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: 1.46). 05/2011; 68(2):194-7. DOI: 10.1097/SAP.0b013e318212f39a
Source: PubMed

ABSTRACT 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.
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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.
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