Patent Publication Number: US-2012024296-A1

Title: Pannus support adapted for surgical procedures

Description:
TECHNICAL FIELD 
     The present invention relates to surgical equipment and in particular, to a device that is intended to support and contain a pannus during a surgical procedure to provide unobstructed access to the surgical site and provide, post surgery, a clean site that is exposed to air to promote proper healing. 
     BACKGROUND 
     Pannus is a medical term for a hanging flap of tissue. When involving the abdomen, it is called a panniculus and consists of skin, fat, and sometimes contents of the internal abdomen as part of a hernia. A pannus can be the result of loose hanging tissues after pregnancy or weight loss. It can also be the result of obesity which unfortunately is becoming more and more widespread in society. A pannus can come in many different sizes and shapes and can become very large, even hanging down below the knees. The extra tissue of a hanging pannus can make personal hygiene difficult. Skin conditions such as yeast infections under the pannus are common problems since the tissue under the pannus is not properly exposed to air but rather is a warm, moist area where bacteria thrive. A massive hanging pannus can get in the way of walking and prevent a person from performing many of life&#39;s daily tasks. A smaller pannus can be an annoyance with clothing as the individual sits or stands. 
     In term of abdominal panniculi, a grading system has been developed to better assist the physician in classifying the degree of the pannus. The grading system is as follows: grade 1: panniculus barely covers the hairline and mons pubis but not the genitalia; grade 2: extends to cover the genitalia; grade 3: extends to cover the upper thigh; grade 4: extends to cover the mid thigh; and grade 5: extends to cover the knees or beyond. 
     One situation where a pannus is particularly troublesome and must be properly dealt with is during the delivery of a child from an obese woman. It is generally understood that the term “obese” actually refers to anyone who is more than 30% over their ideal body weight. Obesity can be the result of many factors, including inactivity, poor diet, and certain health-related complications. Obesity is becoming a growing concern among both genders and all age groups. In 1962, 13% of the American population was classified as obese. By 1994, this number had increased to 23%. Yet, just six years later in 2000, this number had skyrocketed to over 30%. Today, an estimated two-thirds of Americans are considered overweight while one in three is obese. As a result, in America, being obese has officially become a marker for classifying a pregnancy as high risk. 
     Of particular concern for women of childbearing age are the effects that obesity can have on your reproductive health. Obesity put you and your baby at risk for some serious health complications. If a person is obese during pregnancy, the person is at risk of several serious health complications, including: (a) preeclampsia which is a condition which causes high blood pressure, fluid retention, and swelling during pregnancy (When serious, preeclampsia can restrict placental blood flow, endangering baby); (b) gestational diabetes is a form of diabetes that develops during pregnancy and prevents the body from breaking down sugar and can put the baby at risk for gaining too much weight in utero; (c) cesarean section: women who are obese during pregnancy have an increased risk of experiencing problems during delivery and labor is more likely to be slow and prolonged, increasing the likelihood of cesarean section; (d) postpartum infection: Obesity during pregnancy also makes a woman more vulnerable to experiencing a difficult postpartum recovery and in particular, if a woman had a c-section, they are at risk for developing dangerous postpartum infections. 
     The presence of a pannus during a cesarean section surgical procedure complicates the overall process and additional procedures must be followed to prepare the woman for surgery. As is know, in a conventional cesarean section surgical procedure, after the skin is thoroughly cleansed with an aseptic solution and sterile drapes spread over the surgical field, the abdomen is entered by making an incision through all the layers of the abdominal wall: the skin, the fat and then several muscle layers and muscle sheaths (fascia). This incision can be made either vertically below the umbilicus like a zipper, or horizontally right above the pubic bone, a “bikini cut.” Usually all the intestines have been pushed up into the upper abdomen by the enlarged uterus and the uterus lies directly against the abdominal wall. Next, the incision through the muscle wall of the uterus is made and stopped just short of the amniotic sac that contains the baby. The amniotic sac is ruptured carefully, so as not to hurt the baby, and the baby is delivered much as if she were coming out through the vagina. 
