1. Case Study 47 year old female Weight = 505 lbs Height = 5’6” BMI = 81.5 Medical History: Asthma, sleep apnea, pulmonary hypertension, arterial hypertension, diabetes, DVT, osteoarthritis, non union of tib- fib fracture, bedrest for 1 year. Mother reports that she had a “draining sore spot” on her coccyx before admission

2. Surgery & Initial Postop Course Roux en Y gastric bypass on August 2, 2002 Initial Postoperative Course Ventilator dependency Tracheostomy Atrial fibrillation Stroke Fluid and electrolyte imbalances Diarrhea from tube feeding Sepsis from TPN Acute renal failure Rashes from plastic allergy and Candida

3. One Month Postoperatively Height = 5’6” Weight = 395 lbs BMI = 63.7 Albumin = 2.7 Still on ventilator in AICU Renal failure recovering– off SLED Multiple skin and wound problem

4. Bariatric S1 Overview

5. Bariatric S1 Ulcer 1e September 5, 2002

6. Bariatric S1 Ulcer 1f September 5, 2002

7. Bariatric S1 Ulcer 1g September 5, 2002

8. Bariatric S1 Ulcer 1h September 5, 2002

9. Bariatric S1 Thigh September 10, 2002

10. Bariatric S1 Finger Depth September 10, 2002

11. Bariatric S1 Packing September 10, 2002

12. Bariatric S1 Packing 2 September 10, 2002

13. Bariatric S1 Packed September 10, 2002

14. Bariatric S1 Ulcer 1a September 12, 2002

15. Bariatric S1 Ulcer 1b September 12, 2002

16. Bariatric S1 Ulcer 1c September 12, 2002

17. Bariatric S1 Ulcer 1d September 12, 2002

18. Bariatric S1 Close September 18, 2002

19. Bariatric PU1 September 18, 2002

20. Bariatric S1PU3 September 18, 2002

21. Bariatric Dressing September 18, 2002

22. Bariatric S1 OR6 9-19-02

23. Bariatric S1 OR5 9-19-02

24. Bariatric S1 OR4 9-19-02

25. Bariatric S1 OR3 9-19-02

26. Bariatric S1 OR2 9-19-02

27. Bariatric S1 OR1 9-19-02

28. Bariatric S1 postop vac September 26, 2002

29. Bariatric S1 postop vac2 September 26, 2002

30. Bariatric S1 PU4 10-9-02

31. Bariatric S1 PU3 10-9-02

32. Bariatric S1 PU2 10-9-02

33. Bariatric S1 PU1 10/9/02

34. Bariatric S1 Breast Fold 1 around 9-5-02

35. Bariatric S1 Breast Fold 2 around 9-19-02

36. Bariatric S1 healing breast fold 10-9-02