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Informational/Educational Report
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Morbid pannus syndrome and wound care challenges James T. Evans, MD, FACS, Rebecca Read, BSN, FNP-C The number of morbidly obese patients being seen by healthcare providers of all specialties continues to increase. These patients who are especially prone to pressure ulcers can especially challenge wound care professionals in treating pressure ulcers. However, an even more challenging problem in morbidly obese patients can be that of morbid pannus syndrome previously described as follows: a condition occurring in patients with a large abdominal pannus with distal extension at least 15 cm below the pubis accompanied by repeated bouts of cutaneous inflammation such as cellulitis, nonhealing intertriginous dermatitis, skin abscesses, gangrene, nonhealing ulcers, or folliculitis. Late sequelae of this syndrome include lymphedema, urinary incontinence, respiratory distress, difficulty ambulating, and difficulty with toileting. Most troublesome is cytophagic histiocytic panniculitis which is a severe variant of relapsing febrile nodular nonsuppurative panniculitis characterized by lobules infiltrated by histiocytes that have phagocytized erythrocytes, leukocytes, and platelets; it is sometimes accompanied by systemic conditions that can be fatal, such as multiorgan failure, coagulopathies with hemorrhaging, and overwhelming infection. Clearly the most significant treatment is weight loss; however, in patients not candidates for bariatric bypass surgery this is often very difficult. Our recommended treatment algorithm is based on a three level classification: early stage (cellulitis), intermediate stage (recurrent infections with edema), advanced stage (ulcers, active or healed with brawny edema). Biopsy is recommended for intermediate and advanced stages Early and intermediate stages may be managed by wound care and minor surgical procedures. Advanced stage patients may require more extensive procedure such a serial debridement of the pannus. A mainstay of treatment in all stages is topical anti-microbial therapy. These wounds can often be of large size and each case must be individualized. The current mainstay of treatment consists of topical antimicrobial cleansing solutions combined with silver containing topical wound care products. Evans JT, Read R. Morbid pannus syndrome: treatment with serial surgical procedures. SUR-1. Southern Med J. 2004;97(10)suppl:S70ÐS71. Stanhope RC, Winburn KA, Silverman BM. Indicated noncosmetic panniculectomy in gynecologic surgery. J Pelvic Surg. 2002;8(4):197Ð201 Lipsett PA, Beilman GJ, Bulger EM, Sawyer RG. Gram-positive infections in the surgical patient: the good, the bad, and the ugly. Presented at the 25th Annual Surgical Infection Society Meeting/2nd Joint Surgical Infection Society Meeting of North America and Europe in Miami, FL, May 5, 2005. . |
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