     Recent studies have found that maternity units are not particularly well equipped for obese pregnant women. Presently, fairly crude techniques are used to deal with obese pregnant women that have a pannus that is obstructing the abdomen area where the cesarean section is to be performed. For example, in order to push the pannus back and hold the pannus away from the underlying tissue where the cesarean incision is to be made, an elongated band, such as adhesive tape or the like, is attached to the lower abdomen above the incision on either side and is pulled up and back with sufficient force to lift the pannus away from the underlying tissue, and the other end of the band is fixedly attached to another structure. The structures to which ends of the band are attached can be legs of the bed or other fixtures in the operating room. Once the pannus is lifted, the surgical procedure continues. After delivery of the baby, the incision is closed up and the patient is brought to a recovery room. Unfortunately, the pannus is let to hang back over the incision. As mentioned above, the hanging of the pannus over the incision provides a warm, moist area where bacteria thrive and proper healing is more difficult. 
     It will be appreciated that while a cesarean section is described herein as being a surgical procedure that is complicated by the presence of a pannus, any surgical procedure where an incision is made in the abdomen or proximate area that is covered by a pannus is equally complicated by the presence of the pannus. 
     There is therefore a need to provide a pannus support member or adapter that is designed not only to be worn prior to a surgical procedure, such as a cesarean section, but also after it during the recovery period. 
     SUMMARY 
     In one embodiment, a pannus support member for lifting and containing a pannus of a patient includes a belt portion for securing around the abdomen of the patient. The belt portion is positioned and is adjustable about the abdomen such that the pannus is contained and lifted by the belt portion away from a target incision area on the abdomen. The pannus support member also includes a pair of straps that are coupled at each end to the belt portion. The pair of straps is constructed to extend across shoulders of the patient and apply a lifting force to the belt portion to cause the pannus to be maintained in a lifted position away from the target incision area. The belt portion includes a bottom edge that has a contoured arcuate shaped front section that is positioned above the target incision area when the belt portion is secured around the abdomen. 
     In another embodiment, a pannus support member for lifting and containing a pannus of a patient includes a belt portion for securing around the abdomen of the patient. The belt portion is positioned and is adjustable about the abdomen such that the pannus is contained and lifted by the belt portion away from a target incision area on the abdomen. The pannus support member also includes a pair of straps that are coupled at each end to the belt portion. The pair of straps is constructed to extend across shoulders of the patient and apply a lifting force to the belt portion to cause the pannus to be maintained in a lifted position away from the target incision area. A protective cover is detachably attached to a front section of the belt portion and is formed of a liquid impervious material so as to conceal and protect the underlying belt portion in at least the front section. 
     In yet another embodiment, a method for lifting and maintaining a panniculus in a spaced relationship from the abdomen of a patient includes the steps of: (a) securing a belt portion of a pannus support member around the abdomen of the patient above a target incision area that is located within an abdomen area of the patient, (b) positioning and tightening the belt portion about the abdomen such that the pannus is contained and lifted by the belt portion away from the target incision area; (c) positioning a pair of straps that are coupled at each end to the belt portion across the shoulders of the patient, the pair of straps being constructed to apply a lifting force to the belt portion to cause the pannus to be maintained in a lifted position away from the target incision area; and (d) making an incision in the target incision area, with a bottom edge of the belt portion being located proximate but spaced from the incision. 
     These and other aspects, features and advantages shall be apparent from the accompanying Drawings and description of certain embodiments of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a front perspective view of a pannus support member according to a first embodiment being worn by a patient who is in a standing position; 
         FIG. 2  is front perspective view of another pannus support member; 
         FIG. 3  is a cross-sectional view taken along the line  3 - 3  of  FIG. 1 ; 
         FIG. 4  is front perspective view of a pannus support member according to a second embodiment being worn by a patient who is in a lying position; 
         FIG. 5  is an exploded front perspective view of the pannus support member of  FIG. 4 ; 
         FIG. 6  is a cross-sectional view taken along the line  6 - 6  of  FIG. 4 ; 
         FIG. 7  is a side perspective view of a pannus support member according to a third embodiment being worn by a patient who is in a standing position; 
         FIG. 8  is a is an exploded partial front perspective view of the pannus support member of  FIG. 7 ; 
         FIG. 9  is a cross-sectional view taken along the line  9 - 9  of  FIG. 7 ; and 
         FIG. 10  is a partial front perspective view of the pannus support member of  FIG. 7 . 
