Can You Do My High Risk Abdominal Panniculectomy?

Q: Dr. Eppley, I am a 44 year old female. I weigh somewhere between 350 and 370lbs. I have spent many years with multiple medical problems. I currently have Crohn’s Disease, Diabetes (Insulin Pump), Fibromyalgia, Asthma, Underactive Thyroid, Pernicious anemia, CVID and Sleep apnea. Through the years, a strong use of steroids resulted in my right femur breaking. On my first surgery for the femur (Sep 2003), I developed MRSA. I spent the next 4 years constantly having surgeries and receiving vancomycin. In April 2007, the MRSA went dormant. This required removing all hardware from my leg. I currently have a lame right leg. I am wheel chair bound. It was after I permanently moved to a wheelchair that I began to gain weight. I am currently prednisone dependent and I must constantly watch for adrenal crisis. The steroids have greatly added to my weight. Since 2007, my weight has managed to stay around 350 – 360lbs. My skin in so thin and damaged from the steroid use that I have developed an extremely large pannicula. It is very large. On the right side of my body it hangs below the knee. On the left it hangs below the genital area. I develop ulcers in my stomach area. The ulcers often become large, oozy, painful and infected. I have had to take vancomycin to cure the infections. I have a location (at the end on the longest piece of pannicula) that receives inadequate blood flow and it has become hard like a rock. Additionally, I develop fungal infections. I had a C-section in 1999. The fungal infection seems to form on the scar and the infection spreads out. I develop open places along the C-section scar. These places itch and bleed. I am currently treating the fungal infection with a mixture of ketoconazole cream and Diaper rash cream. I also sprinkle a nyoxin powder on the fungal infection. The fungal infection is very difficult to treat. My Infection Disease Doctor and my Rheumatologist has suggested a Panniculectomy. Each doctor feels that it is important that I receive a Panniculectomy. The doctors said they feel a Panniuclectomy should be performed first and I should look at the gastric sleeve after I have healed. I have been unable to find a Doctor willing to perform this surgery. I know it is a high risk surgery. I am inquiring to find out if anyone in your facility has any experience with this surgery.

A:  Thank you for your inquiry. You are literally between a rock and a hard place. Your needed abdominal panniculectomy procedure is more than just high risk…it is virtually certain to have a 100% complication rate when it comes to wound healing. And that is not to mention your general medical condition which will require considerable after surgery management and is certain to have its own set of complications that could even include severe infection and death. Between the wound and your health complications I could easily see you sending a long time in the hospital. Whomever decides to take on your surgery has to do it with a team approach and be expectant of what is going to ensue. Your best bet is to have this done at a university-based hospital where there is a plastic surgery training program due to the need for a lot of doctors caring for you both during surgery and afterwards.

Dr. Barry Eppley

Indianapolis, Indiana