Definitive surgical treatment of infected or exposed ventral hernia mesh.
OBJECTIVE
To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique.


BACKGROUND
The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration.


METHODS
Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps.


RESULTS
Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months).


CONCLUSIONS
Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh.
Szczerba
Steven R
SR
Department of Surgery and the Division of Plastic Surgery, Emory University, Atlanta, Georgia, USA.
Dumanian
Gregory A
GA
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000150:complications / Q000601:surgery; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013526:Surgical Mesh / Q000009:adverse effects