     
    
    
     DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS OF THE INVENTION 
       FIGS. 1 and 3  illustrate a pannus support member  100  according to one embodiment that is designed to lift and contain a pannus so as to expose the abdomen area to allow a surgical procedure to be performed and to allow proper healing post-surgery. 
     The pannus support member  100  is formed of a main belt portion  200  that extends around the belly of the wearer and can be adjusted to fit snuggly around the belly. The belt  200  has a first end  202  and an opposite second end  204 , with the first end  202  having a first connector  210  (first coupling member) and the second end  204  having a second connector (second coupling member)  220 . The first and second connectors  210 ,  220  are complementary to one another and are configured to mate with one another for attaching the belt portion  200  around the belly. As with most belts, the length of the belt and thus tightness of the belt can be adjusted. 
     The first and second connectors  210 ,  220  can be any number of different connectors that are suitable for the intended use. For example, the first and second connectors  210 ,  200  can be in the form of hook and loop type connectors. In this embodiment, the first connector  210  is one pad formed of hook and loop material formed on an exterior surface  230  of the belt portion  200  proximate the first end  202 , while the second connector  220  is another pad formed of complementary hook and loop material formed on an inner surface  240  of the belt portion  200  proximate the second end  204 . Hook and loop material connectors  210 ,  220  permit the length of the belt portion  200  to be adjusted and customized based on the size of the patient and other considerations. 
     The first and second connectors  210 ,  220  can also be based on a mechanical type connection and therefore can be in the form of a latch type connector formed of a plastic material. When the first and second connectors  210 ,  220  are in the form of a latch type connector, the first and second connectors  210 ,  220  can be located so as not to interfere with the person lying or reclining on a support surface since the pannus support member  100  is intended to be worn on a person that is sitting on a support surface, such as a bed. More specifically, the first and second connectors  210 ,  220  can be located such that when worn on a person, the first and second connectors  210 ,  220  are positioned on the hip of the person. In a hip position, the first and second connectors  210 ,  220  are spaced from the back of the person and likewise are spaced from the front abdomen portion of the person where the surgical procedure is to be performed. On a side, hip portion, the connectors  210 ,  220  do not interfere with patient sitting and lying down on a surface. 
     When the first and second connectors  210 ,  220  are in the form of hook and loop material, the connectors  210 ,  220  can be located at a rear portion of the belt portion  200  or can be located at a side portion. 
     The belt portion  200  includes a top edge  206  and an opposing bottom edge  208 . The belt portion  200  can have a generally rectangular shape (top edge  206  and bottom edge  208  being parallel) or, as described below, the belt portion  200  can have an irregular shape where one section (e.g., front portion) of the belt portion  200  has a greater width. 
     The pannus support member  100  also includes a pair of straps  300 ,  310  are designed to lift the belly and pannus to the shoulders. Each of the straps  300 ,  310  has a first end  330  that is attached to a front section of the belt portion  200  and a second end  340  that is attached to a rear section of the belt portion  200 . The straps  300 ,  310  are configured so as to provide the necessary lift force that lifts belly and the belt portion  200  for that matter in a direction toward the shoulders. 
     In one embodiment, the straps  300 ,  310  are formed of an elastic material and represent elastic bands whose lengths can be extended when a force is applied thereto. The lengths of the elastic material straps  300 ,  310  are selected so that the straps  300 ,  310  must be stretched in order to extend across the shoulders of the wearer. Thus, when worn and placed in an elongated condition, the straps  300 ,  310  store energy and provide the necessary lifting force that causes the pannus to be lifted and contained within the belt portion  200 . The combination of the belt portion  200  and the straps  300 ,  310  contains the pannus within the belt portion  200  and therefore, exposes the abdomen area and permits the incision to be made. In this embodiment, each strap  300 ,  310  has a single piece construction and can be attached to the belt portion  200  using conventional techniques, including using stitching, etc. In addition, ends of the straps  300 ,  310  can be attached to the belt portion  200  using hook and loop type material. 
