Vacuum Assisted Closure® therapy in the treatment of mesh infection after hernia repair

Tamhankar, Anand P.; Ravi, K; Everitt, NJ

doi:10.1016/s1479-666x(09)80010-3

Cited by 26 publications

(27 citation statements)

References 20 publications

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“…The removal and/or replacement of the mesh, in conjunction with NPWT use, may have allowed for complete closure of the wounds. These results support previous findings that describe NPWT as an effective adjunct in managing wounds with infected mesh (26,28,29).…”

Section: Discussionsupporting

confidence: 92%

“…In most cases, standard care for these open abdominal wounds includes saline moistened gauze and if necessary, removal of the infected mesh (25). However, this can lead to a more complex wound, such as an underlying abdominal wall weakness or other complications (26–28), and most certainly will result in subsequent hernia recurrences and longer hospital stays (27,29). The loss of intra‐abdominal domain can be detrimental in these patients and can lead to more complex surgical procedures resulting in longer hospital stays.…”

Section: Discussionmentioning

confidence: 99%

“…For those patients with PP mesh, there was only one mesh extracted and one mesh replaced during NPWT compared with five extractions and four replacements prior to NPWT. This decrease in procedures may be because of NPWT's effectiveness in removing excess wound fluid (18), increasing local tissue perfusion(19) and promoting granulation tissue formation through the mesh (26,28).…”

Section: Discussionmentioning

confidence: 99%

“…In light of these findings, some case studies have used NPWT in the treatment and salvage of infected meshes after hernia repair (26,28,29,35). In a recent study by Tamhankar et al , four patients with mesh infection following abdominal wall hernia repair were treated with NPWT.…”

Section: Discussionmentioning

confidence: 99%

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

Baharestani

Gabriel

2010

International Wound Journal

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Baharestani

Gabriel

2010

International Wound Journal

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“…More recently, there has been a trend toward mesh salvage, as explantation is plagued by hernia recurrence, loss of domain and risk of enterotomy or enterocutaneous fistula formation [7] to solve this problem. Rectus abdominis myofascial flap closure, known as 'separation of parts' hernia repair, can be done to reduce the hernia recurrence rates [41]. We can do mesh excision and repair with biological mesh [1] such as porcinederived dermal matrix (Strattice) [7] as they do not inhibit the body's ability to fight infection and do not require removal when exposed or infected [7] but it may just be a temporary solution until we can permanently repair hernia [35].…”

Section: Management Of Infected Meshmentioning

confidence: 99%

Postoperative Mesh Infection—Still a Concern in Laparoscopic Era

et al. 2015

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Introduction of synthetic mesh was a landmark breakthrough in the management of hernia repair and has significantly reduced recurrence rates. But in addition to the benefits, some more problems have come in picture major being 'mesh infection'. Prolene mesh has shown promise when used in abdominal and inguinal hernia repair, especially when used in planned surgeries. This material, derived from monofilament polypropelene, is found to be biologically inert in almost every person. Being a foreign material, a slightest breach in asepsis can lead to favourable environment for bacterial proliferation and form a 'biofilm'. This phenomenon especially after laparoscopic surgeries gives rise to chronic discharging sinus at the port site, abscess formation around mesh and even sepsis. It appears that laparoscopic hernia repair is a promising method but having chances of mesh infection owing to difficult approach and lack of uniformity in sterilization of laparoscopic instruments. Slightest breach in sterility or protocols might lead to such a large ventral wall sinus, increasing morbidity and cost of treatment. Treatment of infected mesh is possible by local debridement, irrigation, mesh removal and systemic antibiotics culminating in increased morbidity over duration of disease, but still it would be worth emphasizing-'Prevention is better than cure'.

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