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Theisen et al. Plast Aesthet Res 2020;7:56 I http://dx.doi.org/10.20517/2347-9264.2020.83 Page 7 of 13

Figure 6. Chronic wound at the proximal aspect of the graft, where it was anastomosed to the native skin at the base of the penis. Must
have penis on maximum stretch in supine position just to see entire graft and wound

Figure 7. The first image is a patient with a separate abdominal pannus and escutcheon. The second shows a “single-bubble”, no
separation and direct impingement of the abdominal pannus onto the penis. The latter benefit is from plastic surgery involvement and
panniculectomy

Drains are essential when patients undergo panniculectomy, as the increased potential space that is created
during elevation of the abdominal wall flap puts the patient at a higher risk for seroma or hematoma
formation. We generally place two large drains (19 Fr). Drains are removed once they have less than
30 milliliters per day output for multiple consecutive days. For abdominal panniculectomy patients, drains
are sometimes required for weeks. We also require that patients who undergo panniculectomy wear an
abdominal binder at all times for 4 weeks after surgery.