Reducing the Risk of Postoperative Problems With Panniculectomies Using the Prevena Plus™ 125 Incisional Management Dressing

Abdominal wall reconstruction procedures have become increasingly popular in recent years as technology and surgical techniques have improved. The downside to these procedures has been the high rate of postoperative complications. Surgical site infections have been reported as high as 33.7% of the $9.8 billion spent annually on these complications. I present the case of a 62-year-old morbidly obese woman who underwent a combined procedure of abdominal wall reconstruction and panniculectomy. A total of 45 lbs of pannus was removed through a transverse incision that extended from hip to hip, measuring 90 cm in length. Following panniculectomy, abdominal wall reconstruction was performed by mobilizing the abdominal skin flap from the lower abdominal panniculectomy incision (avoiding a T-shaped incision with a traditionally high risk of dehiscence), and placement of biologic mesh as an underlay followed by fascial closure. Prevena Plus™ 125 (3M + KCI, San Antonio, TX) was applied for postoperative closed incisional negative pressure therapy (ciNPT) and continued for 10 days. No postoperative complications occurred. The incision healed without incident with no hernia recurrence at one year. ciNPT in high-risk patients can help minimize the risk of postoperative wound healing complications and should be considered in high-risk patients. Those patients undergoing combined procedures and especially morbidly obese patients undergoing combined abdominal wall reconstruction and panniculectomy are at particularly high risk for wound healing complications. ciNPT should be considered as a postoperative dressing of choice in this challenging patient population.