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Resection of Panniculus Morbidus: A Salvage Procedure with a Steep Learning Curve

Friedrich, Jeffrey B. M.D.; Petrov, Roman V. M.D.; Wiechman Askay, Shelley A. Ph.D.; Clark, Molly P. M.S., R.D., C.D.; Foy, Hugh M. M.D.; Isik, F Frank M.D.; Dellinger, E Patchen M.D.; Klein, Matthew B. M.D.; Engrav, Loren H. M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000293760.41152.29
Reconstructive: Trunk: Original Articles
Abstract

Background: A subset of obese people develop a pannus hanging to the floor. This panniculus morbidus prevents weight loss, as the patient cannot exercise. It prevents hygiene, leading to a profound odor and ultimately results in intertrigo, cellulitis, and/or abdominal ulceration. The only two options are to live/die with it or resect it. Some of these people are otherwise ready for a weight loss program. For this group, resection of the panniculus morbidus may be indicated. The authors reviewed the literature and found the condition has not been addressed in this Journal since 1994 and was not considered in the recent supplement on body contouring. In 1998, the authors began resecting panniculus morbidus for this small group. The authors found the learning curve to be profoundly steep, with many wound complications, a finding that is quite in conflict with the literature on the subject, and decided to present their experience.

Methods: The authors conducted a retrospective chart review of 23 patients and collected data on demographics, ambulation, hygiene, technique, complications, and outcome.

Results: The technique of closure evolved as the authors struggled with complications. The current method of closure is three suture layers over four suction drains with a small wound vacuum-assisted closure device at each end of the incision. All patients ultimately healed and found it easier to ambulate and perform hygiene.

Conclusion: Resection of panniculus morbidus is a beneficial salvage procedure for some morbidly obese people, but the learning curve is steep and the current literature is misleading.

Author Information

Seattle, Wash.

From the Department of Surgery, Division of Plastic Surgery, and Department of Rehabilitation Medicine, University of Washington, and Department of Hospitality and Nutrition, Harborview Medical Center.

Received for publication January 5, 2006; accepted June 23, 2006.

Disclosure: None of the authors has a financial interest in any aspect of this article.

Loren H. Engrav, M.D., Department of Surgery, Division of Plastic Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, Wash. 98104, engrav@u.washington.edu

©2008American Society of Plastic Surgeons