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.