Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges.

Sixty-one percent of Americans are overweight, and 20% are considered obese. The number of obese adults has doubled since 1960, and the number of overweight teenagers has tripled. In many overweight people, skin and wound conditions develop over the abdominal area, largely because of the consequences related to a large abdominal apron or panniculus. Panniculectomy surgery is performed to remove a massive pannus, or abdominal apron, which frequently contributes to a number of health concerns and threatens quality of life. Some patients are candidates for surgical removal of the pannus, and some are not candidates for this surgery. Occasionally cellulitis develops over the panniculus, leading to panniculitis. Panniculitis can lead to skin and wound problems; likewise, skin injury can lead to panniculitis. Additionally, in obese patients who require general surgery in the abdominal area, skin and wound complications may develop simply as a result of having a large panniculus. In this article, local wound care and preoperative and postoperative nursing care are discussed and case studies are presented.