     In another embodiment, the straps  300 ,  310  can have an accordion construction to permit stretching of the straps  300 ,  310  to permit placement of the straps over the shoulders of the wearer. Once again, the straps  300 ,  310  provide the necessary lifting force for lifting the pannus away from the abdomen. 
     In yet another embodiment, each strap  300 ,  310  can be formed of two strap pieces that are attached to one another with a buckle assembly  301  that permits the strap  300 ,  310  to be tightened and loosed by adjusting the overall length of the strap  300 ,  310 . 
     For female patients, the straps  300 ,  310  can include removable, adjustable comfort pads  500  that can be adjusted along the lengths of the straps  300 ,  310  and are intended to be placed over the breasts of the patient so as to comfort and pad the breasts from the straps  300 ,  310 . The pad  500  can include a slot  510  formed therein to permit the strap  300 ,  310  to be received therein and permit the pad  500  to be adjusted along the length of the strap  300 ,  310 . A bottom surface of the pad  500  can have a concave surface that seats against the breast. It will also be appreciated that the pads  500  can be used along the shoulders of the person to provide comfort in this region of the patient. 
     As shown in the figures, the belt portion  200  is constructed to displace the pannus from the surgical area where the incision (I) is made and therefore, the belt portion  200  can be specifically contoured to provide the desired support for displacing and holding the pannus away from the abdomen area but also permit clearance for the incision (I) to be made. For example, the bottom edge  208  can include a concave shaped cutout that defines a concave edge portion  209 . The concave edge portion  209  is formed in an area such that when the belt portion  200  is securely attached to itself around the wearer&#39;s body, the concave edge portion  209  is positioned over the incision to provide an area of increased clearance for making the incision. In addition, the concave edge portion  209  causes the belt to be spaced even more slightly away from the incision and the fluids that can flow therefrom. 
     As shown in  FIG. 3 , the belt portion  200  can be formed of an outer layer  211  (e.g., nylon, etc.) and an inner layer  213  that is typically a padded layer. 
     As shown in  FIG. 1 , the pannus support member  100  is constructed and intended to be worn by a patient pre-surgery, during surgery, and post surgery and further is intended to be worn in normal everyday positions, including standing, sitting and lying down. 
     As shown in  FIG. 2 , the front section of the belt portion  200  can include a coupling strip  201  that extends along a length of the front section and permits another member (item) to be attached to the belt portion  200 . For example, the coupling strip  201  can be in the form of a length of double sided adhesive material that includes a removable release cover to expose the adhesive material. The items that can be attached to the belt portion  200  can be gauze dressing (pads) that extends across the lower edge of the belt portion  200  to provide additional therapeutic benefit to the area of the incision by providing a material that can absorb any fluids, etc., that can create an undesired, moist atmosphere. As discussed herein, the drape ( FIG. 4 ) that is laid over the patient also includes an adhesive backing material and therefore. The drape could cover the coupling strip  201  and therefore, when the drape is placed on the belt portion  200 , the drape can be adhesively bonded to the protective cover of the coupling strip  201  and therefore, lifting of the drape will result in lifting of the protective cover. The removal of the drape thus performs two steps, namely, it removes the drape but it also prepares the coupling strip  201  for use by removing the protective cover, thus exposing the underlying adhesive to permit attachment of the gauze material to the belt portion  200 . 
     It will be appreciated that the coupling strip  201  is not limited to being an adhesive material strip. 
     Now referring to  FIGS. 4-6 , a pannus support member  600  according to another embodiment of the present invention is shown.  FIG. 4  shows the pannus support member  600  being worn by a patient that is lying on a bed prior to a surgical procedure being performed. A drape  610  is disposed over the patient with a window  612  thereof being aligned with the surgical site, e.g., abdomen or pubic bone area. The drape  610  is formed of a liquid impervious material and includes an adhesive on a backside thereof to permit adhering of the drape  610  to the patient. As is known, the drape  610  can include pockets or the like for capturing the fluid. 
