title: Resection of panniculus morbidus: a salvage procedure with a steep learning curve.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Friedrich
authors.forename: Roman V
authors.initials: RV
authors.lastname: Petrov
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Wiechman Askay
authors.forename: Molly P
authors.initials: MP
authors.lastname: Clark
authors.forename: Hugh M
authors.initials: HM
authors.lastname: Foy
authors.forename: F Frank
authors.initials: FF
authors.lastname: Isik
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Loren H
authors.initials: LH
authors.lastname: Engrav
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies