A radical approach to bacterial panniculitis of the abdominal wall in the morbidly obese.

The morbidly obese patient, although at risk for many perioperative complications of radical surgery, paradoxically presents the opportunity for wide excision of abdominal soft-tissue infections. This report describes the successful radical surgical management of bacterial panniculitis of the abdominal wall occasioned by a variety of extrafascial and intraperitoneal sources in 13 patients. All patients were followed up for a minimum of 2 years, except for one patient who died 2 months after hospital discharge. The remainder are alive with intact fascial closure and no pannicular infection. A radical approach to the infected abdominal wall, incorporating wide en-bloc excision of skin, subcutaneous tissue, muscle, and strangulated intestine, facilitates successful fascial and skin closure in a noninfected field in the morbidly obese.