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.