P-110 Surgical Mesh Infection Secondary to Skin Necrosis Managed With Negative Pressure Therapy in a Patient Undergoing Tar (Transversus Abdominis Muscle Release)

Abstract

Aim To Show the management of skin necrosis, wound dehiscence and mesh infection in a patient undergoing TAR (Transversus Abdominis Muscle Release) through NPT (Negative Pressure Therapy) Material and Methods A 55-year-old man underwent elective surgery in 2017 for a giant hydatid cyst with portal rupture during the intervention, making a subcostal incision and subsequently midline laparotomy. Subsequently, he developed portal cavernomatosis and portal hypertension. In 2018, he underwent surgery for incisional hernia in a patient with a complex abdominal wall (extended subcostal incision + median laparotomy) performing a RIVES-type hernia repair. Develops chronic wall infection, mesh rejection and hernia recurrence that required reoperation with TAR (polypropylene mesh). One month after the intervention, he presents skin necrosis, wound infection and mesh infection in the upper third of the wound, which was managed through TPN cures for a year and a half. Results Given the dehiscence in the upper third of about 15×7 cm, conservative management was decided with cures and debridement of non-viable tissue. In contact with the polypropylene mesh, a silver dressing was applied, as well as treatment with negative pressure therapy. This cure was carried out for a year and a half every 3–4 days, being able to cover the mesh with granulation tissue and close it by secondary intention, thus avoiding a reintervention with mesh explant. Conclusions TPN is a useful tool in the management of mesh infections in patients with complex abdominal wall, thus avoiding reintervention and mesh explantation.