Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes

Abstract

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.

Komplikationsmanagement in der Narbenhernienchirurgie: Erhalt von alloplastischem Material in der Infektsituation

“…Die konsekutive Wahrscheinlichkeit des Auftretens eines Rezidivs der Hernie nach infektbedingter Netzexplantation ist deutlich erhöht [7]. Moderne Salvage-Strategien haben dazu geführt, dass der Netzausbau nur im Einzelfall notwendig ist [8]. Die publizierten Erfahrungen diesbezüglich stammen aus einzelnen Zentren und sind dementsprechend limitiert [9].…”

Negative pressure wound therapy for surgical site infection associated with artificial urinary sphincter implantation

“…1 Negative pressure wound therapy (NPWT) has been introduced to reduce removal of infected foreign materials, such as orthopedic implants 2 or abdominal mesh. 3 Herein, we report a first case in which surgical site infection associated with AUS implantation was successfully treated with NPWT in combination with antibiotic therapy.…”

“…However, it has been reported that NPWT can successfully reduce removal of infected orthopedic implants 2 or abdominal meshes. 3 It is assumed that NPWT facilitates wound healing by removing wound exudate, improving local blood perfusion and increasing growth of granulation tissue. 3 In the current case, NPWT in combination with antibiotic therapy cured the surgical site infection associated with AUS implantation without removal of the implants.…”

“…3 It is assumed that NPWT facilitates wound healing by removing wound exudate, improving local blood perfusion and increasing growth of granulation tissue. 3 In the current case, NPWT in combination with antibiotic therapy cured the surgical site infection associated with AUS implantation without removal of the implants. Although infection resulting from urethral erosion requires the removal of the AUS system as a result of continuous exposure to urine, 1 it might be worthwhile to consider applying NPWT for surgical site infection of AUS implantation in cases unrelated to urine contact.…”

Technologies and Geriatric Surgery: In Specialty Centres with Patients at the Center

“…The fields of application of NPWT go far beyond: it is particularly useful in the eventuality of abdominal and perineal wound dehiscence, and in patients with entero-cutaneous fistulas. It is also suitable in wound breakdown in patients with a prosthetic mesh, allowing for mesh preservation and avoiding infections [22]. Side-effects include hemorrhage, protein and electrolytes loss and presumed reduced blood flow on the wall of bowel loops which are directly exposed to NPWT [23].…”