title: An integrated therapy concept for reduction of postoperative complications after resection of a panniculus morbidus.
abstract: BACKGROUND
  Panniculus morbidus is characterized by an edematous, painful hanging abdominal mass, due to laxity and redundancy of the abdominal skin in morbid obesity, particularly after massive weight loss. Panniculectomy, by wedge resection, is a salvage procedure with high satisfaction rates though associated with high complication rates. Here we investigated the effects of perioperative complex decongestive physical therapy (CDP) on outcome and complication rates.
  
  
  METHODS
  We retrospectively analyzed the clinical course and outcome of 24 patients receiving panniculectomy between 1998 and 2009 in our department of plastic surgery. Sixteen patients received perioperative CDP, and eight patients did not receive any form of decongestive treatment. We analyzed the incidence of complications, reoperation, blood transfusions, and length of hospital stay based on chart reviews. Complications were categorized as minor or major according to the necessity of readmission or reoperation. CDP was performed for 4-6 weeks preoperatively and 2 weeks postoperatively.
  
  
  RESULTS
  The incidence of major complications (p = 0.001), the rate of postoperative blood transfusions (p = 0.028), wound healing disorders (p = 0.021), and the incidence for complications (p = 0.001), whether minor or major, were significantly reduced in the CDP group. In summary, 12 of 16 patients within the CDP group had an uneventful course, whereas all non-CDP patients had at least one complication.
  
  
  CONCLUSIONS
  Adequate perioperative CDP treatment in a lymphological clinic may reduce the rate of early postoperative complications after resection of panniculus morbidus.
authors: Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany. georgios.koulaxouzidis@uniklinik-freiburg.de
authors: Georgios
authors: G
authors: Koulaxouzidis
authors: Sebastian M
authors: SM
authors: Goerke
authors: Steffen U
authors: SU
authors: Eisenhardt
authors: Florian
authors: F
authors: Lampert
authors: G Bjoern
authors: GB
authors: Stark
authors: Etelka
authors: E
authors: Foeldi
authors: Nestor
authors: N
authors: Torio-Padron
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D017060:Patient Satisfaction; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome