Abdominal Apron Research Articles

Dermatolipidectomy of Elephantiasis Nostras Verrucosa of the Panniculus

To the Editor.— In 1973, Rudolph and Gross reported in the Archives of Dermatology (108:832, 1973) a case of elephantiasis nostra verrucosa of the panniculus. An etiology of obesity, repeated episodes of erysipelas, and chronic passive congestion was proposed. During the past three years, the patient had been receiving erythromycin and had been free of cutaneous infection. In spite of stable weight, the massive abdominal apron had become a physical and social problem (Fig 1). The patient recently was operated upon for relief of her physical complaints. An abdominal dermatolipectomy was done, with resection of 6.8 kg of fat, scarred subcutaneous tissue, and the plate of verrucoid skin (Fig 2). Significantly enlarged vascular channels were found supplying this dependent tissue mass. Primary wound healing was achieved, and the patient obtained marked relief. Fig 1.—Elephantiasis nostras verrucosa of panniculus. Note verrucoid pattern of abdominal skin. Fig 2.—Early postoperative view. There

Removal of Panniculus Adiposus

To the Editor.— Jejunoileostomy, with or without the concomitant removal of a large panniculus adiposus, is increasingly popular in the treatment of morbid obesity. Methods of removal of a large abdominal apron, some weighing as much as 36 kg (80 lb), are receiving attention in the surgical literature. Steinmann pins attached to Kirschner wire retractors,1hydraulic lifts,2Crutchfield tongs with block and tackle,3and a rigid bar containing screw eyes4have been employed to elevate the panniculus during surgery. Meyerowitz et al5placed two Rush pins through the panniculus and suspended it through a block and tackle on the operating room ceiling. I use a technique that incorporates an overhead bar from the Albee Orthopedic operating table. The bar, which is 144 cm (57 inches) in length and rectangular in cross section, 2.5 × 3.75 cm (1 × 1 1/2 inch), is sterilized and then

An excision of abdominal fat apron (Surgical Technique and Report of a case)

Extreme degrees of obesity have from time immemorial excited the interest and comments of the less obese. Among the anomalies and curiosities of medicine collected by Gould and Pyle 1 reference is made to instances of remarkable obesity. He reports well-authenticated records of persons who weighed more than 700 lb. and suggests that the reference to a Baltimore Negro woman weighing 850 lb. and to a man from North Carolina in 1798 weighing more than 1,000 lb. may very well be accurate. Some extremely obese persons have a peculiar fat distribution resulting in an apron of fat hanging from the lower abdomen. A number of these adipose panniculi have extended to the knees or even to the ankles and weigh more than 50 lb. Some of the persons so afflicted have their body fat distributed in great masses over the abdomen, hips, buttocks, and upper arms, the head, neck, lower