Obesity is a big problem in the United States that seems to be growing. According to a recent study published in JAMA, more than one third of American adults (34.9%) qualify as obese (BMI ≥30) with 7.7% of women in their peak reproductive years (ages 20–39) categorized as obese grade 3 (BMI ≥40).1 While this issue has a myriad of health and healthcare implications, in operative obstetrics, it often presents the practical challenge of how to safely and comfortably perform a cesarean delivery with a massive pannus overhanging the intended surgical site.
With experience, many hospitals, L&D nurses, and obstetricians have developed their own MacGyver-style solutions with some combination of pads, tape, sheets, straps, and gravity. All too often, though, the final plan has relied on good old-fashioned elbow grease from the lowest person on the totem pole. For those of us unlucky enough to have sweated through this extreme retracting opportunity, Clinical Innovations now comes to the rescue with the Traxi Panniculus Retractor.
The Traxi Panniculus Retractor is a 25” x 16” latex-free, hypoallergenic sheet of adhesive-backed film. It is FDA-approved as a Class I device and sterilely packaged as a single-use product. In a nutshell, it looks like a giant piece of Telfa. According to the company, “application is quick and easy.” The idea is to manually retract the pannus, apply the lower portion of the Traxi 5 cm above the incision line, lift the pannus cephalad and secure the upper portion of the device to the upper abdomen/lower thorax and the level of the xiphoid process.
I used the Traxi for cesarean delivery on a patient with a BMI of 45 and a serious overhanging pannus. WOW! This thing really worked! Easy to apply; fully retracted the pannus. I see no obvious areas for improvement from my perspective.