A classification system in the massive weight loss patient based on skin lesions and activity of daily living

Massive weight loss patients frequently have recalcitrant skin rashes and/or infections in the abdominal region and interference with activities of daily living (ADL) due to the redundant abdominal tissues.

A classification of these functional problems is described on the basis of the authors' experience with 75 consecutive massive weight loss patients undergoing surgery between March 2006 and August 2010. Patients are classified in 3 types. Type I: Chronic skin problems confined to the lower abdomen under the pannus and/or the skin folds of redundant pannus (± posterior lower torso). Type II: Chronic skin problems around the navel and/or under a secondary pannus in the mid/upper abdomen in addition to those observed in type I. Type III: Abdominal pannus and/or secondary roll in the abdomen with no chronic skin problems. These 3 types are further categorized on the basis of the abdominal pannus size and associated ADL interference by the subtypes: (A) those with a small pannus and no ADL interference (B) for the large excessive pannus and ADL interference.

Fifty-two patients (70%) were classified as type I. Fifteen patients (20%) were type II. Only 8 patients (10%) had no skin problems. Overall complication rate was 21%. Mean follow-up was 13.3 months postoperatively.

The classification system is proposed to provide a practical method by which to categorize massive weight loss patients based upon the presence and location of skin problems and ADL interference. Surgical guidelines to address these functional requirements are presented on the basis of the classification system.