     As shown in  FIG. 4 , in the lying down position that is typically for performing a surgery, the pannus support member  600  serves to lift and displace the pannus from the abdomen area, thereby freeing the surgical site and allowing the incision to be made. 
     The pannus support member  600  is similar to the pannus support member  100  and therefore, like elements are numbered alike. However, the pannus support member  600  has the additional safety feature of having a removable protective cover  601 . In accordance with the present invention, the removable protective cover  601  can be provided for protecting at least a front section  211  of the belt portion  200  that is exposed to the surgical site, and potentially may come into contact with fluid and foreign matter, such as blood, amniotic fluid, etc. The protective cover  601  is formed of a suitable material that protects the belt portion  200  from foreign matter, such as fluids from the surgical site. The protective cover  601  is therefore formed of a material that is impervious to fluids and for example, the protective cover  601  can be in the form of plastic sheet (synthetic sheet). 
     In the illustrated embodiment, the protective cover  601  is at least partially disposed on both the exterior surface  230  and the inner surface  240  of the belt portion  200 . In other words, the protective cover  601  extends from the exterior surface  230  to the inner surface  240 . 
     In the illustrated embodiment, the protective cover  601  has a first flap  610  that extends over the top edge of the belt portion  200  to the inner surface  240  and an opposing second flap  620  that extends under the bottom edge of the belt portion  200  to the inner surface  240 . The illustrated protective cover  601 , the first and second flaps  610 ,  620  cause the protective cover  601  to have an enlarged center section with two side tabs  630  being formed for placement against the exterior surface  230  of the belt portion  200 . 
     It will be appreciated that the protective cover  601  can be formed using any number of attachment techniques. For example, the cover  601  can be attached to the underlying belt portion  200  using an adhesive material. As shown, a first adhesive section  640  is formed along the first flap  610 , a second adhesive section  650  is formed along the second flap  620 , a third adhesive section  660  is formed along one side tab  630 , and a fourth adhesive section  670  is formed along the other side tab  630 . The adhesive sections  660 ,  670  attached the side tabs  630  to the exterior surface  230  of the belt portion  200 , while the adhesive sections  640 ,  650  attaching the flaps  610 ,  620  to the inner surface of the belt portion  200 . 
     Alternatively, the protective cover  601  can be attached to the belt portion  200  using stitching in which case, the protective cover  601  is attached along a rupturable tear seam. The user simply pulls the protective cover  601 , with sufficient force, to cause rupturing of the tear seam, thereby allowing the protective cover  601  to be removed. 
     The protective cover  601  is designed to protect the exterior surface  230  of the belt portion  200  from any foreign matter including fluids that result from performing the surgical procedure. It will be appreciated that once the surgery is completed and the patient and surgical area is cleaned and the patient is ready is ready to be delivered to a post-operative location, the protective cover  601  can be removed. 
     As shown in  FIG. 4 , the drape  610  is at least partially disposed on the pannus support member  600  and in particular, the drape can be disposed across the front section of the pannus support member  600  including the protective cover  601  thereof. Since the underside of the drape  610  includes an adhesive, the drape  610  is adhesively bonded to the protective cover  601  and therefore, when the drape  610  is removed, the protective cover  601  will also likely be removed therewith. Since the removal of the drape  610  occurs after the surgery is completed and the patient is cleaned, the removal of the protective cover  601  by removal of the drape  610  results in the belt portion  200  being protected from fluids and other foreign matter. Since the protective cover  601  protects the belt portion  200  from foreign material, including fluids, etc., and this permits the pannus support member  100  to be used in a post-operative setting—e.g., while the patient recovers and the incision heals. As a result, the incision area is kept free of the pannus and therefore, the incision area can properly heal since it is exposed to air and can remain clean, can be cleaned, etc. Not only does the pannus support member  600  clear the pannus from the abdomen to allow the surgery to proceed but also provides a much improved recovery period since the pannus is supported and contained by the pannus support member  600  in a manner such that it is kept away from the incision area. 
