Printer Friendly

Sur-1. Morbid Pannus Syndrome: treatment with serial surgical procedures.

We define Morbid Pannus Syndrome as follows: a condition occurring in patients with a large abdominal pannus with distal extension at least 15 centimeters below the pubis accompanied by repeated bouts of cutaneous inflammation such as cellulitis, nonhealing intertriginous dermatitis, skin abscesses, gangrene, non-healing ulcers, or folliculitis. Late sequelae of this syndrome include lymphedema, urinary incontinence, respiratory distress, difficulty ambulating, and difficulty with toileting. This series of patients with Morbid Pannus Syndrome represents a retrospective review of patients seen in a university general surgical clinic with emphasis on complex wounds and wound therapy. Most of the patients presented for management of chronically infected wounds. One patient was diagnosed with calciphylaxis cutaneous gangrene complications in a large pannus secondary to hyperparathyroidism. The infectious complications were consistently resistant to systemic treatments with antibiotics, presumably due to poor tissue concentrations of the antibiotics. Similarly, the intertriginous infections were minimally affected by topical therapies. As a consequence of failure to these non-operative approaches, these patients were offered serial debridement and resections. These high-risk patients are not candidates for cosmetic type panniculoplasty. Due to the high risks of wound infections and possible necrotizing fascitis, these procedures were performed as brief, sequential debridement/resections; usually limited to 200 square centimeters or less at each procedure. There were no operative complications. Wound closures routinely required retention sutures. There were some post-operative wound infections; all were managed on an outpatient basis. Patients with Morbid Pannus Syndrome were successfully managed by multiple serial debridement and or resections of 200 square centimeters. One patient who was non-ambulatory pre-operatively was able to begin a walking exercise and rehabilitation program after only 6 procedures. Patients and their referring physicians generally considered the treatments beneficial. Patients with Morbid Pannus Syndrome can be helped by utilizing serial excision operations.

James T. Evans, MD, and Rebecca Read, FNP-C. Erie County Medical Center and Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
COPYRIGHT 2004 Southern Medical Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

 Reader Opinion




Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Section on Surgery
Author:Read, Rebecca
Publication:Southern Medical Journal
Date:Oct 1, 2004
Previous Article:Rhe-2. Intra-muscular gold therapy for rheumatoid arthritis in patients with concomitant hepatitis C infection.
Next Article:Sur-2. Undifferentiated (anaplastic) carcinoma of the pancreas with osteoclast-like giant cells: a report of long-term survival.

Related Articles
Success of bypass surgery questioned.
Overview of phase II surgery for obstructive sleep apnea syndrome.
Compartment Syndrome of the Leg after Less Than 4 Hours of Elevation on a Fracture Table.
Highlights from the annual scientific assembly: mechanisms to stop the epidemic of obesity: surgical therapy for obesity *. (Special Feature).
Bariatric surgical nursing and patient care.
"Bariatric Nursing" from Mary Ann Liebert.
"Bariatric Nursing" from Mary Ann Liebert.
Pediatric obesity: impact and surgical management.

Terms of use | Copyright © 2015 Farlex, Inc. | Feedback | For webmasters