A 54-year-old, morbidly obese female patient with diabetes was brought into the office by her family for a tetanus shot.  Her huge pannus had scraped on the ground, and she was cut with a rusty nail. When she arrived her pannus was hanging below her knees onto her feet.  

During her exam, I lifted up the huge pannus and found a foul smelling sore.  She told me it had been there for 24 years. It was left over from a cesarean section performed during the birth of her daughter, who was sitting in front of me. I further examined the wound, which measured 7 cm in diameter and had three tunnels. A wooden Q-tip was buried to the hilt in one tunnel.  

The wound previously tested positive by her last physician for methicillin-resistant Staphylococcus aureus. I quickly called the tertiary care hospital located 30 miles north of my office. The hospitalist accepted my patient. The family loaded her into the back of a pickup truck and drove her to the hospital. Once admitted, general surgery and plastics were consulted.  She had a pannectomy two days later. The huge pannus weighed in at 122 lbs. Needless to say, she feels much better. She also got the tetanus shot.

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