     Now referring to  FIGS. 7-10 , a pannus support member  700  according to another embodiment is illustrated. The pannus support member  700  is similar to the other pannus support members described herein and therefore, like elements are numbered alike. However, in this embodiment, the pannus support member  700  includes a removable accessory  800  that provides additional support and padding for the pannus. The accessory  800  is formed of a body  810  that is complementary to the front section  211  of the belt portion  200  and includes a top edge  820  and an opposing bottom edge  830 . The body  810  includes a front surface  812  that mates with the inner surface  240  and also includes a first support and comfort providing member  840  and a second support and comfort providing member  850 . The first support member  840  is disposed along the top edge  820  and the second support member  850  is provided along the bottom edge  850 . The first support member  840  is not only designed to provide additional support for the pannus but also provides comfort along the top edge  820 . In particular, the first support member  840  can include a padded inner material  842  that is surrounded by a cover material that can be the same as and an integral part of the body  810 . The first support member  840  can have a rounded shape so as to protect the wearer from a potentially sharp upper edge of the belt portion  200 . The support member  840  can be a foam member. 
     The second support member  850  is not only designed to provide additional support for the pannus but also provides comfort along the bottom edge  850 . In particular, the second support member  850  can include a padded inner material  852  that is surrounded by a cover material that can be the same as and an integral part of the body  810 . The second support member  850  can have a rounded shape so as to protect the wearer from a potentially sharp lower edge of the belt portion  200 . 
     The front surface  812  of the body  810  can include a coupling member  818  that is used to attach the body  810  to the inner surface  240  in a release yet secure manner. For example, the coupling member  818  can be in the form of a piece of hook and loop material that mates with a complementary piece of hook and loop material. Alternatively, the coupling member  818  can be in the form of fasteners, such as buttons, etc. 
     When the accessory  800  is coupled to the belt portion  200 , the first support member  840  extends above and over the upper edge of the belt portion  200  and the second support member  850  extends under and across the bottom edge of the belt portion  200 . 
     The exterior surface  230  of the belt portion  200  can include a pocket  900  for receiving a stiffening member  910 . The stiffening member  910  can be formed of a rigid material, such as a rigid plastic insert that is disposed within the pocket  900 . The stiffening member  910  adds support and rigidity to the front section of the belt portion  200 . This increased rigidity prevents the belt portion  200  from freely rolling or folding over. 
     In yet another aspect, the belt portion in any of the embodiments can include one or more sections that are formed of anti-microbial material. As is known, anti-microbial material often includes silver ions and is effective against bacteria which are common in a moist, warm area, such as skin of a perspiring person. Preferably, the anti-microbial material contacts the skin when the pannus support member is worn. 
     In addition, the protective cover used herein can be formed of a material that will change its appearance when exposed to a liquid. For example, the protective cover can change its color when exposed to liquid, thereby alerting the surgical staff that liquid did come into contact with the protective cover during the procedure. Appropriate actions can then be taken including removal of the protective cover. 
     In yet another embodiment, one or more body coupling members (not shown) can be provided for providing an additional means for attaching the belt portion  200  to the patient&#39;s body. The coupling members can be in the form of complementary hook and loop type members (e.g., hook and loop pads), with a first hook and loop pad being attached to the body and a second hook and loop pad being attached to the inner surface  240  of the belt portion  200 . For example, the first pad can contain an adhesive layer on one side of the pad (opposite the hook and loop material) that permits the pad to be attached to the patient&#39;s body in the abdomen area. The second pad is attached to the inner surface  240  using conventional means such as a bonding material (adhesive) or a mechanical attachment, such as a stitch, etc. 
     As previously mentioned, it will be appreciated that while a cesarean section is described herein as being a surgical procedure that is complicated by the presence of a pannus, any surgical procedure where an incision is made in the abdomen or proximate area that is covered by a pannus is equally complicated by the presence of the pannus. Accordingly, the pannus support member  100  can be used in other surgical procedures, such as gastric by-pass surgery, appendectomy procedure, gallbladder removal, hysterectomies, etc. As a result, the pannus support member  100  is not limited to being worn by a woman but in some settings and for some surgical procedures, can be worn likewise by a man. 
     While the invention has been described in connection with certain embodiments thereof, the invention is capable of being practiced in other forms and using other materials and structures. Accordingly, the invention is defined by the recitations in the claims appended hereto and equivalents thereof.