvement in patients undergoing massive panniculectomy. Methods A retrospective review of panniculectomies performed from 1994-2012 was conducted. Twenty seven patients with resections greater than 20 lbs were selected. Data on demographics, operative details, complications, and pre- and post-operative functional capacity (using the Steinbrocker Functional Classification) were collected. Results The pre-operative mean BMI was 58 kg/m2 with a mean resection weight of 33 lbs. The overall complication rate was 74%. A statistically significant improvement in functional capacity (pre-op mean 3.7 vs post-op mean 2.0; p<0.0001) was identified. Conclusions Panniculus morbidus is a functionally debilitating condition and massive panniculectomy is often the only treatment option available. Our data suggest that massive panniculectomy is a viable option for patients functionally incapacitated by panniculus morbidus.
    American journal of surgery 01/2013; 207(3). DOI:10.1016/j.amjsurg.2013.09.010 · 2.29 Impact Factor
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    ABSTRACT: Background: Obesity remains a significant health problem associated with considerable morbidity and mortality. Panniculectomy in the obese patient population aims at treating complications related to excess abdominal skin in an attempt to improve quality of life, increase mobility, and potentially prepare the patient for subsequent bariatric surgery or enrollment in a weight-loss program. We describe the indications and outcomes of "supersize" panniculectomy in the extreme obesity patient population. Patients and methods: A Duke University institutional review board-approved retrospective chart review of patients who underwent a "supersize" panniculectomy by a single surgeon during a 6-year period was conducted. Data on patient demographics, operative indication, preoperative imaging, concomitant operations, and postoperative complications were collected. Results: Twenty-six patients underwent a "supersize" panniculectomy for indications including immobility secondary to excess abdominal skin, panniculitis, ventral hernia, and presence of a gynecologic tumor. The mean pannus resection weight was 15.6 kg and the mean follow-up was 15.7 months. Twelve patients underwent preoperative abdominal computed tomographic imaging. Eleven patients underwent concomitant surgical procedures at the time of their panniculectomy. The overall wound complication rate for the "supersize" panniculectomy was 42.3% (11/26 patients). However, the rate of major complications, defined as those complications requiring a return to the operating room, was only 11.5% (3/26 patients). Conclusions: "Supersize" panniculectomy is defined as a panniculectomy in the obese patient population with a resected pannus specimen weight greater than or equal to 10 kg, and a pannus formation that extends to the mid-thigh level or below. Despite the obstacles and reported high complication rates, the incidence of major complications in this series justifies the operative intervention in patients with an otherwise therapy-resistant "supersize" pannus. A preoperative computed tomographic imaging may rule out an underlying hernia in most cases and is recommended by the authors.
    Annals of plastic surgery 05/2013; 73(4). DOI:10.1097/SAP.0b013e31827f5496 · 1.49 Impact Factor
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    ABSTRACT: The incidence of obesity is on a rise the United States and worldwide. Complications following panniculectomy are higher for the super obese patients, often requiring re-admissions and additional interventions. In this study, we compare the outcomes of patients who underwent primary closure (PC) of their resection wounds to the outcomes of patients who underwent initial open wound management (OWM) with a negative pressure dressing. The records of all patients who underwent panniculectomy between 2007 and 2012 were reviewed. Of 14 patients with a body mass index (BMI) greater than 50, nine underwent primary closure and five patients were treated with open wound management. A retrospective chart review was performed. There were no statistically significant differences in the age and pre-operative comorbidities, but BMI was higher for the OWM group (66.4 v 58.9, p = 0.039). There were no statistically significant differences in mean operative time, resection weight, estimated blood loss and hospital length of stay. The primary closure group had 44% readmission rate and 33% re-operative rate for wound complications. The open wound management group had no wound related readmissions or secondary procedures for debridement. Open wound management in the massive panniculectomy patient reduces hospital readmission and secondary operations. This case series provides reasons to support the consideration of open wound management following massive panniculectomy in the super morbidly obese patient population.
    Plastic and Reconstructive Surgery 10/2013; 133(1). DOI:10.1097/01.prs.0000436818.34332.34 · 2.99 Impact Factor
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