The panniculus is a layer of tissue. Panniculus is often used for the abdominal panniculus adiposus, a layer of fatty tissue in the lower abdominal region. In severe cases, the panniculus can appear suspended and reach the knee or lower back height. An abdominal panniculus or significant weight loss can also occur in obese patients after pregnancy.
What Is The Panniculus?
The term panniculus adiposus refers to a layer of fatty tissue in the lower area of the abdomen.
It is common for panniculus to form after severe weight loss, in patients with obesity, or as a result of pregnancy. This is characterized as excess skin hanging over your trousers’ top.
The panniculus is an overhang of the abdominal layer of subcutaneous fat, which is complicated by the appearance of lymphedema.
Morbid obesity (BMI over 40) can lead to a blockage of the lymphatic canals resulting in a relative reduction of the lymphatic drainage capacity.
In cases where lymphatic occlusion does not seem to be the only factor causing panniculus, reflux and blockage of valvous superficial veins in the anterior abdominal wall also appear to contribute to edema.
If significant weight gain causes panniculus, surgeons may ask patients to lose weight before surgery to remove excess tissue, as being overweight can be dangerous for this type of operation. Panniculus in patients with terminal abdominal obesity may develop mobility impairment and become bedridden, increasing the risk of death.
One of the risks of the panniculus is the tendency to form skin folds. These deposits can become a problem if they grow and become more pronounced. This can cause considerable discomfort to the patient. In the case of abdominal fat, it can begin to grow in the abdomen, covering the genitals and reaching up to the knees.
The skin folds tend to be dark, humid, and warm, making it an ideal breeding ground for organisms such as bacteria and fungi.
The infection not only causes an unpleasant smell and exposes patients to the risk of septicemia but can also enter the bloodstream and lead to multiple organ failure.
Patients can develop severe skin infections and suffer large ulcers and lesions due to the uncontrolled growth of microorganisms.
The weight of the panniculus can distort the patient’s posture and strain the back. It is difficult to perform diagnostic tests on adipose tissue, making it difficult to identify the structure of the abdomen.
The patient may need more invasive tests to discover more about what is happening. The patient or doctor may also believe that there is dangerous tumor growth.
In patients with mild panniculus during pregnancy, most of the skin goes back into place and tightens in the lower abdomen when the body recovers.
However, severe and rapid weight loss can leave pockets of excess fat on the skin, and some patients may need surgery to remove the excess once their weight has stabilized.
An operation called a panniculectomy is a tummy tuck in which part or all of the adipose tissue is removed.
Several studies have been published on the surgical removal of the abdominal panniculus and the massive weight loss caused by bariatric surgery.
Frequent follow-up examinations and advice on diet and exercise have contributed to better results. It may be that interventions in the form of manual lymphatic drainage and compression clothing be used to prevent the need for surgery at an early stage.
Surgeons know that the venous congestion caused by the panniculus increases the risk of significant blood loss.
Part of the challenge associated with a massive panniculectomy is maintaining the skin occlusion with a minimum of dead space. To achieve this, the undermined edges of the skin are reduced to a minimum, and the fascia is closed.
Surgery is associated with a high number of serious complications, including:
- adipose tissue necrosis
- seroma formation
- abdominoplastic nerve damage
- scar asymmetry
- wound infections
These complications can lead to increased hospitalizations and further admissions, especially in patients who are obese and prone to wound-healing disorders.
A panniculectomy surgery has proven to be an effective surgical technique for increasing the patient’s mobility and quality of life.
It also improves the cosmetic appearance of the patient’s abdomen and allows the patient to start a weight loss program.
As a result, it can increase the addition of perioperative complex decongestive physical therapy (CDP), which is beneficial as CDP is only possible during the preoperative phase. In cases associated with morbid obesity, patients should consider possible bariatric surgery after the procedure.
It has been suggested that preoperative CDP reduces local tissue inflammation, edema, and infection rates to reduce postoperative complications. CDP includes:
- daily manual lymphatic drainage
- compression bandages
- lymphedema education
Manual lymphatic drainage helps to stimulate the contractility of the lymphatic system and remove excess interstitial fluid, while compression bands help the return of the interstitial fluid. CDP reduces lymphatic accumulation and promotes good skin and wound care.
Panniculus morbidus is a rare disease described in the literature. The pathophysiology of abdominal wall lymphedema is based on a reduction of the lymphatic and venous function in the anterior abdominal wall.
There is a strong correlation between obesity and lymphedema, and its incidence is likely to increase. Diuretics play only a limited role in the correction of lymphedema and diet does not diminish the mass of the abdominal panniculus once it has established itself.
If you are unsure if Panniculus surgery is the right procedure for your body, talk to your doctor to find the best option to get your body where you want it to be.
People with panniculus tend to be women and children or people who are obese and have lost a lot of weight.
These scenarios can lead to patients developing a panic disorder that is difficult to eliminate with proper nutrition and exercise. Panniculus surgery is designed to improve your quality of life and get you on track to being a healthier version of yourself.