Poor surgical exposure, ventral hernia formation, and aesthetic and hygienic deformity have been commonly noted following resection of massive abdominal tumors. In this series, nine patients underwent transverse abdominal panniculectomy, resection of attenuated rectus ab-dominis and oblique sheath and muscle, and removal of the mass. There was significant improvement in surgical exposure as well as diminished blood loss. The incidence of ventral herniorrhaphy and abdominal wall weakness was significantly less than previously quoted. Cosmesis was notably improved, and postoperative intertrigo was not seen. Rectus functional recovery was excellent within 2 to 4 months following surgery in all patients. Anesthetic and pulmonary complications were minimal. Anesthesia time was prolonged 2 lA to 4 hours but did not appear to increase the anesthetic or surgical risks. Transverse anterior abdominal wall resection and immediate reconstruction appear to be significant adjuncts to safe and expeditious resection of massive abdominal tumors along with resultant improved abdominal function and cosme-sis.
Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1- to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.
At the University of Massachusetts Medical Center, from 1984 to 1992, we performed laparotomy or panniculectomy on 42 individuals weighing from 290 to 600 pounds, each with a height-weight index of over 55. All patients weighed more than 220 percent of ideal body weight. Fellow up ranged 8 to 52 months. All patients underwent panniculectomy except one. Pannus resection was performed by means of a large transverse ellipse. A suprapubic wedge resection often was used to minimize the discrepancy between the lengths of the upper and lower transverse incisions. With severe discrepancy, lateral V-flaps also were utilized to minimize the lateral dog-ear. To facilitate preparation, pannus exsanguination, and surgical resection, 10 to 12 towel clips or 4 to 5 large K-wires or Steinmann pins were passed through the central pannus. These were then suspended by rope from the overhead lighting. A two-team approach appears to have distinct advantages, including minimized blood loss, operative time, pulmonary compromise, and hospital stay. The technical difficulties of manipulating a large pannus were simplified by pannus suspension. Early preoperative involvement of the entire operative team, particularly the plastic surgeon, the anesthesiologist, and the nursing staff, allows for proper evaluation of underlying medical problems and appropriately detailed anesthetic and surgical planning. Surgical management of the abdominal pannus in the morbidly obese patient in this series was performed with apparent clinical efficacy, reasonable safety, and long-term functional improvement.
Mandal, Ashis K. M.D., F.A.C.S.; Thadepalli, Haragapal M.D.; Matory, Yvedt M.D.; O'Donnell, Vincent A. M.D.; Lou, Mary Ann M.D., F.A.C.S; Matory, William E. M.D., F.A.C.S., F.A.A.S.T.
